The country showed that it is possible to
contain the coronavirus without shutting down the economy, but experts are
unsure whether its lessons can work abroad.
Chung Sung-Jun/Getty Images
By Max Fisher and Choe Sang-Hun
No matter how
you look at the numbers, one country stands out from the rest: South Korea.
In late February and early
March, the number of new coronavirus infections in the country exploded from a
few dozen, to a few hundred, to several thousand.
At the peak, medical
workers identified 909 new cases in a single day, Feb. 29, and the country of
50 million people appeared on the verge of being overwhelmed. But less than a
week later, the number of new cases halved. Within four days, it halved again — and again the next day.
On
Sunday, South Korea reported only 64 new cases, the fewest in nearly a month, even as
infections in other countries continue to soar by the thousands daily,
devastating health care systems and economies. Italy records several hundred
deaths daily; South Korea has not had more than eight in a day.
South Korea is one of only two countries with large outbreaks,
alongside China, to flatten the curve of new infections. And it has done so without China’s
draconian restrictions on speech and movement, or economically damaging
lockdowns like those in Europe and the United States.
As global
deaths from the virus surge past 15,000, officials and experts worldwide are
scrutinizing South Korea for lessons. And those lessons, while hardly easy, appear
relatively straightforward and affordable: swift action, widespread testing and
contact tracing, and critical support from citizens.
Yet other
hard-hit nations did not follow South Korea’s lead. Some have begun to show
interest in emulating its methods — but only after the epidemic had accelerated
to the point that they may not be able to control it any time soon.
President Emmanuel Macron
of France and Prime Minister Stefan Löfven of Sweden have both called South
Korea’s president, Moon Jae-in, to request details on the country’s measures,
according to Mr. Moon’s office.
The head of
the World Health Organization, Tedros Adhanom Ghebreyesus, has hailed South Korea as demonstrating that
containing the virus, while difficult, “can be done.” He urged countries to
“apply the lessons learned in Korea and elsewhere.”
South Korean officials
caution that their successes are tentative. A risk of resurgence remains,
particularly as epidemics continue raging beyond the country’s borders.
Still,
Scott Gottlieb, a former commissioner of the Food and Drug Administration, has
repeatedly raised South Korea as a model, writing on Twitter, “South Korea is showing Covid-19
can be beat with smart, aggressive public health.”
Lesson 1: Intervene Fast,
Before It’s a Crisis
Just one week
after the country’s first case was diagnosed in late January, government
officials met with representatives from several medical companies. They urged
the companies to begin immediately developing coronavirus test kits for mass
production, promising emergency approval.
Within two weeks, though
South Korea’s confirmed cases remained in the double digits, thousands of test
kits were shipping daily. The country now produces 100,000 kits per day, and
officials say they are in talks with 17 foreign governments about exporting
them.
Officials also swiftly
imposed emergency measures in Daegu, a city of 2.5 million where contagion
spread fast through a local church.
“South
Korea could deal with this without limiting the movement of people because we
knew the main source of infection, the church congregation, pretty early on,”
said Ki Mo-ran, an epidemiologist advising the government’s coronavirus
response. “If we learned about it later than we did, things could have been far
worse.”
South Koreans, unlike
Europeans and Americans, were also primed to treat the coronavirus as a
national emergency, after a 2015 outbreak of Middle East respiratory syndrome
in the country killed 38.
The coronavirus is thought
to have a five-day incubation period, often followed by a period
of mild symptoms that could be mistaken for a cold, when the virus is highly communicable. This pattern creates a lag of a
week or two before an outbreak becomes apparent. What looks like a handful of
cases can be hundreds; what looks like hundreds can be thousands.
“Such
characteristics of the virus render the traditional response, which emphasizes
lockdown and isolation, ineffective,” said Kim Gang-lip, South Korea’s vice
health minister. “Once it arrives, the old way is not effective in stopping the
disease from spreading.”
Lesson 2: Test Early, Often
and Safely
South Korea has tested far more people for the coronavirus than any
other country, enabling it to isolate and treat many people soon after they are
infected
The country has conducted
over 300,000 tests, for a per-capita rate more than 40 times that of the United
States.
“Testing
is central because that leads to early detection, it minimizes further spread
and it quickly treats those found with the virus,” Kang Kyung-wha, South
Korea’s foreign minister, told the BBC, calling the tests “the key behind our
very low fatality rate as well.”
Though South Korea is sometimes portrayed as having averted
an epidemic, thousands of people were infected and the government was initially accused of complacency. Its approach to testing was designed to turn back an
outbreak already underway.
To spare
hospitals and clinics from being overwhelmed, officials opened 600 testing
centers designed to screen as many people as possible, as quickly as possible —
and keep health workers safe by minimizing contact.
At some
walk-in centers, patients enter a chamber resembling a transparent phone booth. Health workers administer
throat swabs using thick rubber gloves built into the chamber’s walls.
Relentless public messaging
urges South Koreans to seek testing if they or someone they know develop
symptoms. Visitors from abroad are required to download a smartphone app that
guides them through self-checks for symptoms.
Offices,
hotels and other large buildings often use thermal image cameras to identify
people with fevers. Many restaurants check customers’ temperatures before
accepting them.
Lesson 3: Contact Tracing,
Isolation and Surveillance
When someone tests
positive, health workers retrace the patient’s recent movements to find, test —
and, if necessary, isolate — anyone the person may have had contact
with, a process known as contact tracing.
This allows health workers
to identify networks of possible transmission early, carving the virus out of
society like a surgeon removing a cancer.
South Korea developed tools
and practices for aggressive contact tracing during the MERS outbreak. Health
officials would retrace patients’ movements using security camera footage,
credit card records, even GPS data from their cars and cellphones.
“We did our epidemiological
investigations like police detectives,” Dr. Ki said. “Later, we had laws
revised to prioritize social security over individual privacy at times of
infectious disease crises.”
As the coronavirus outbreak
grew too big to track patients so intensively, officials relied more on mass
messaging.
South Koreans’ cellphones
vibrate with emergency alerts whenever new cases are discovered in their
districts. Websites and smartphone apps detail hour-by-hour, sometimes
minute-by-minute, timelines of infected people’s travel — which buses they
took, when and where they got on and off, even whether they were wearing masks.
People
who believe they may have crossed paths with a patient are urged to report to
testing centers.
South Koreans have broadly
accepted the loss of privacy as a necessary trade-off.
People ordered into
self-quarantine must download another app, which alerts officials if a patient
ventures out of isolation. Fines for violations can reach $2,500.
By
identifying and treating infections early, and segregating mild cases to
special centers, South Korea has kept hospitals clear for the most serious
patients. Its case fatality rate is just over one percent, among the lowest in
the world.
Lesson 4: Enlist The
Public’s Help
There aren’t enough health
workers or body-temperature scanners to track everybody, so everyday people
must pitch in.
Leaders concluded that
subduing the outbreak required keeping citizens fully informed and asking for
their cooperation, said Mr. Kim, the vice health minister.
Television broadcasts,
subway station announcements and smartphone alerts provide endless reminders to
wear face masks, pointers on social distancing and the day’s transmission data.
The
messaging instills a near-wartime sense of common purpose. Polls show majority
approval for the government’s efforts, with confidence high, panic low and
scant hoarding.
“This public trust has
resulted in a very high level of civic awareness and voluntary cooperation that
strengthens our collective effort,” Lee Tae-ho, the vice minister of foreign
affairs, told reporters earlier this month.
Officials
also credit the country’s nationalized health care system, which guarantees
most care, and special rules covering coronavirus-related costs, as giving even
people with no symptoms greater incentive to get tested.
Is The Korean Model
Transferable?
For all the attention to
South Korea’s successes, its methods and containment tools are not
prohibitively complex or expensive.
Some of the technology the
country has used is as simple as specialized rubber gloves and cotton swabs. Of
the seven countries with worse outbreaks than South Korea’s, five are richer.
Experts cite three major
hurdles to following South Korea’s lead, none related to cost or technology.
One
is political will. Many governments have hesitated to impose onerous measures
in the absence of a crisis-level outbreak.
Another is public will.
Social trust is higher in South Korea than in many other countries,
particularly Western democracies beset by polarization and populist backlash.
But
time poses the greatest challenge. It may be “too late,” Dr. Ki said, for
countries deep into epidemics to control outbreaks as quickly or efficiently as
South Korea has.
China turned back the catastrophic first outbreak in Hubei, a province
larger than most European countries, though at the cost of shutting down its
economy
South Korea’s methods could
help the United States, though “we probably lost the chance to have an outcome
like South Korea,” Mr. Gottlieb, the former F.D.A. commissioner, wrote on Twitter. “We must do everything to avert the
tragic suffering being borne by Italy.”
Max Fisher reported from New
York, and Choe Sang-Hun from Seoul, South Korea.
Max
Fisher is a London-based international reporter and columnist. He has reported
from five continents on conflict, diplomacy, social change and other topics. He
co-authors The Interpreter, a column exploring
the ideas and context behind major world events. @Max_Fisher • Facebook
Choe
Sang-Hun is the Seoul bureau chief for The New York Times, focusing on news on
North and South Korea.
