This retrospective longitudinal study showed mask supply coverage and fairness using the administrative statistics of a name-based rationing system. By increasing the production of face masks, the weekly average face mask supply increased to a maximum of 5·1 masks per person. The weekly, monthly, and total face mask supply showed that the name-based rationing system supplied masks fairly to the total population, can provide universal coverage, and was sufficient for daily use for the population.
As COVID-19 cases continued to surge in Wuhan, China, on January 21, 2020, the CECC announced the first confirmed imported case of an individual who resided in southern Taiwan and worked in Wuhan. The Taiwanese public started panic buying and hoarding face masks,23 and face masks were difficult to find online and offline. Because China produces half of the world’s face masks, a major disruption of the global supply chain occurred. Therefore, Taiwan CDC began distributing surgical masks from the stockpile to convenience stores for purchase by the public.18 A total of two million surgical masks have been released for sale from January 22 to January 30, 2020. However, a huge gap remains between demand and supply, and panic buying and soaring prices have increased. Healthcare professionals have been the most affected.24
Because approximately 90% of face masks are imported into Taiwan,25 the Taiwanese government had to produce masks domestically. The daily production of face mask manufacturers in Taiwan before the outbreak was 1.88 million face masks with a maximum production capacity of 19 million face masks per day. In response to precautionary measures recommended for mitigating COVID-19 infection during the early phase, the CECC announced a free supply of masks for healthcare professionals and an affordable price for the public by introducing the name-based rationing system. We believe that offering easy access to simple and cheap face masks can be effective precautionary measures for COVID-19 infection based on Taiwan's experience in this outbreak.11
By comparing monthly and weekly face mask supply to the population of Taiwan, the results revealed that the name-based rationing system (1·0/2·0/3·0), using online, offline, and integrated online and offline strategies, showed a fair distribution of face masks to the population. The main reasons of success in fair supply which were face masks supply are sufficient, the masks price very affordable, provided 20,000 sales points, and district public health centers supplied masks in remote areas; thereby removing any barrier to accessibility. We found that when using the electronic platform alone, the number of masks supplied was much lower than when using the on-site purchase in pharmacies and district public health centers; moreover, unfair mask supply in age groups 0–9, 30–39, 40–49, 60–69, 70–79, and 80–89 years. One important reason was the difference in operation design. The eMask system adopts pre-order masks; the public must wait at least 7 days to obtain masks. Conversely, although on-site purchase limits the number of masks purchased in each pharmacy, one can pay for the mask.
Whether face masks mitigate the spread of COVID-19 is debatable.26 Panic buying in Taiwan originated due to experience with the SARS crisis nearly 20 years ago.20 However, although there is a lack of evidence on the effectiveness of the face mask policy during the early COVID-19 pandemic, the Taiwanese government enforced the regulation of mask supply. Increasing evidence suggests that using masks can prevent COVID-19. Surgical face masks can prevent the transmission of human coronaviruses and influenza viruses from symptomatic individuals.27 Studies have demonstrated that universal masking strategies in healthcare systems are associated with a significantly lower rate of SARS-CoV-2 positivity among healthcare workers.28 A study evaluating state policy for mandatory mask use showed a decline in the COVID-19 growth rate compared with states that did not have this mandate.29 The results from an epidemic model indicate that only actively finding symptomatic people and their contacts do not decrease transmission number and should be combined with a mask-wearing campaign.30 Mass masking for source control is a useful and low-cost adjunct to social distancing and hand hygiene during the COVID-19 pandemic.16 This approach is particularly useful for a pathogen with a relatively common asymptomatic carriage and can effectively mitigate the transmission of COVID-19.
The CECC announced that mask-wearing is mandatory in schools, places of worship, medical and health facilities, public transportation, entertainment venues (KTVs, sports centers, nightclubs, bars, and amusement parks), cinemas and concerts, markets (night markets, shopping malls, and farmers markets), and large social events.31 Since late June, a few foreign nationals from Japan, Thailand, and Belgium with unidentified sources of infection have tested positive for COVID after leaving Taiwan. The CECC empowers the public to take precautions by masking the face. Presently, COVID-19 cases in Taiwan are sporadic and imported. Based on the current epidemic status, the risks of imported cases remain high. The high transmissibility of the virus and the potential of community outbreak remain a threat to Taiwan's healthcare system and society.
The major strength of this study is that it provides statistical data on the use of a face mask nationwide to understand face mask supply coverage and fairness under the name-based rationing system. Studies related to face mask coverage during the COVID-19 pandemic are lacking. Nonetheless, one substantial limitation of this study is that it lacks on-site face mask purchase information related to estimated face mask supply coverage, excluding the period from April 9 to April 15, 2020, and April 23 to April 29, 2020, as some records were not available.