This study investigated how three Asian countries–Republic of Korea (ROK), Republic of China (Taiwan), and Singapore–considered as standouts, responded to the coronavirus disease 2019 (COVID-19) in terms of governance system, health sector innovation, and social distancing to draw lessons that other countries can learn from. The countries were commonly in success of the response in early stage of the pandemic thanks to their effective and efficient strategies paired with advanced information and communications technology (ICT). Consequently, the three jurisdictions reported lower confirmed cases as well as fatality rate of the infectious disease compared to other high-income countries. In addition, the countries’ previous experiences with other pandemics, including influenza A, Middle East respiratory syndrome, and severe acute respiratory syndrome, enabled them to establish resilient public health systems and gain public acceptance to governmental control or surveillance during national infectious disease-related crises outbreaks. Advanced ICT infrastructure and digital technology were used as effective tools for testing, tracing, and treatment of the pandemic in collaboration with the private sector as a crucial player. The ROK, Taiwan, and Singapore adopted different strategies between containment and mitigation policy to flatten the epidemic curves effectively according to their own situation and judgement. Despite the exemplary aspect of the three nations in coping with the COVID-19 pandemic, a few limitations were also observed in terms of vaccination and unequal consequences of the pandemic among people. These should be further discussed in order to be prepared for future pandemics.

BACKGROUND/AIMS: Scrub typhus is known as a self-limited infectious disease. Cardiac complication is uncommon and usually not life-threatening. Until now, few cases of fulminant myocarditis by scrub typhus have been reported. So, we investigated incidence and predictors of acute myocarditis in severe scrub typhus. METHODS: We retrospectively reviewed 89 patients among 91 scrub typhus confirmed patients who examined an echocardiogram and cardiac biomarkers from 2005 to 2015 in the intensive care unit at our hospital. We excluded two patients who didn’t have electrocardiography. Patients were divided into two groups and compared between scrub typhus with (n = 13) and without (n = 76) acute myocarditis. RESULTS: Age, sex, and underlying diseases were similar between the groups. The existence of eschar and duration of general ache and fever were similar between the groups. However, patients with acute myocarditis had more elevated total bilirubin, high incidence of ST elevations and paroxysmal atrial fibrillation (PAF) than those without acute myocarditis. Receiver operating characteristic analysis showed that the PAF was a predictor of myocarditis with a sensitivity of 70% and specificity of 84%. Predictive power of combination of ST-segment elevation and PAF was significantly associated with myocarditis in the multivariate analysis (odds ratio, 1.57; 95% confidence interval [CI], 1.21 to 11.7; p = 0.041) and area under the curve was 0.947 (95% CI, 0.878 to 0.983; p < 0.001). CONCLUSIONS: Acute myocarditis with scrub typhus may be more common than previously reported. Patients with high bilirubin and PAF are at increased risk of acute myocarditis with scrub typhus. These patients warrant closer follow-up and echocardiogram would be needed.
Atrial Fibrillation ; Bilirubin ; Biomarkers ; Communicable Diseases ; Electrocardiography ; Fever ; Follow-Up Studies ; Humans ; Incidence ; Intensive Care Units ; Multivariate Analysis ; Myocarditis* ; Republic of Korea* ; Retrospective Studies ; ROC Curve ; Scrub Typhus* ; Sensitivity and Specificity