An analysis published by The New York Times this week takes a close look at South Korea’s successful efforts to “flatten the curve” of COVID-19 infections without shutting down the nation’s economy and presents four key lessons from the country’s response. The study concludes by addressing the question of whether South Korea’s response is transferrable to other countries, including the U.S.
The report, written by Max Fisher and Choe Sang-Hun, begins by highlighting just how successful in comparison to other countries South Korea’s response to coronavirus has been.
“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,” the journalists write. “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.”
So how has South Korea pulled it off so far? It was not through draconian or economy-crushing measures implemented by the likes of China and now an increasing number of countries across the globe, including the U.S.
The answer is four key measures: 1) rapid intervention before the pandemic is a full crisis; 2) implement widespread testing; 3) contact tracing and isolation; and 4) get the public to help.
The Times piece breaks down how South Korea implemented each of these measures, the first: “Intervene Fast, Before It’s a Crisis” (formatting adjusted):
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.
Officials also imposed strategically targeted emergency measures on a particularly hard-hit city, Daegu.
Early, frequent, safe and centralized testing is another key response measure:
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.”
The Times notes that South Korea opened up some 600 testing centers to minimize the burden on hospitals and clinics. Thermal image cameras were also widely used to help detect symptoms, with restaurants and other establishments often scanning customers.
A third step was tracing the contact of those who were infected and then isolating and surveilling those who were in contact with the infected persons. South Korea’s approach to this was heavily informed by the MERS outbreak, which taught the country to aggressively track contacts by “retrac[ing] patients’ movements using security camera footage, credit card records, even GPS data from their cars and cellphones.”
When the outbreak expanded too much to do this effectively, the Times explains, government officials turned to increased mass messaging via emergency alerts to residents when new cases were discovered in their districts. The government ordered self-quarantines for those who believed they might have had contact with infected individuals and fines for failure to do so were imposed.
Finally, South Korea also effectively enlisted the public’s help, the Times explains:
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 big question is how much of South Korea’s response is transferrable to other countries. For the U.S. some of the early detection and widespread testing is coming potentially too late to be as effective as South Korea’s response, a sentiment expressed by former FDA commissioner Scott Gottlieb in a ten-part Twitter thread on March 12 (below).
In an update on the testing situation on Wednesday, President Trump announced significant progress on that front. “Just reported that the United States has done far more ‘testing’ than any other nation, by far!” Trump tweeted. “In fact, over an eight day span, the United States now does more testing than what South Korea (which has been a very successful tester) does over an eight week span. Great job!”
Just reported that the United States has done far more “testing” than any other nation, by far! In fact, over an eight day span, the United States now does more testing than what South Korea (which has been a very successful tester) does over an eight week span. Great job!
— Donald J. Trump (@realDonaldTrump) March 25, 2020
Below is Gottlieb’s outline of how America should aggressively address the pandemic (formatting adjusted):
In U.S. we face two alternative but hard outlooks with [COVID-19]: that we follow a path similar to South Korea or one closer to Italy. We probably lost chance to have an outcome like South Korea. We must do everything to avert the tragic suffering being borne by Italy.
It starts with aggressive screening to get people diagnosed. While testing capacity expands its not evenly distributed to places most needed, we’re far behind current caseloads. To many people still can’t get screened. So we can’t identify clusters and isolate disease.
In some respects our fate rests on the entities that are capable of sharply ramping testing and distributing the services nationally. Academic labs can serve their institutions. Only big national clinical labs like LabCorp and Quest can fill the void. A lot rides on them now. These are great American companies led by outstanding management teams, staffed with deeply committed, public health mind people who live in communities hurt by this virus. The national interest turns on their efforts. We must scale their ability to sharply expand screening.
That means getting diagnostic kits approved that the companies can run on their automated platforms to dramatically scale testing. Only these big national chains have throughput, scale, and ordering systems to fill the void that was created. We look to them now. We need them.
Public health labs have been an outstanding pillar. They’re working around the clock. They’re the nation’s backbone of response. But they aren’t richly funded and are being maxed out against current facilities. Only clinical labs have ability to sharply scale the efforts.
Business is leading the way on mitigation and social distancing, filling a void left by policy makers. But shutting down NBA games is not enough. This must be practiced in places large and small. Small gatherings, parties, all should be postponed for the next month or two.
We need to create surge capacity in hospitals. Congress must support the effort. Patients and providers can too. Elective procedures should be postponed for next few months. Hospitals should lower volumes everywhere they can. We need to prepare for an influx of cases.
Social separation works. Every day we delay hard decisions, every day leaders don’t demand collective action, the depth of epidemic will be larger. We must act now. We have narrow window to avert a worse outcome. The virus is firmly rooted in our cities. We’re losing time.
We’ll get through this. It’ll end. We have two hard months ahead of us. We need to sacrifice some of the trappings of normal life to reduce the scope and severity of what’s ahead. We must protect the vulnerable. We must act collectively in common interest. We must work together.
This article has been updated to include President Trump’s tweet on testing.