From time to time, until the crisis has passed, the HEPL blog series authors will be given the opportunity to provide short updates on their country/region’s continuing response to this worldwide catastrophe and their further reflections on those responses. Each update will be labelled accordingly with the original response at the bottom of each post.

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HEPL blog series: Country Responses to the Covid19 Pandemic

 

South Korea’s response to the Coronavirus Pandemic – Update (May 2020)

Caleb Park¹, SangJune Kim², Friedhelm Schnitzler³, Jina Kim²

¹ London Business School, Regent’s Park, United Kingdom
² Department of Health Policy, London School of Economics and Political Science, United Kingdom
³ International Health Management Consulting, Germany/Korea

 

In the months of strong lockdown measures and longer periods of “the peak” in many countries, South Korea has experienced a different game. For what was once the world’s second largest outbreak, the country tested every suspected case regardless of the symptoms, rapidly decreasing the number of new cases and deaths. In the regions with an intense local outbreak (Daegu), patients were fully recovered and discharged, and subsequently the medical staff could go back to their original positions. Community treatment centres (CTC) have temporarily closed as the number of new cases dropped, while drive-through and other screening stations continue to run in reduced numbers. May 6th marked the country’s third consecutive day without a new local infection, an impressive feat solely through “trace, test and treat” and voluntary social distancing.

South Korea made three important contributions to the national and the larger community. First, as mentioned in the previous article, tens of thousands of expats and students returning from other heavily affected countries through the open border were successfully tested and quarantined. 1,142 cases have been detected and confirmed at the point-of-entry screening, 90.2% of who were South Korean citizens. Second, amid global concerns around reinfection, scientific investigations in South Korea found that the signals were from fragmented dead virus rather than reactivation. Third, the country could run their parliamentary election, one of the building blocks of modern democracy, through fast yet unobtrusive infection control measures. Through designating, disinfecting, and managing facilities for symptomatic voters, no cases were linked to the voting stations and/or the staff.

In the eyes of the global community, the Korean way seems to draw a lot of privacy concerns. In reality, there are internal debates and efforts to balance the communal goal of containing the disease while keeping the freedom and privacy of individuals uncompromised. For example, discussions around electronic wristbands began after reported incidences of returning residents violating their two weeks of mandatory quarantine. Under critical reception from civil and academic societies, the government limited the wristband to quarantine violators, and further allowed the right to refuse the wristband, in which case the violator would instead go to a quarantine facility for two weeks and bear the additional facility costs.

Another example is the epidemiological investigations. Contrary to the privacy concerns, most of the confirmed patients voluntarily provided location and tracing information, obviating the need for intrusive measures.  Exceptions would only be made for inconsistent or blatantly false claims. In the recent nightclub outbreak, 30% of the guests on the entrance form had deliberately misinformed the club with fake credentials, which spoke of the need to utilise and match personal data. Digital contact tracing could be a long-term option, but given the time-sensitive nature of the problem, the current practice of limited and discretionary use of private information is justifiable.

Finally, the epidemic is engendering sensitivity to human rights in the population as well as in public health communication. The recent nightclub outbreak in the Itaewon district of Seoul has been linked with LGBT groups as the names of the clubs were revealed through media outlets and the internet. The government immediately issued public warnings against leaking personal information and ensured privacy protection for those who get tested. As a result, thousands have voluntarily stepped in to test centres within less than a week. Time will tell whether this is the beginning of a second peak or a subsiding fluctuation.

As local outbreaks are unavoidable under the “new normal life,” countries need to continue to stick to the basics. Tests should be made physically and socially accessible, mindful of the thin line between detection and discrimination, lowering the socio-cultural barrier to healthcare access. Other requirements would include limited but flexible epidemiological investigations as well as building risk-prepared health system capacity. There are also neighbouring countries playing a role in the larger picture where different forms of governments and phases of efforts coexist. With the world under heavy economic pressure, lockdowns and blame games, South Korea hopes to continue demonstrating a prime example of protecting democratic values and keeping an open economy in the midst of a pandemic.

 

South Korea’s response to the Coronavirus Pandemic – Original post (April 2020)

Friedhelm Schnitzler¹, Caleb Park²,  Jina Kim³, SangJune Kim³

¹ International Health Management Consulting, Germany/Korea
² London Business School, Regent’s Park, United Kingdom
³ Department of Health Policy, London School of Economics and Political Science, United Kingdom

 

After the outbreak of the COVID-19, S. Korea was initially the country with the highest number of infections outside China, driven by a fast-spreading regional cluster infection. S. Korea’s preparedness and quick response slowed down daily new infections to a controllable size, allowed borders to remain open and avoided massive lockdown. Early detection with a high quality of testing, quarantine, and close observation of the confirmed cases were the basic strategies, which has kept the case mortality rate below 1.7% to date. In this report, we focus on how the country managed to flatten the initial peak of this pandemic and evaluate the response in terms of preparedness, responsiveness, equity, efficiency and social distancing.

Preparedness
Unlike Europe, S. Korea experienced three major infectious disease outbreaks in the 2000s, including SARS in 2003, Influenza H1N1 in 2009, and MERS in 2015. In particular, MERS caused 186 infections and 39 casualties, and left a severe psychological impact on society. Following these outbreaks, S. Korea revised its response system and legislation related to new and emerging diseases. Data protection law for controlling infectious disease was amended so that the Minister of Health and Welfare and the Head of the local government can request personal location information from mobile companies, credit card companies and others under such an emergency. The country also introduced Emergency Use Authorization (EUA) to accelerate access to new diagnostic methods, in addition to expanding its epidemiological investigations.

Responsiveness
The new EUA scheme and expert groups facilitated responsiveness in the early stage of the outbreak. Countries that have been scaling up massive screening have also experienced a major bottleneck in securing adequate amounts of good quality RT-PCR kits. As soon as China released the sequencing of the virus, the Korean Society for Laboratory Medicine and the Korean Centers for Disease Control and Prevention (KCDC) invited domestic companies to utilise EUA to expedite approvals and start mass production without risking quality. Then they made the analysis available not only to 18 local public institutes but also to major regional hospitals and private institutes, for a total of 77 institutes capable of processing specimens.

Together with the early setup of its analysing capacity, the country promoted responsiveness through public channels and community care centres. S. Korea announced its 24-hour hotline and urged people to act upon showing symptoms by getting tests in both local public health centres and hospitals, as well as in drive-through centres. Although a large proportion of patients show mild symptoms, high-risk patients often show rapid progression to a fatal condition, hence requiring hospital care. Initially, all patients were treated in negative pressure rooms in designated hospitals, but after the intense outbreak in Daegu exhausted the available hospital beds, a four-level triage system was implemented. Based on case severity, patients were quarantined either in hospitals or in “Community Care Centres (CCCs)”, where doctors and nurses stay with and monitor patients 24/7. CCCs have contributed to curbing inter-family infection and securing the appropriate bed resources for high-risk cases as well as existing patients not related to COVID-19. Moreover, support from public health doctors and the Korean Society of Critical Care Medicine, and voluntary services of doctors and nurses resolve significant demands placed on the workforce.

Equity
The system provides universal coverage for everyone, free of charge. Under the infectious disease prevention law for new and emerging infectious diseases, patients can receive a free consultation, testing and treatment, if the patients meet the KCDC case definition or if doctors prescribe them. This enables the vulnerable population to access care without having financial concerns. Foreigners are also fully covered, not only for the sake of humanitarian principles but also for a comprehensive strategy against the viral spread. Also, health officials are temporarily exempted from the obligation to report undocumented migrant workers, so that access to testing takes priority over visa-related concerns.

Efficiency
The health information system significantly contributed to improving efficiency. In particular, a prescribing assistance program, called “Drug Utilisation Review system (DUR)”, was essential to an efficient distribution of facial masks. This system sends doctors an alarming notification in case of overlapping prescriptions of the same drugs for the same patient but from different providers. To tackle the shortage of masks, the government utilised DUR so that everyone under the health system can procure masks through pharmacies at a given price, two masks per person per week. The DUR hence helped prevent over-purchase or hoarding of masks, even under high demand.

In addition, active self-monitoring was made easy through a mobile application, increasing administrative efficiency significantly. This accounts for persons who are to be self-contained as well as those that have entered from a foreign country. Since each person reported their symptoms and temperature twice a day with the official app, a modest number of civil servants were enough to monitor the vast population effectively.

Social distancing and mask-wearing
While European countries implemented social distancing during lockdowns, enforced travel restrictions and only left manageable borders open, S. Korea heavily acted on tracing suspected cases and wearing facial masks, which were complemented by the general public’s willingness to take tests and comply with health guidelines. An intensive epidemiological investigation found more than 80% of epidemiological links, a remarkable effort made by the workforce combined with the legislative to access location history of confirmed cases, under the new law enacted following the MERS epidemic. The rationale of public disclosure is to ensure that individuals with potential exposure are examined and quarantined before they spread the virus further. The disclosure, which continues to date, accompanied by wide media coverage promoting up-to-date information, social distancing and ways to minimise risks, has raised public awareness throughout the outbreak.

Many countries in Europe now encourage wearing facial masks. South Korean medical professionals have advocated wearing masks in public environments since the beginning of the outbreak. There has been a 40% decline in public transport usage since the outbreak. Fewer than 100 new cases are found per day across the nation. This is thought to be an effect of wearing facial masks, which protects clusters in public environments and enhances the effect of social distancing. Wearing facial masks has been common and culturally accepted in S. Korea over the past decade, mainly to fight air pollution and fine dust from East Asia. As a result, there is an existing market with sufficient demand, as well as active an supply from multiple companies.

Conclusion
As of now, the mortality rate of COVID-19 in S. Korea is one of the lowest in the world, at around 1.7%. Legal and technical readiness after the MERS outbreak in 2015 led the country to take actions promptly. Digital platforms were the key to containment. The commitment of the public towards social distancing was crucially effective and without draconian measures. The public showed self-responsibility and strong solidarity. S. Korea still preserves an open border, and public life continues without a government-mandated lockdown. Only one battle is over, as the country continues to look out for a possible second peak.

 

References

Kwon S, Lee Tj, Kim Cy. Republic of Korea Health System Review. Vol.5 No.4. Manila: World Health Organization, Regional Office for the Western Pacific, 2015.

http://www.cdc.go.kr/CDC/cms/content/mobile/66/74966_view.html  [Accessed 1 April 2020]

http://easylaw.go.kr/CSP/CnpClsMain.laf?popMenu=ov&csmSeq=830&ccfNo=2&cciNo=2&cnpClsNo=1  [Accessed 1 April 2020]

 

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