The Country That Learned To Live With Covid-19
Bloomberg Businessweek|December 14, 2020
As other nations locked down or let the coronavirus run rampant, South Korea found a middle way—and a road map for future pandemics
Matthew Campbell and Heesu Lee

Park Young Joon was worried that South Korea could lose control. As director for epidemiological investigations at the Korea Disease Control and Prevention Agency, he’d been dispatched to Daegu, a city of 2.5 million in the south, to deal with an urgent situation. A rash of novel coronavirus cases had just emerged among members of the Shincheonji Church of Jesus, an obscure and secretive religious group whose services involve close physical contact. The first congregant tested positive on Feb. 17, becoming South Korea’s 31st Covid-19 patient. Soon the number of new daily cases was in double digits, then triple—evidence that an exponential outbreak was in progress. “I remember seeing the triple-digit cases,” Park says, speaking through a translator, “and thinking to myself that this must be what people mean when they use the word ‘surge.’ ”

In the early days of the outbreak, public-health officials treated each case more or less individually, with contact tracers compiling detailed histories of a patient’s recent whereabouts and screening others accordingly. But many of the churchgoers and family members who were testing positive had no obvious link with earlier cases. The virus was spreading along paths Park and his team at the KDCA couldn’t see.

The only way to stop it, he thought, was something drastic: quarantining everyone who’d set foot in the nine-story building that housed Shincheonji’s Daegu operations. The measure would be mandatory, covering about 9,000 people, regardless of where they’d been in the building or whether they’d interacted with a known carrier. Anyone who subsequently tested positive would have their contacts screened; then those people would have their own contacts screened, and so on until the chain stopped.

It was a sharp, costly escalation in strategy—and, it turned out, a highly effective one. The quarantine effort was under way within four days of the first Shincheonji diagnosis, and by mid-March the Daegu outbreak was under control. The response established the template for one of the world’s most impressive efforts to contain Covid. For most of the past 10 months, South Korea has managed to keep infections within a manageable band of several hundred or fewer new cases a day, never quite vanquishing the virus but never allowing it to thrive beyond the authorities’ ability to cope.

On at least three occasions, the country has contained dangerously fast-moving outbreaks by deploying aggressive testing, high-tech contact tracing, and mandatory isolation. It’s done so without a single day of lockdown, a strategy its government, led by President Moon Jae-in, rejected early on as too costly to citizens’ livelihoods and social bonds. Indeed, in September the Organization for Economic Cooperation and Development projected that the Korean economy will contract by only 1% in 2020, compared with an average decline of 4.1% across the Group of 20 nations. Unemployment is about 4%, higher than before the virus but far below the levels in other major economies.

Much of Asia has performed well during the pandemic. Yet it’s arguably South Korea that provides the most compelling example for nations struggling to limit death and disablement in the months before widespread vaccination—a period that U.S. President-elect Joe Biden warned could see more than 250,000 American fatalities. South Korea isn’t small: With a population of 52 million, it’s about three-fourths the size of the U.K., and Seoul is both larger and denser than London. It isn’t authoritarian, featuring arguably the most vibrant democracy in Asia and a diverse political landscape that includes religious groups that resist public-health measures. And unlike China, New Zealand, and other members of the pandemic premier league, it hasn’t pursued a strategy of outright viral elimination, a goal that would now be impracticable in most of the world.

South Korea’s response hasn’t been perfect. The country has lost more than 500 people to Covid, representing a relatively high fatality rate by Asian standards. New outbreaks, even if relatively small, remain a constant threat. The authorities are currently battling a tenacious wave of infections centered in Seoul, the worst flare-up since February. And daily life isn’t normal: Social distancing measures of varying intensity are in place throughout the country, and masks are required in virtually every public space. Restaurants, cafes, and even nightclubs and gyms have stayed mostly open, but capacity is often limited, and patrons must scan a QR code linked to a national contact-tracing system before entering. Schools have gone partially digital to give students room to space out, imposing an additional burden on mothers in what’s already a deeply unequal society for working women.

It’s hard not to be impressed, all the same, by the way Korea’s government and people confronted a choice the citizens of Western countries were frequently told was unavoidable—between economy-shattering lockdowns and appalling viral casualties—and resolved to accept neither option. The country decided instead to deploy all the resources it could in the service of a simple goal: to keep society functioning. And for the most part, it’s worked.

The strategy has depended upon a degree of vigilance that can seem excessive until you consider the horrific costs of, say, the American approach. For most of this year, Park has been sleeping in a dormitory at the KDCA’s headquarters, some 60 miles south of Seoul. He works about 16 hours a day, six days a week, slipping into the capital to see his family only on the occasional Sunday. His life has been anything but balanced, but he says it’s been worth it. He and his colleagues have helped Korea find an equilibrium, one Park argues it can sustain until the pandemic ends. “We call it long-term suppression—maintaining our society while suppressing the virus,” he says. “The basic concept we are working with is living with Covid-19.”

Five years ago, South Korea learned the hard way that it wasn’t ready for a novel viral outbreak. In May 2015 a 68-year-old Korean man who ran a greenhouse business in Bahrain became ill after returning to Seoul. When his symptoms didn’t improve, he was admitted to a hospital outside the city, where doctors diagnosed pneumonia. Five days later, after he’d been transferred to a more sophisticated medical center, a test confirmed that he was Korea’s first carrier of Middle East respiratory syndrome, an often-fatal viral disease that’s related to both severe acute respiratory syndrome and Covid.

By then the MERS virus, which first emerged in Saudi Arabia in 2012, was on the move. Dozens of people had been exposed at the first hospital where the returning traveler was treated. The pathogen then took hold at the second hospital, after a man exposed in the earlier outbreak visited its emergency room, coughing severely. Eighty-two people were infected as a result. Such nosocomial infections—spread in medical facilities—are one of the worst-case scenarios in public health, not least because hospitals are by definition full of people who are already sick and therefore vulnerable. Testing delays also gave the virus more time to spread, and officials inflamed public anxieties by declining to disclose where MERS patients were being treated. Thirty-eight people ultimately died.

The government, led at the time by conservative President Park Geun-hye, was determined not to repeat the experience, and initiated a series of public-health reforms. The KDCA, historically a health ministry department with little real autonomy, became the coordinating body for outbreak response—a “control tower” for other agencies and local administrations. An emergency process for approving new diagnostic tests was also created, shortening the time required from a year to a week or less. And the country’s main public-health law was amended to allow contact tracers to scrape data from cellphones, credit card and public- transit records, and other sources “if necessary to prevent infectious diseases and block the spread of infection.” The law required that the information be used only for public-health purposes and that it be destroyed when the danger passed.

The earliest phase of the coronavirus pandemic seemed to validate the new policies. Korea reported its first Covid case on Jan. 20, the same day as the U.S. A week later the KDCA interrupted the Lunar New Year holiday to summon executives from a range of health-care companies to Seoul, where the agency shared a testing method it had developed for the new virus and urged them to start producing kits based on the same protocol. The first was approved for use on Feb. 4.

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