Seok Woo Kim, MD, PhD
On Tuesday, April 28, 2020, health care workers in Seoul Medical Center commemorated the 100th day since the first appearance of a COVID-19 patient in South Korea. As of May 6, 2020, the nation’s total number of cases stands at 10,806, with six new imported infections and no new local ones, according to the Korea Centers for Disease Control and Prevention (KCDC). The daily number of confirmed new infections had peaked on February 29 at 909. Also according to the KCDC, as of May 6, the death toll has reached 255, and the fatality rate reached 2.34%. A total of 9,333 people who were confirmed to have had COVID-19 have recovered so far, up 50 from a day earlier.
According to the KCDC global map of COVID-19 cases on May 6, China, which once had the highest number of COVID-19 patients in the world, had a fatality of 5.59% with 82,883 confirmed cases and 4,633 deaths. In the United States, cases continue to grow, with 1,203,502 confirmed cases, 71,022 deaths, and a fatality rate of 5.9%. In comparison, South Korea, which initially had the world’s largest outbreak of COVID-19 outside China, appears to be entering a stable phase with fewer infections.
Managing an Outbreak
Although South Korea did not implement a nationwide lockdown, many steps were taken to reduce the spread of COVID-19.
Aggressive Testing, Free of Charge
The South Korean government primarily focused on aggressive testing. The government procured high-quality diagnostic kits based on a tightly coordinated transfer of public-funded technology to private manufacturers. This allowed the nation to quickly establish a mass testing system in which public health centers played a central part. Currently, the country has more than 600 testing sites (including 80 drive-through centers) that are capable of testing a total of 20,000 people per day. Moreover, individuals with suspected COVID-19 symptoms and contact history are legally entitled to be tested free of charge.
Contact Tracing and Privacy Concerns
South Korea’s government also focused on tracing contacts to contain community transmission. Each time a new case was identified, local governments used contact tracing to quarantine potential carriers and publicly disclosed their individual travel histories in order to inform nearby residents of their potential exposure. This helped to contain infection clusters. Similarly, the triage system in hospitals helped to prevent patients with severe symptoms from indiscriminately infecting health care workers and other patients.
The authorities relied on mobile-phone GPS (global positioning system) data, credit card transaction records, and closed circuit video footage for contact tracing. Although this use of personal data is legal in South Korea and proved effective in combating the virus, it also raised significant privacy concerns. The country’s National Human Rights Commission and advocacy organizations have called for an appropriate balance between protecting the public and respecting individual rights, and this debate continues today.
Our government established a strict triage system to protect other patients and health care workers. If a patient with respiratory symptoms visits the hospital, he or she must go through a triage system called “Seon-Byul-Jin-Ryo-So,” which roughly translates to “screening center”. After measuring body temperature, the patient’s basic respiratory symptoms, recent travel history, visits to areas with COVID-19, contacts with COVID-19 patients, etc, are checked. If findings suggest possible COVID-19 infection, tests are conducted. Outpatient treatment is allowed only if the results are confirmed negative. Patients with suspected COVID-19 infection may have to wait at a triage system for hours before the results are available.
In outpatient care, all patients, regardless of whether they are respiratory patients or not, and all health care workers, including doctors and nurses, are advised to wear masks. Washing hands and using hand sanitizer for each examination is recommended.
Telemedicine was designed to provide health care to people who live in hard-to-reach areas such as remote islands or sparsely populated areas by connecting patients to doctors over the internet. In principle, telemedicine was banned in South Korea. However, because of the rapid spread of COVID-19, South Korea adopted telemedicine to help battle the outbreak.
The government opened state-run isolation facilities in the hardest-hit regions, such as Daegu and North Gyeongsang Province, to quarantine and monitor COVID-19 patients who showed mild symptoms. These facilities were opened after criticism was shared that people with severe symptoms were not being properly treated due to the lack of hospital beds.
The government has so far opened 16 community centers that can admit up to 3,800 patients in the southeastern city of Daegu and surrounding North Gyeongsang Province. However, the Korean Medical Association, which represents more than 105,000 physicians across the country, has continued its opposition, citing safety concerns and other potential problems.
Videoconferencing for Work
In my personal work setting, we are asked to wear masks and sit one seat apart from each other when having meetings. At first, many people took off their masks during meetings, but HR staff quickly intervened by holding up a smartphone screen that says “Please wear your mask” against the meeting room window. Wearing a mask and using the spray sanitizer at the entrance of the office has become a daily routine. As time passes, everyone starts to feel it is a social obligation to follow the rules, but there have been no penalties for not following these rules.
The prevalence of video meetings and interviews is one of the changes that seems likely to stay, even as the pandemic situation subsides. Holding a videoconference is definitely convenient, but only when you have become familiar with the system. Nonetheless, online meetings are increasingly becoming the modus operandi as governments around the world impose social distancing to keep the spread of the highly contagious disease in check.
Doubts Cast on COVID-19 Reinfections
Although the number of new COVID-19 infections has decreased sharply in South Korea, fears of resurgence persist. Some coronavirus patients in Korea who tested positive for COVID-19 after recovery are sounding the alarm about possible reinfections. These fears arose after the Korea Centers for Disease Control and Prevention reported cases of recovered patients testing positive for COVID-19 again. By Monday, there were at least 277 people who fell into that category. However, the current RT-PCR testing method is unable to differentiate between an active virus and an inactive virus, which is probably why people who already recovered from the disease were testing positive again—not because they were infected a second time.
Adjusting to the New Reality
As the coronavirus crisis has gripped the world, life as we know it has changed. As the number of cases in South Korea plummeted, many wondered what South Korea did to curtail the spread of the virus and how so many tests could be carried out in such a short period. As a government official said, “I think highly of the public following the new etiquette. Of course, some credit should go to the government and the medical personnel, but the public’s role was also important.” I agree with that in part. But most of all, I would like to give more credit to the medical staff and health care workers who silently took care of their patients day and night, as well as the low medical costs and high hospital accessibility behind the scenes.
There may be a second wave of the virus this winter. Some experts even say that the pattern of the pandemic may be repeated until 2024. So, the new way of living will likely become a normal thing for many. As a society, we must be ready.