How Did South Korea Manage COVID-19 Cases?

South Korea is often cited as an international example in controlling the spread of coronavirus.

In the recent issue of the Journal of American Medical Association (Vol: 323, No: 21, page 2129, June 2, 2020),  the authors explained how South Korea managed to trace, track, contain the coronavirus epidemic. The methodology and outcome were so much different than how it was handled in the United States, that I thought of sharing this medical journal article  with you.

The authors state that the first case of COVID-19 was detected in South Korea on January 20, 2020. As of April 20th, there were 10,683 confirmed cases, 2,233 people were quarantined or hospitalized, and 237 deaths.  According to the press accounts, the first USA confirmed case in the USA was on January 20th.The confirmed cases, and deaths as of April 20th were 749,203 and 35,793, respectively. On the per capita basis, South Korea had 2 deaths per 10 million population, vs. U.S. A’s 50 deaths per 10 million population. This graph shows the differences more clearly. 

There is no question, that the two countries; although being democracies and being technologically advanced, are vastly different in their size, socioeconomic and cultural diversity, laws and population. The population of South Korea is 51 million whereas that of the USA is 331 million.

Notwithstanding these differences, it is useful to learn how South Korea managed to keep their numbers low without lockdowns, closing businesses, schools, offices, travel, and its national borders.

The authors state (insert link # 1) that South Korea had developed a national to deal with future highly infectious epidemics in 2015. This was done in response to the Middle East Respiratory Syndrome (MERS) pandemic.

South Korea has strong personal information and privacy protection laws. One of such law, the Personal information Protection Act (PIPA), was enacted in 2011. At the outset of the current epidemic, the Korean legislature modified the PIPA and the Contagious Disease Prevention and Control Act (CDPCA) to allow the Ministry of Health and the Korean CDC (KCDC) to override certain provisions of PIPA to collect personal data and profiles at the outset of infectious epidemics which were deemed national public health threats.

The data included location (from mobile devices), personal identification information, medical and prescription records, health insurance data, credit/debit card transaction data, transit pass and public transportation data and closed-circuit TV (CCTV) footage.

According to the authors, this plan, which was developed after the 2015 MERS epidemic, was on the books and ready to be implemented. In March 2020, when the coronavirus infection became a public health issue, the updated and revised Contagious Disease Prevention and Control Act (CDPCA) was immediately implemented. The data was collected and organized it into 7 categories. This information was then passed on to the KCDC and Ministry of Health and Welfare (MOH). The police was however only given the “location” data. The KCDC and MOH then passed this on to the Health Insurance systems, central government, healthcare professionals and associations, municipal and local governments and eventually to the public. The graph in the journal article is illustrative.  

Furthermore, the Korean Government developed a customized App as a part of the strategy to deal with the infectious disease epidemic. The quarantined individuals were required to self-report their health status using this App. Other IT-based strategies were also implemented nationwide for containment, contact tracing, statistical and epidemiological modeling.

Based on the mandate and the authority, the KCDC launched the nationwide tracing and surveillance program in early March 2020. The regulations required the Ministry of Health to promptly make publicly available on the internet or through press release, the following information:

•          the path and means of transportation of infected persons,
•          the medical institutions that treated them,
•          the health status of those who came in contact with them,
•          their sex, age and nationality.

Names were withheld.

As expected, there was public criticism regarding the potential loss of personal privacy. Because of such concerns and the recommendations from Korea’s National Human Rights Commission, the KCDC modified the guidelines on March 14, 2020. Authorities were advised to limit the scope of information and details that could be given out publicly. Going forward, the Korean Government agreed to refine the laws and regulations and use aggregated data rather than individual-level data to deter misuse of information.

 The authorities however, touted the benefits of individual and site-specific information. One such example given was the ability to quickly identify locations visited by infected persons. Once known, these establishments could be disinfected quickly without much publicity and without negative impact on such establishments, the authorities said.

With all the pros and cons, the people of Korea were able to keep schools open, and reduce the number of deaths and keep the economy humming,. According to a report in the New York Times (6/6/2020) the Korean economy is expected to shrink by 1.2% this year compared to the US economy that may shrink by 5.9%.

I hope that authorities in the United States also develop strategies to control future contagious disease epidemics, that are effective, timely, suitable, and acceptable to the diverse US population.

As we say, we are all in this together.