Monday, May 4, 2020

No Lockdown In South Korea: COVID is Beaten

South Korea’s Health Minister on How His Country Is Beating Coronavirus Without a Lockdown: It wasn’t looking good for South Korea in mid-February. The nation had the world’s second highest number of coronavirus cases after China, owing to a cluster of infections that arose from the Shincheonji Church in the city of Daegu, some 150 miles south of the capital Seoul.

But thanks to early preparations, and a robust public health response based around extensive testing and tech-powered contact tracing, the nation’s tally of infections has been kept to just 10,765, about half directly related to Shincheonji. More impressive still, no major lockdown or restrictions on movement have been imposed, save a few scattered curfews.

On Apr. 15, some 29 million people turned up to vote in parliamentary elections—yet no known infections arose, thanks to strict social distancing at the polls. On Wednesday, South Korea had zero local infections for the first time since the outbreak was first recorded 72 days previously (though four new cases had been imported.) “This is the strength of South Korea and its people,” President Moon Jae-in said on announcing the news.

South Korea’s health and welfare minister Park Neung-hoo explained to TIME exactly how his nation engineered such a remarkable turnaround. The following written answers were translated from Korean and have been edited for length and clarity.

Q: What was your reaction when you first heard about the virus? I imagine you must get a lot of these alerts that turn out to be nothing?
A: The bitter memory of MERS (Middle East Respiratory Syndrome) puts me on edge whenever a novel virus infection is reported, so we thoroughly check up on any new viral outbreaks. [South Korea had the second-largest number of MERS cases after Saudi Arabia and its public health response was highly criticized.] So we tried to collect as much information as possible, and I thought that quick, early action should be taken.

Q: What were the most critical policies toward containing COVID-19?
A: As COVID-19 displays very unique features, we needed to be creative and innovative, as well as using traditional methods to combat the virus. For example, drive-thru screening clinics, an ICT [information and communications technology] app called Special Immigration Procedure [provided to new airport arrivals], and Life Treatment Centers for patients with mild symptoms were innovative. If we had failed to separate them and tried to put all new patients in hospitals, our overloaded healthcare system could have collapsed.

In addition, if we had delayed developing test kits by a month, without prior and proactive consultation and cooperation with the private sector, our current system based around quick, mass testing couldn’t have been established.

Q: How do instant test results help thorough contact tracing?
A: COVID-19 is highly contagious in the early stage of infection and even when the symptom is mild, and it spreads fast. Therefore, it is critical that the infected patient is identified and isolated as quickly as possible in containing the spread of the virus. For this, a quick test is essential.

Q: How important has technology proved for contact tracing?
A: ICT plays a decisive role in accurately identifying people and swiftly locating their contacts. For example, tracing them through credit card usage, CCTV, mobile phone location tracing, and so on helps us to learn about a patient’s travel time, route and location quickly, and can also help to identify close contacts of the patient. The faster we find the contacts, the better we are able to stem further spread of the virus.

Q: Why did you decide to make drive-through testing so widespread?
A: Drive-thru screening clinics are much faster and safer than ordinary screening clinics. Examination, temperature check, and specimen collection are done while the driver is still sitting in the car. Conventional specimen collection may take half an hour compared with only ten minutes in total for drive-thru. And the risk of cross infection between the medical professionals and visitors is significantly reduced.

Q: What would be your advice for other nations trying to contain COVID-19?
A: Since COVID-19 spreads very fast, an early diagnostic test is critical. About 80% of COVID-19 patients have mild symptoms, and only 10% have severe symptoms. So the medical system needs to respond accordingly. In other words, efficient allocation of limited medical resources is very important.

Next, the greatest leverage we have for controlling COVID-19 is people’s trust in the state. Deep trust not only minimizes public anxiety, but is critical in inducing the participation and cooperation of the people in enforcing the potent vaccine that is social distancing.

For this, it is very important to provide relevant information to the people in the most transparent possible manner. In addition, it is also important to have smooth inter-ministerial and central-to-local governmental communication.

Q: How did you resist the urge to impose more draconian containment measures like in China or other countries?
A: We never considered a full lockdown as part of our policy response to COVID-19. Although there was an explosive new outbreak in a certain region, we had confidence that we could locate contacts and isolate them successfully.

South Korea is a democracy which respects and ensures the individual freedom of the people as much as possible, so we relied on people’s voluntary cooperation based on their trust in public anti-epidemic authorities.

As such, instead of physical lockdown, we fought the virus through an epidemiological approach such as wide diagnostic testing and isolation of contacts, while encouraging people’s voluntary cooperation for social distancing. We believed this was more effective than forcible measures and indeed it paid off.

Q: How do you weigh public health concerns versus restarting the economy?
A: Finding a mid-point between economic activities and containing an epidemic outbreak is a delicate balancing act. Given the nature of COVID-19, it will be next to impossible to wipe it out without the development of a vaccine.

The key is whether we are able to keep COVID-19 cases within our medical system’s capacity to treat patients. In Korea, we set strict standards and regularly evaluate how patient numbers match our medical capacity, allowing us balance the two pressing needs [of public health and economy.]

Q: Do you feel public pressure to end containment measures and open up?
A: Just like epidemic prevention is part of our life, so are socioeconomic activities. We need economic activities to ensure a sustainable anti-epidemic response. I perceive the need and feel the pressure for normalization of economic activities.

Anti-epidemic authorities are making an ongoing assessment of the current progress and are exploring ways to achieve both minimal risk of spread of infection and normal life and economic activities. For example, from the end of March until mid-April, strengthened social distancing was enforced. From Apr. 20 to May 5, some public facilities are reopening, gradually easing the strength of social distancing.

We will continue to adjust the level of social distancing in consideration of further progress, and we are ready to implement a “social distancing in normal life,” under which our normal life and virus containment can both be achieved in balance with each other.

As of this week, South Korea had just over 9,000 confirmed coronavirus cases, which puts it among the top 10 countries for total cases. But South Korea has another distinction: Health experts are noting that recently the nation has managed to significantly slow the number of new cases. And the country appears to have reined in the outbreak without some of the strict lockdown strategies deployed elsewhere in the world.

"We've seen examples in places like Singapore and [South] Korea, where governments haven't had to shut everything down," said Mike Ryan, head of the World Health Organization's Health Emergencies Programme. "They've been able to make tactical decisions regarding schools, tactical decisions regarding movements, and been able to move forward without some of the draconian measures."

Speaking this week to journalists, Ryan said that countries that have tested widely for the virus, isolated cases and quarantined suspected cases — in the way that South Korea and Singapore have done — have managed to suppress transmission of the virus. President Trump has also praised South Korea's handling of the health crisis and even asked President Moon Jae-in for help with medical equipment to fight the outbreak in the United States.

The head of the WHO, Tedros Adhanom Ghebreyesus, has called on other countries around the world to "apply the lessons learned in [South] Korea and elsewhere" in their own battles against the coronavirus.

South Korea's foreign minister, Kang Kyung-wha, speaking to the BBC last week, said the key lessons from her country are that it developed testing for the virus even before it had a significant number of cases.

"In mid-January, our health authorities quickly conferred with the research institutions here [to develop a test]," Kang said. "And then they shared that result with the pharmaceutical companies, who then produced the reagent [chemical] and the equipment needed for the testing."

So when members of a religious sect in Daegu started getting sick in February, South Korea was able to rapidly confirm that it was COVID-19. "Testing is central" to the outbreak response, said Kang, "because that leads to early detection. It minimizes further spread." And it allows health authorities to quickly isolate and treat those found with the virus.

Hong Kong and Singapore have followed similar paths in responding to this outbreak. They've used testing aggressively to identify cases — not only testing people who are so sick that they're hospitalized but also mild cases and even suspected cases. They've quarantined tens of thousands of people who may have been exposed to confirmed cases.

The vast majority of the people ordered to quarantine at home are perfectly healthy and never do get sick, but the few who do develop symptoms can be quickly isolated further. Tedros of the WHO refers to this as cutting off the virus at the bud — basically stopping the virus from spreading further and preventing community transmission.

Hong Kong also reacted with incredible speed in the outbreak's early days. On Dec. 31, 2019, Hong Kong's Centre for Health Protection, the city's health department, sent out an alert to its doctors telling them to be on the lookout for patients presenting with fever, acute respiratory illness, pneumonia and/or shortness of breath — and particularly patients with these symptoms who'd recently traveled to the Chinese city of Wuhan, the initial epicenter of the pandemic. Prior to this crisis, a high-speed rail line went directly from downtown Hong Kong to Wuhan (it was shut down on Jan. 30 and hasn't run since).

The other thing that South Korea, Hong Kong and Singapore have in common is that they've been able to keep most factories, shopping malls and restaurants open. Singapore has even kept its schools open at a time when nations around the world are shutting down classrooms.

Japan is another Asian country notable for its response. Although Japan has more than twice the population of South Korea and also has strong ties to China, it has recorded only a fraction of the cases that South Korea has — just over 1,000 as of Thursday. Japan hasn't been testing nearly as widely as South Korea, but it appears to have fended off significant community transmission by quickly investigating any flare-ups of cases, identifying who exactly is infected and then monitoring their contacts.

Despite the successes in Asia in containing this virus, recently several places have seen surges in imported cases from Europe. This week, after Singapore saw an uptick in cases among people who'd recently flown into the country, it announced new restrictions on travelers, blocking all short-term visitors from entering.

"Part of the reason for the tougher border measures is to ensure we keep Singapore as safe as possible," Singapore's minister of education, Ong Ye Kung, wrote this week in a Facebook post. He said the highly restrictive entry rules are "so that daily activities, like going to work, eating out and attending school, can go on."

He argued that children are safer and more productive in school and that closing schools places a significant burden on working adults, including health care workers. "Keeping our healthcare system strong is paramount in the fight against COVID-19," he said. "Our frontline warriors will be much more assured if their children are in school, meaningfully engaged, in a safe and healthy environment."

He also pushed back against the idea that schools could be breeding grounds for the virus, saying there is little "evidence to show that the young are vectors or spreaders of the virus. The reverse appears to be the case, where the young get infected by adults at home." (Health agencies such as the Centers for Disease Control and Prevention do note that even though children may often present with milder symptoms than adults, "There is much more to be learned about how the disease impacts children.")

Another thing that links Hong Kong, Singapore and South Korea is that they've all had bad coronavirus outbreaks in the past. Hong Kong and Singapore were hit hard by SARS in 2003, and South Korea came to a standstill during a MERS outbreak in 2015.

Their experiences with these past outbreaks may have made officials more aggressive in responding to COVID-19 and possibly made residents more willing to accept intrusive measures to contain the virus. South Korea has used data from surveillance cameras, cellphones and credit card transactions to map the social connections of suspected cases.

Hong Kong issues detailed information each evening about every newly confirmed case. While Hong Kong doesn't give out the names of those infected, health officials release each person's age, gender, street address, medical symptoms — and often the exact location of where the person works. This allows other residents to determine if they might have been in contact with the infected individual.

For instance, in late February the health department announced that a 55-year-old fry cook at a KFC restaurant on King's Road in the North Point neighborhood had tested positive. The department reassured residents that the heat of cooking oil probably kills the coronavirus and that patrons were not considered at risk of having contracted the virus. The fast-food branch, however, closed immediately and has remained shut. A sign on the door said the management was going to thoroughly clean the premises.

Another day in February, one of the newly diagnosed patients was a 75-year-old man living in Block 1, Seaview Garden in Tuen Mun. He first developed symptoms on Jan. 25, according to a statement released by the health department. Until he was isolated at Tuen Mun Hospital on Feb. 18, he had breakfast each morning at the Hoi Tin Garden Restaurant located at 5 Sam Shing Street, Tuen Mun — except for Feb. 15, when for some reason he didn't. The report details that his wife, age 83, tested positive the day before he did.

The health department also releases license plate numbers of taxi drivers who test positive and the flight numbers of infected travelers who recently arrived — again, so members of the public can determine if they might have had contact.

In Singapore, the police force works with the Ministry of Health to trace connections between cases and to track chains of transmission. Singapore also makes details of these infections public in the hope that other residents will come forward if they may have come in contact with a confirmed case.

The aggressive efforts by Hong Kong, Japan, Singapore and South Korea to investigate and isolate every possible infection is exactly what the World Health Organization has been calling for since January. The WHO's Maria Van Kerkhove acknowledged this week that for countries dealing with hundreds and even thousands of new cases every day, "finding every case" can be difficult.

"We hear you. This is overwhelming," Van Kerkhove said on Wednesday. "But it's really important for us to take the examples of all these countries, look at what they did as it relates to the epidemiology in their country and learn from them."

RT-PCR (reverse transcription polymerase chain reaction) is a testing method developed in Korea that uses DNA to quickly and accurately diagnose the novel coronavirus disease (COVID-19). The photo shows a test kit used in Korea. (Yonhap News)

A test kit for the novel coronavirus disease (COVID-19) developed in Korea has been exported to the United Arab Emirates (UAE). Cheong Wa Dae Spokesperson Kang Min-seok on March 17 said the UAE, which has a "special strategic partnership" with Korea, urgently requested the same day through a diplomatic channel the purchase of the kits. The request came after a phone call between President Moon Jae-in and UAE Crown Prince Mohammed bin Zayed Al Nahyan.

Last weekend, the Korean Ministry of Foreign Affairs contacted the kit's manufacturers and expedited the export of 51,000 units to the Mideast nation. "This is the first export of this test kit and part of international cooperation to combat COVID-19," the spokesperson said.

"Seventeen nations have asked for the test kits through government channels such as Korean government offices abroad and foreign government offices in Korea." He added, "Twenty-six countries have asked Korea to send protective goods including the test kits or dispatch health officials."

Aside from these urgent export requests, the test kit producers in Korea got direct calls about export from about 30 countries. The specific contracts will probably be made at the private level.

Meanwhile the United Kingdom has become the 7th country in the world to reject Chinese test kits for coronavirus. The UK has said that 3.5 million test kits brought from China are unreliable and dangerous.

Traces of the new coronavirus were found on virus test kits being shipped to the UK from China, adding to a growing list of concerns about the safety and reliability of medical supplies being sent abroad from China.

(Blogger's Notes: US and Australia's policy of locking down the whole society and isolating the whole healthy population instead of tracking and isolating every possible infection seems to be a absolutely stupid idea and also a very expensive one costing trillions of dollars. Especially in Australia when they thoughtlessly shut all pubs and clubs and gyms down they basically cripple the society.)