South Korea reveals itself as the country that has best managed the Covid-19: this is everything that Spain and Italy have done differently
Some already call it the "Korean miracle". And, in recent days, among all the countries affected by the coronavirus outbreak, the case of South Korea stands out, which after accumulating days with more than a thousand new cases, has taken almost a week with significant drops in new patients.
In fact, the South Korean government itself says it has developed "a new model suitable for a pandemic in a globalized world" and many analysts agree that, being a democracy, its "methods" are much more exportable than the Chinese. So we have asked ourselves, what has the Korean outbreak been like? What have been your key measures? What can we learn from Europe?
South Korea against coronavirus
Between January 20 and February 17, South Korea detected 30 cases of coronavirus. Only three of those cases had no direct connection to any uncontrolled community contagion zone or to someone who had been in them. The epidemic, according to the protocols of the World Health Organization, was controlled. However, patient number 31 changed everything.
When doctors started asking about close contacts in the past few days, they discovered that he was a member of Shincheonji, a South Korean Christian religious movement, and that he had attended several meetings of the sect with symptoms. From this moment on, the South Korean authorities begin a double strategy to understand the origin and structure of the outbreak and understand the dimension that it had already reached.
The heart of the outbreak: the Shincheonji sect
The Shincheonji cult is organized in “megachurches” with thousands of faithful and its celebrations usually include close physical contact. In other words, on paper, the risk of spreading was high; the realdiad quickly confirmed it. On the 19th, there were already 20 new cases, and on the 20th, they numbered 70. And, according to the Korean health authority, all linked to the members of Shincheonji.
On the same day, 20, Daegu (where the first cases were concentrated) asked its 2.5 million inhabitants not to go outside, and a day later, the authorities declared that city and Cheongdo "special zones". All the military bases in the country were closed and an economic shock plan was approved. And more than 9,000 Shincheonji are placed in strict quarantine. In addition, cultural events were canceled, concerts were postponed, and internal flights were reduced.
As of January 22, 1,261 of the 9,000 quarantined people had already shown symptoms. At that time, 169 confirmed cases were related to the church and another 111 came from Cheongdo Hospital, where the sect had held a massive funeral ceremony. The evolution seemed clear: of the 123 new cases on February 23, 75 were from Shincheonji and 129 of the 161 cases from 24. The rest could connect with members of the church.
The Government, in addition to delaying the start of the semester by one week in kindergartens, colleges, institutes and universities, set its efforts to control the church and the possible side effects. However, Shincheonji already had a somewhat conflicting history of secrecy and sectarian practices.
Faced with Shincheonji's lack of collaboration, the police entered his main temple in Gwacheon and health authorities launched an extensive program to locate and examine the 245,000 members of the sect. Meanwhile, the health authorities started a very aggressive policy to find possible risk cases.
The massive tests and the shadow of the MERS
There is another thing that draws attention when we start to investigate the Korean case, the enormous amount of laboratory tests that have been carried out on its population. Discounting China, which has done more than 300,000 tests for obvious reasons, Korea and its 189,236 are well above countries such as Italy (49,937), Spain (17,500) or the United Kingdom (23,500). 3,600 tests for every million inhabitants compared to 800 Italians and 350-400 in the countries that follow in the ranking.
This has involved the Korean comparative advantage that for years has had some of the largest PCR test manufacturing companies in its national territory and has the capacity to do more than 12,000 tests a day (20,000 if necessary); but also, as experts point out, the shadow of the 2015 MERS outbreak that has motivated the authorities to deploy an aggressive and very transparent policy.
On May 20, 2015, Korea detected an outbreak of 'Middle East Respiratory Syndrome', a disease caused by another coronavirus that had already caused outbreaks in the Arabian Peninsula a few years earlier. In the following days and while the outbreak grew, the Ministry of Health kept the information private, even knowing that one of the infected had been in a meeting with 1,565 people. He didn't even contact them to see how they were doing. When it came to light and the participants were identified, 64 were infected and 5 had died.
That raised a huge social dust and has had a striking effect on how to deal with the coronavirus epidemic. The great obsession of the Korean government during these weeks has been to locate possible cases and isolate them to stop the expansion. They have used temporary facilities to carry out tests, they have used GPS positioning to trace possible contacts and they have subjected travelers to continuous controls (using the app to update symptoms).
To get an idea, officials used interviews with sect members, credit card excerpts, and images from security cameras to piece together each patient's steps and search for people exposed to risky contacts. They became very precise looking for people who, by way of example, would have been “in the hot springs of Yeongju city at 17:30 on February 17, or in a private yoga class in Andong after 14 on 18 ”.
The keys to the Korean model
As we said, the Korean government is clear that the most important element is the ability to diagnose the virus quickly and accurately. In his own words, "we believe that we have created a new model suitable for a pandemic in a globalized world" based on transparency and the provision of updated and accurate information. This has allowed "instead of erecting and imposing physical and legal barriers" it was "social barriers that created social distancing."
However, it seems risky to ensure that this approach is a "new model". Analyzing the evolution of the outbreak in detail, we can see that it was strongly focused on a relatively socially isolated community (62.8% of all cases are members of Shincheonji and it is estimated that more than 85% are directly related to them). This, on the one hand, makes the "social distancing" relatively simple, which prevents the virus from leaving that community; although it subjects this population to problems that we must not forget either (for example, 750,000 signatures were gathered to make the church in question illegal).
On the other, it calls into question the actual effectiveness of mass testing. After all, of the 189,236 tests carried out, only 7,755 cases tested positive (almost all linked to the focus in question). No one is very clear how this approach would have worked if the outbreak had been multifocal and if the follow-up measures taken could have been taken in such a scenario. In any case, when the crisis is over, we can assess the usefulness of this approach in identifying ramifications of the epidemic that would not have been identified with traditional methods. It is, in any case, a very interesting case study.
Spain vs South Korea
Given the Korean case, it is interesting to study the differences with the Spanish (and Italian) case. The first, obviously, is the nature of focus. From an epidemiological point of view, it is always preferable to have a large well-controlled outbreak than a small uncontrolled one. On this point, we have little room for maneuver, and yet it is a key factor. When we review the Korean measures we see that on a social level, they were few. Except for the members of Shincheonji and the rest of the infected, the only two measures were to delay the start of classes by one week and to do tests in a massive way.
Evidently, the health authorities made recommendations (such as those of Daegu on February 20 and general recommendations of a sanitary type) and called for a "war" against the virus; However, as the Korean Government itself acknowledges, except in the most affected areas, the life of the country has continued with great normality. It is also true that the MERS controversy was still fresh in the country's collective memory and this may have conditioned a more proactive social reaction.
Beyond the level of "aggressiveness" in the measures, the most striking difference with the Spanish case is the lack of massive tests and precisely this has been a controversial issue in recent days, the secrecy around the number of tests carried out. Once the number was made public, it was confirmed that far fewer had been made than in Italy; however, most of the Italian tests were carried out in the first days and then were reduced with the intention of better managing the social consequences of the outbreak (and lightening the overcrowding of health centers). Thus, it is not easy to discern whether our lack of tests is due to a supply problem or a decision of the health authorities.
Image | Saveliy Bobov