Emerging COVID-19 success story: South Korea learned the lessons of MERS

South Korea is one country which has responded well to the Coronavirus pandemic. How did they do so? In-country experts provide key insights.

05 March 2021

This is a guest post by June-ho Kim (I), Julia Ah-Reum AN (i), Seungju Jackie OH (I), Juhwan OH (II) and Jong-Koo Lee (II) as part of the Paradigm in Global Health Platform (see Institutional Partnerships 1).

Notice

This article was published early in the Covid-19 pandemic based on the latest publicly available data at the time.

It is currently based on data on confirmed cases and deaths published by WHO. You can find the latest data for all countries in the Coronavirus Data Explorer.

Read the previous version of this article published 30 June 2020.

A previous version of this article covered the Covid-19 pandemic in South Korea from January to June 2020.

Introduction

The South Korean response to Covid-19 has been impressive. Drawing on its experience responding to the Myers Sachs Respiratory Syndrome (MERS), South Korea was able to quickly contain the outbreak by the end of 2020 without having to close businesses, impose stay-at-home orders, or implement many of the strict measures adopted by other high-income countries. They rewarded this success by formulating clear guidelines for the public, implementing comprehensive testing and contact tracing, and helping those in quarantine to comply. South Korea successfully managed outbreaks that arose in March and August, and gradually controlled a larger, more dispersed outbreak in December 2020. South Korea has been successful in three phases of its epidemic preparedness and response framework: detection, containment, and treatment.

• Detection South Korea has established innovative, high-capacity screening facilities and worked closely with the private sector to ensure sufficient test supplies from the early days of the pandemic. South Korea has approximately 600 screening and 150 diagnostic testing centers, with a capacity of 110, 000 tests by November 2020.
• These include:
• Improved compliance by isolating infected Korean patients and supporting them in quarantine, and detecting contacts with unusual thoroughness. Hundreds of epidemiological intelligence officers were deployed to these detection efforts and were authorized to use a variety of data sources, including credit card transactions and closed-circuit television broadcasts.

Countermeasures: Especially in Daegu, which caused larg e-scale collective infections in March 2020, the medical system increased to respond to demand. We hired additional healthcare professionals in Daegu alone. Nationwide, the government reorganized the hospital system, established a temporary hospital to improve accommodation, and dealt with the shortage of personal protective equipment (PPE) through government intensive purchases.

Context

Country Overview

South Korea's strong environment was positioned for the Korean government to act quickly and effectively. After the response to MERS in 2015 was incomplete, the government carried out 48 reforms to strengthen and strengthen public health. In addition, sufficient national health insurance system, abundant human resources and infrastructure, the Presidential Office, the Ministry of Health, the Ministry of Education, the Ministry of Education, the Korean Disease Control Prevention Center (Pandemic During the Pandemic South Korean Disease Management Prevention Institute (KDCA) (KDCA) Construction relationships between major organizations such as (renamed) also enabled extremely compelling response to pandemic.

Since the 1960s, South Korea's economic growth has been remarkable, and now has been ranked 12th in the world. South Korea introduced social health insurance in the 1970s, achieved the universal insurance system in 1989, and moved to a single burden system in 2004.

The Korean medical system focuses on hospital medical care. The number of beds per 1, 000 population is 12, 3 beds, twice the average of the members of the Economic C o-operation and Development (OECD) member. South Korea is excellent not only in hospital capacity but also for interaction with doctors, and 16, 6 examinations per year are connected to OECD member countries. 5. There are criticisms that Korea's medical system depends on secondary and tertiary facilities rather than primary facilities, but thanks to such surplus abilities, hospitals take care of patients other than COVID-19. 6 is able to respond quickly to COVID-19 without sacrifice. < SPAN> Countermeasures: Especially in Daegu, which caused larg e-scale collective infections in March 2020, the medical system increased to respond to demand. We hired additional healthcare professionals in Daegu alone. Nationwide, the government reorganized the hospital system, established a temporary hospital to improve accommodation, and dealt with the shortage of personal protective equipment (PPE) through government intensive purchases.

South Korea's strong environment was positioned for the Korean government to act quickly and effectively. After the response to MERS in 2015 was incomplete, the government carried out 48 reforms to strengthen and strengthen public health. In addition, sufficient national health insurance system, abundant human resources and infrastructure, the Presidential Office, the Ministry of Health, the Ministry of Education, the Ministry of Education, the Korean Disease Control Prevention Center (Pandemic During the Pandemic South Korean Disease Management Prevention Institute (KDCA) (KDCA) Construction relationships between major organizations such as (renamed) also enabled extremely compelling response to pandemic.

Since the 1960s, South Korea's economic growth has been remarkable, and now has been ranked 12th in the world. South Korea introduced social health insurance in the 1970s, achieved the universal insurance system in 1989, and moved to a single burden system in 2004.

Outbreak Timeline

The Korean medical system focuses on hospital medical care. The number of beds per 1, 000 population is 12, 3 beds, twice the average of the members of the Economic C o-operation and Development (OECD) member. South Korea is excellent not only in hospital capacity but also for interaction with doctors, and 16, 6 examinations per year are connected to OECD member countries. 5. There are criticisms that Korea's medical system depends on secondary and tertiary facilities rather than primary facilities, but thanks to such surplus abilities, hospitals take care of patients other than COVID-19. 6 is able to respond quickly to COVID-19 without sacrifice. Countermeasures: Especially in Daegu, which caused larg e-scale collective infections in March 2020, the medical system increased to respond to demand. We hired additional healthcare professionals in Daegu alone. Nationwide, the government reorganized the hospital system, established a temporary hospital to improve accommodation, and dealt with the shortage of personal protective equipment (PPE) through government intensive purchases.

South Korea's strong environment was positioned for the Korean government to act quickly and effectively. After the response to MERS in 2015 was incomplete, the government carried out 48 reforms to strengthen and strengthen public health. In addition, sufficient national health insurance system, abundant human resources and infrastructure, the Presidential Office, the Ministry of Health, the Ministry of Education, the Ministry of Education, the Korean Disease Control Prevention Center (Pandemic During the Pandemic South Korean Disease Management Prevention Institute (KDCA) (KDCA) Construction relationships between major organizations such as (renamed) also enabled extremely compelling response to pandemic.

Since the 1960s, South Korea's economic growth has been remarkable, and now has been ranked 12th in the world. South Korea introduced social health insurance in the 1970s, achieved the universal insurance system in 1989, and moved to a single burden system in 2004.

The Korean medical system focuses on hospital medical care. The number of beds per 1, 000 population is 12, 3 beds, twice the average of the members of the Economic C o-operation and Development (OECD) member. South Korea is excellent not only in hospital capacity but also for interaction with doctors, and 16, 6 examinations per year are connected to OECD member countries. 5. There are criticisms that Korea's medical system depends on secondary and tertiary facilities rather than primary facilities, but thanks to such surplus abilities, hospitals take care of patients other than COVID-19. 6 is able to respond quickly to COVID-19 without sacrifice.

Despite its powerful medical system, South Korea struggled to deal with MERS in 2015. Six months after the outbreak, the Koreans lived in fear, and the government lost nearly $ 2. 6 billion from the tourism revenue, and spent nearly $ 1 billion in diagnosis, treatment, and other response. 6

After the MERS, the country in total, including increasing the number of infection management staff and isolation units, expanding trendy simulation, training in PMU, and collaboration between medical centers and local governments in order to improve pandemic preparation and response. Reforms were implemented. When the 7 COVID-19 occurred, the painful memories of MERS encouraged the government's early and aggressive response. For example, wearing masks in public places, which was already common for air pollution, became social norms in the early pandemic. According to the 8 Public Opinion Polls, when the COVID-19 trends, more people were complying with public preventive protocols than MERS's outfit.

Click to open the interactive version

South Korea is one of the first countries where the COVID-19 first occurred, and on January 20, 2020, the first patient imported from China in China was reported (see Figure 1). The government launched the Central Disaster Countermeasures and Security Headquarters within a few days, and since then, have held meetings every day, and the Prime Minister has attended at least three times a week. 9

For one month after the occurrence, the number of infected people was identified from 0 to 2 per day, but on February 19, 15 infected people were confirmed in Daegu, a city with a population of about 2. 5 million. Starting with the cluster, a cluster was confirmed. This cluster was due to a person called a patient 31 who traveled in Daegu City (including Shinka Jesus Church) and Seoul City before the diagnosis. Has reached the peak of 909 people.

Detect

After the peak, the number of new infected people decreased rapidly over two weeks, and on March 12, the number of infected people per day fell below 200. Since then, the number of infected people per day decreased steadily, almost zero, but in mi d-May it began to resume, so it recovered slightly (about 30 cases per day). 11

COVID-19 years: New number of new infected people per day (average for 7 days) (see the interactive version) < SPAN> South Korea is appropriate for MERS that occurred in 2015 I struggled to deal with it. Six months after the outbreak, the Koreans lived in fear, and the government lost nearly $ 2. 6 billion from the tourism revenue, and spent nearly $ 1 billion in diagnosis, treatment, and other response. 6

After the MERS, the country in total, including increasing the number of infection management staff and isolation units, expanding trendy simulation, training in PMU, and collaboration between medical centers and local governments in order to improve pandemic preparation and response. Reforms were implemented. When the 7 COVID-19 occurred, the painful memories of MERS encouraged the government's early and aggressive response. For example, wearing masks in public places, which was already common for air pollution, became social norms in the early pandemic. According to the 8 Public Opinion Polls, when the COVID-19 trends, more people were complying with public preventive protocols than MERS's outfit.

Click to open the interactive version

South Korea is one of the first countries where the COVID-19 first occurred, and on January 20, 2020, the first patient imported from China in China was reported (see Figure 1). The government launched the Central Disaster Countermeasures and Security Headquarters within a few days, and since then, have held meetings every day, and the Prime Minister has attended at least three times a week. 9

Since the 1960s, South Korea's economic growth has been remarkable, and now has been ranked 12th in the world. South Korea introduced social health insurance in the 1970s, achieved the universal insurance system in 1989, and moved to a single burden system in 2004.

Contain

Travel Restrictions

After this peak, the number of new infected people decreased rapidly over two weeks, and on March 12, the number of infected people per day fell below 200. Since then, the number of infected people per day decreased steadily, almost zero, but in mi d-May, the government began to resume, so it recovered slightly (about 30 cases per day). 11

COVID-19 years: Number of new infected people per day (average for 7 days) (see the interactive version) Despite the powerful medical system, Korea is struggling with the appropriate response to MERS that occurred in 2015 did. Six months after the outbreak, the Koreans lived in fear, and the government lost nearly $ 2. 6 billion from the tourism revenue, and spent nearly $ 1 billion in diagnosis, treatment, and other response. 6

Isolation and Quarantine

After the MERS, the country in total, including increasing the number of infection management staff and isolation units, expanding trendy simulation, training in PMU, and collaboration between medical centers and local governments in order to improve pandemic preparation and response. Reforms were implemented. When the 7 COVID-19 occurred, the painful memories of MERS encouraged the government's early and aggressive response. For example, wearing masks in public places, which was already common for air pollution, became social norms in the early pandemic. According to the 8 Public Opinion Polls, when the COVID-19 trends, more people were complying with public preventive protocols than MERS's outfit.

Click to open the interactive version

South Korea is one of the first countries where the COVID-19 occurred, and the first patient imported from Chinese Wuhan on January 20, 2020 (see Figure 1). The government launched the Central Disaster Countermeasures and Security Headquarters within a few days, and since then, have held meetings every day, and the Prime Minister has attended at least three times a week. 9

For one month after the occurrence, the number of infected people was identified from 0 to 2 per day, but on February 19, 15 infected people were confirmed in Daegu, a city with a population of about 2. 5 million. Starting with the cluster, a cluster was confirmed. This cluster was due to a person called a patient 31 who traveled in Daegu City (including Shinka Jesus Church) and Seoul City before the diagnosis. Has reached the peak of 909 people.

After the peak, the number of new infected people decreased rapidly over two weeks, and on March 12, the number of infected people per day fell below 200. Since then, the number of infected people per day decreased steadily, almost zero, but in mi d-May it began to resume, so it recovered slightly (about 30 cases per day). 11

COVID-19 years: Number of new infected people per day (average for 7 days) (see interactive version)

Contact Tracing

On May 6, national mandates regarding social withdrawal were relaxed and soft guidelines were adopted. Schools began face-to-face classes relatively early, on May 20. By June, only 20 states had reopened schools, and four states had never closed schools. 12 The return to face-to-face classes in South Korea was staggered by grade and completed by June 8, 2020. 13 A study conducted in the summer found that school reopenings had limited impact on the outbreak of new disease clusters. 14 For six months from September 2020, schools were given greater autonomy over opening procedures, capacity restrictions were lightened, and guidelines were set by the Ministry of Education depending on the level of social withdrawal. 12 Throughout the school closure and reopening process, government support for childcare, internet, and technology was provided to families in need. South Korea's Spring School Reopening Plan 15

The number of infections continued to rise in mid-August, reaching an average of 343 and 9 cases on August 28. In response, the city of Seoul reinstated Level 2 (out of three) restrictions, limiting indoor gatherings to 50 people and outdoor gatherings to 100 people. It also collected the names of about 4, 000 church members and tested about half of them, but was unable to trace their contacts. 16 Level 2 restrictions were reinstated on August 23, and by September 20, the number of daily infections had fallen below 100.

In September 2020, the Korea CDC, which had previously been under the Ministry of Health and Welfare, was transferred to an autonomous agency called the Korea Disease Control and Prevention Agency (KDCA), and its personnel were increased. The KDCA publishes daily reports that identify not only the raw numbers (cases, deaths, and patients with high severity, etc.) but also the remaining capacity of the health system, such as locations and cases from different clusters and the number of intensive care unit beds. 9

In mid-November, when South Korea's third pandemic began, the number of daily patients hovered around 100 and peaked at over 1, 000, but declined in January 2021. 11.

• The KDCA had received virus samples from China and had begun developing diagnostic tools even before the first case was confirmed in South Korea. Once the first case was reported, South Korea began to focus on preparing for large-scale testing. In the years between MERS and COVID-19, several biotechnology companies emerged17, enabling public-private partnerships and the development of scale-up testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19.
• On January 27, 2020, one week after the first COVID-19 patient in South Korea, the KDCA mandated private companies to manufacture diagnostic reagents. 18 Within two weeks of the first outbreak, thousands of test kits were shipped daily, and the number reached 100. 000 kits per day in March. 19 By April 24, 118 institutions were able to perform an average of 15. 000 tests (up to 20, 000). The number of institutions conducting tests continued to gradually increase, reaching 146 in August. 9 Testing capacity then increased by 600%, reaching 110. 000 tests per day in November 2020.
• After the expansion of testing capacity, the focus shifted to testing. For example, COVID-19 screening clinics were set up outside the entrance to prevent infected people from entering the hospital. Those flagged based on symptoms or answers to screening questions were tested and told to go home and isolate while waiting for the results, and those deemed low risk were given daily admission cards. Screening stations were set up in several strategic locations, including Incheon International Airport. By September 22, 599 checkpoints had been set up, including 48 transit centers. To encourage full testing in migrant worker communities, where many groups exist, the government announced that it would no longer require health care workers to report known irregular migrants. 9
• When cases surged in Daegu in February 2020, health authorities used innovative approaches to open 600 outreach centers and increase capacity. 18 For example, infection testing centers collected three times as many samples as before while eliminating the need for negative pressure rooms to prevent contaminated air from leaking into uncontaminated areas. 20 Meanwhile, phone booth stations allowed health workers to assess and test individuals without direct contact. At first, health workers stood outside negative pressure stands wearing PPE. Eventually, they moved to positive pressure stands, which minimized the need for PPE and prevented fatigue. 21 By the end of March, more than 300, 000 tests had been performed in the United States.

The positivity rate was below 2% after March 15 and below 1% from April 6 to August 15. During the second spike in August, the positivity rate peaked at 2. 5%, and during the December spike it reached 3. 3%. 11

Click to open interactive version

In late January 2020, South Korea introduced a special entry procedure for travelers from Wuhan. This procedure initially included a set entry line and questionnaire, but was later expanded to temperature checks, testing of all travelers at the border, and a mandatory quarantine monitored for 14 days. (Travelers who have not been in South Korea will be provided with facilities for self-screening, but will be at their own expense.) This quarantine policy does not restrict entry and is in line with WHO recommendations.

As the number of cases increased globally during the summer and fall of 2020, South Korea tightened travel restrictions and made visas required for almost all foreigners from October 2020. Visas and visa-exempt countries are suspended, with some exceptions (e. g., flight attendants). Visa applicants are required to submit health documentation and show asymptomatic certificates from medical professionals. Overall, Korean tourists dropped 81% year-on-year. 9

For the first few months of Pandemic, the South Korean government has changed public facilities and recreation areas owned by private companies to a temporary isolation area. This was to take care of COVID-19 patients while preventing infection at home and to eliminate hospital shortages. Medical workers regularly monitored and isolated clinically stable patients who do not require treatment in hospitals. 8

Social Distancing

In Daegu, where the first cluster occurred, 15 regional treatment centers, including dormitories of private companies such as Samsung and LG, accepted 3, 033 people between March 3rd and 26, 2020. Medical experts monitored the center, and patients regularly reported their symptoms on smartphone apps and telephones. The facility had a pulse oximeter, X-ray device, and RT-PCR tests for SARS-COV-2. Of the 3, 033 cases, only 81 were transported to hospitals for more advanced treatment. twenty two

South Korea's quarantine policy is strict, but cooperative. Those who contact the patient who have been identified, traveled abroad, or suspected of infection need to be confident. The isolated person is required to use the sel f-awareness protection app for 14 days. Case workers monitor apps that include position tracking to determine when to release isolation. Violators are required to wear an electronic wristband called a "seat belt", linking to the app staff, and has a special warning if they are not in the same place as the mobile terminal. The fine for violating sel f-questions is expensive as US $ 8. 217.

At the same time, case workers provide support for smooth quarantine. We check for sel f-nominations twice a day, deliver food and basin tools, and provide video streaming services for psychological counseling and entertainment. 8

South Korea focused on mental health during the pandemic, establishing hotels and registrations for people who were isolated as of January, and maintaining a national psychological support team. twenty four

Treat

Examples of contact tools by a private company in South Korea 25 < SPAN> The Korean government has changed public facilities and recreation centers owned by private companies to a temporary isolation area. This was to take care of COVID-19 patients while preventing infection at home and to eliminate hospital shortages. Medical workers regularly monitored and isolated clinically stable patients who do not require treatment in hospitals. 8

In Daegu, where the first cluster occurred, 15 regional treatment centers, including dormitories of private companies such as Samsung and LG, accepted 3, 033 people between March 3rd and 26, 2020. Medical experts monitored the center, and patients regularly reported their symptoms on smartphone apps and telephones. The facility had a pulse oximeter, X-ray device, and RT-PCR tests for SARS-COV-2. Of the 3, 033 cases, only 81 were transported to hospitals for more advanced treatment. twenty two

South Korea's quarantine policy is strict, but cooperative. Those who contact the patient who have been identified, traveled abroad, or suspected of infection need to be confident. The isolated person is required to use the sel f-awareness protection app for 14 days. Case workers monitor apps that include position tracking to determine when to release isolation. Violators are required to wear an electronic wristband called a "seat belt", linking to the app staff, and has a special warning if they are not in the same place as the mobile terminal. The fine for violating sel f-questions is expensive as US $ 8. 217.

At the same time, case workers provide support for smooth quarantine. We check for sel f-nominations twice a day, deliver food and basin tools, and provide video streaming services for psychological counseling and entertainment. 8

South Korea focused on mental health during the pandemic, establishing hotels and registrations for people who were isolated as of January, and maintaining a national psychological support team. twenty four

Example of a contact tool by a private company in South Korea. This was to take care of COVID-19 patients while preventing infection at home and to eliminate hospital shortages. Medical workers regularly monitored and isolated clinically stable patients who do not require treatment in hospitals. 8

In Daegu, where the first cluster occurred, 15 regional treatment centers, including dormitories of private companies such as Samsung and LG, accepted 3, 033 people between March 3rd and 26, 2020. Medical experts monitored the center, and patients regularly reported their symptoms on smartphone apps and telephones. The facility had a pulse oximeter, X-ray device, and RT-PCR tests for SARS-COV-2. Of the 3, 033 cases, only 81 were transported to hospitals for more advanced treatment. twenty two

Health and Economic Impact

South Korea's quarantine policy is strict, but cooperative. Those who contact the patient who have been identified, traveled abroad, or suspected of infection need to be confident. The isolated person is required to use the sel f-awareness protection app for 14 days. Case workers monitor apps that include position tracking to determine when to release isolation. Violators are required to wear an electronic wristband called a "seat belt", linking to the app staff, and has a special warning if they are not in the same place as the mobile terminal. The fine for violating sel f-questions is expensive as US $ 8. 217.

At the same time, case workers provide support for smooth quarantine. We check for sel f-nominations twice a day, deliver food and basin tools, and provide video streaming services for psychological counseling and entertainment. 8

South Korea focused on mental health during the pandemic, establishing hotels and registrations for people who were isolated as of January, and maintaining a national psychological support team. twenty four

Example of contact with a Korean private company 25

Conclusion

South Korea took an active approach to the detection of contacters early on. First, the network of the tracer contacters was expanded. Second, we gave these staff to access data more than regular patients' interviews. Third, we utilized public communication so that citizens can support the health system through tracking contacters.

South Korea quickly trains about 250 local health centers, hires 300 private epidemiologists, and utilizes 11 no n-governmental organizations who are training and supporting EIS officers. The personnel of the normal epidemiological information service (EIS) have been expanded. The mult i-layered approach was effective, with veteran EIS representatives conducted the most difficult survey in larg e-scale clusters and health facilities, and temporary staff was in charge of small clusters, including family. As a result of such efforts, cases were discovered early, the new infection rate was reduced, and the estimated mortality rate could be reduced, preventing hospitals overcrowding and hig h-risk groups. 6

South Korea's COVID-19 epidemiological survey process 26

The business of EIS officers was further promoted by the revision of the MERS law in 2015. As needed, the officer in charge was able to obtain four types of information in addition to interviews with patients and doctors:

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