Fight against COVID-19: Lessons from South Korea

On the last day of 2019, the WHO China Country Office was informed that a new type of coronavirus – novel coronavirus– was identified in a cluster of 41 people in the eastern city of Wuhan, the largest city in Hubei Province with a population of over 11 million, exhibiting some clinical signs and symptoms mainly fever, difficulty in breathing and invasive pneumonic infiltrates in both lungs. National authorities reported that patients had been isolated and were receiving treatment in local medical institutions. At that time, no one could have guessed that a major outbreak would spread all over the world, infecting 167 countries and causing death of at least 8,018 people.

While the novel coronavirus was sweeping Asian countries, South Korea was the second country experiencing a massive outbreak after China. The first COVID-19 case in the country was detected on January 20th, a 35-year-old Chinese woman. February 18th was the beginning of a severe outbreak in the country when Patient 31, a member of a religious sect called Shincheonji Church of Jesus in the southeastern city of Daegu was tested positive. In less than two weeks, the number of cases jumped from 30 to 6,000 within the country while travel warnings and restrictions for South Korea kept coming one after another.

The country has 8,413 cases as of March 18th, having one of the lowest fatality rates, just 1% with 84 deaths whereas the rate is 4.02% regarding other countries in the world. That is far lower than the 4% of COVID-19 patients who have died so far in China, the 7.9% in Italy, 6.1% in Iran, 4.5% in Spain or 1.8% in the United States. Today, the number of new daily cases stood at 93, in contrast to a couple of weeks ago where the number had reached the peak of 813 on February 29th.

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South Korea’s daily COVID-19 trend (Source: coronaboard.kr)

Because testing capacity and the transparency of reporting the cases vary widely from country to country, growth factor gives a relatively more reliable insight to perceive the spread of the virus within different countries. To be more precise, growth factor is the factor by which a quantity multiplies itself over time. The formula used is every day’s new cases / new cases on the previous day. A growth factor above 1 indicates an increase, whereas a figure between 0 and 1 signal a decline. A growth factor constantly above 1 can be a sign of exponential growth. Recently, South Korea appears to have managed slow exponential growth, it means the number of cases in the country doubles up in 14 days, whereas this period is only 4 days or even less in most countries.

Although it is too early to say whether the South Korean response has been adequate to deal with the COVID-19 outbreak, South Korea still offers some important insights that should be learned by any country hoping to overcome an epidemic. So, where has South Korea succeeded, and what should the rest of the world learn from them?

Consistent SOP

It is crystal clear that the issue today is no longer about preventing the COVID-19 outbreak, but about its containment. In this process, South Korea has taken obvious measures of which proper execution resulted in flattening the curve, slowing the rate of increase in infections. Having a steady standard operating procedure, South Korea essentially followed five steps: Aggressive testing, a transparent information campaign, quarantine of infected individuals, treatment of those in need, and disinfection of contaminated environments.

Quick approval to testing systems

A MERS outbreak in 2015 taught South Korea a painful lesson, killing 38 people and drilling the economy. With this past experience, the South Korean government has recognized the importance of early diagnosis and isolation of infected individuals to prevent the spread. Five years later, in the current COVID-19 case, South Korean officials did not leave things to chance, and they swiftly stepped in to ramp up testing as soon as the novel coronavirus broke out in China. A key reform was made, allowing the government to give quick approval to testing systems, turning a year-long approval procedure into a week. Four companies have rapidly developed testing kits, and as a result, the country quickly had a system with a capacity to test 20,000 people a day.

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Tests completed in South Korea (Source: coronaboard.kr)

Aggressive testing

As of today, South Korea has tested more than 295,647 people and identified 8,413 cases. The results are processed by 118 public and private laboratories where staff are working 24 hours a day. The testing program is available to all individuals including undocumented immigrants, and is free to those with symptoms or a doctor referral. Additionally, the government made the access to testing much easier by setting up more that 43 drive-through testing centers all over the country where people can get tested for free while sitting in their car.

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Drive-through coronavirus testing center

Trace, test and treat

The measures taken by the South Korean government included neither lockdowns nor restriction on movement. South Korea has only restricted the entry of travelers with passports from China’s Hubei Province, as well as anyone who has visited that region in the past 14 days. Apart from that, all visitors are to undergo a temperature check when entering the country. Those exhibiting symptoms are required to take a diagnostic test and quarantine for 14 days. However, South Korea has not isolated any city or region, including Daegu and the surrounding North Gyeongsang Province, the center of infections with 87% of the nationwide cases. Instead, the main strategy has been to trace, test and treat.

Transparency

From the very beginning, all process has been conducted in a total clarity and transparency. The government began posting the precise movement of everyone who tested positive, everything from the restaurants where they stopped for lunch to the bus they took to work. Everyone they had made contact with, symptomatic or asymptomatic, were also tested. The government obtained the information from mobile phone records, credit card receipts and other private data which is authorized to collect in a health emergency. Furthermore, the government passed a law, making testing mandatory for those who were symptomatic and/or had contact with an infected individual. The ones who refused testing faced a fine of 3,000,000 KRW (2,415 USD).

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Coronavirus map website tracking the precise movement of infected individuals coronamap.site

Coronavirus mobile apps

The Ministry of Health provided daily updates, and constantly shared information on testing, new cases, recovery status of infected individuals and fatalities with the public through press briefings and websites. Announcement on affected communities and regions as well as suspected sources of infection were also disclosed.

website
The Ministry of Health and Welfare website constantly updates and shares information on cases ncov.mohw.go.kr

The national mobile phone alert system has been warning residents of the respective districts when a new case is detected, accompanied with a link to detailed information about the recent locations traversed by diagnosed patients with the approximate times of visitation so that people can quickly find out whether they might have been at risk. Map applications were also used and constantly updated to track the precise movement of infected individuals to prevent people from visiting high-risk areas. The government has also developed two mobile phone applications. One of them is mandatory for people arriving in South Korea from high-risk areas such as China, Hong Kong and European countries who have to answer daily questions about their possible symptoms for 14 days. The other app warns public officials whenever someone in quarantine leaves the isolation zone.

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Notifications coming through national mobile phone alert system

Immediate treatment & penal sanctions

Additionally, the Ministry of Health immediately set up a telephone line in seven different languages. Before visiting a doctor or a hospital right away, people exhibiting symptoms were asked to call this line first. Then they were visited and tested by health care personnel at home, and taken to hospital if necessary. In this way, further spread of virus and possible throngs at hospitals were prevented. Meanwhile, being aware of the impossibility of quarantining and treating all patients, major hospitals focused more on severe patients while patients with mild symptoms were treated in smaller health centers or they stayed at home and got treated. In accordance with the new law introduced by the government, violations of quarantine by diagnosed individuals were punished with either a fine from 3,000 ,000 to 10,000,000 KRW (2,415 to 8,050 USD) or imprisonment up to 1 year after recovery.

Mask control

Within this time period, all South Koreans were asked to wear facial masks not to further spread the virus even though they do not show any symptoms. In buses and subway stations, masks and hand sanitizers were provided. Due to the nationwide shortage, the South Korean government promised in early March to improve its mask distribution, and also announced it would ban the exportation of masks and require face mask producers to report their sales volumes to the government in order to deal with price gouging. In the last two weeks, the government began selling face masks at both pharmacies and public post offices for cheaper price and limited the sales to two masks per person each week. To prevent a large crowd, people can go to pharmacies or post offices to get their masks on predetermined days according to the last digit of their birth year.

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Masks and hand sanitizers provided in subway stations

Apart from these, just like many other countries, South Korean authorities banned large gatherings, shut down educational institutions and other public spaces such as sports facilities and daycare centers, and cancelled all major sport events soon after discovering the first major eruption of disease in the country. Offices also encouraged people to work from home. Recognizing the need of a healthy mental state for a healthy immune system, diagnosed patients at hospitals regularly met psychiatrists. Because most Koreans enjoy Korean dramas and TV shows, patients were given free TV packages.

In a nutshell, dealing with the threat of coronavirus has become the new normal in South Korea over the past one month. Instead of lockdown and restriction on movement, South Korea chose to make aggressive testing while consistently informing and educating the public in transparency. South Korea’s battle with the novel coronavirus is not over yet, with confirmed cases continuing on a daily basis. However, it is believed that the worst of the outbreak might be over. As of March 15th, the daily new cases decreased to two digits for the first time since February 21st. Time will tell if South Korea is able to maintain those results with its distinctive approach.

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