The great re-opening of South Korea: A Layman’s Observations

Log-scale number of confirmed patients vs. number of days since 100th patient

Intro: Despite being an early leader of the number of COVID-19 patients, South Korea has managed to flatten the curve without a nation-wide lockdown or a massive toilet paper shortage. Now that the number of daily new cases has been diminished to a single digit, the country is preparing to ease its social distancing rules. Although I live in Seoul where the population density is about 1.7 times greater than that of New York City, my life hasn’t changed much other than minor inconveniences like wearing a face mask and not going to large gatherings. I’ve been going to work. I’ve been going outside. Most restaurants and cafes have been open. The country just held a general election. I am uncertain how the situation will progress, but I am optimistic South Korea will manage the crisis well going forward. I am not an epidemiologist, virologist, nor public health expert. I am just a layman compiling my ‘own’ observations of how things were handled in Korea. It is quite sad to see my home state Michigan is going through a lot of political turmoil because of strict social distancing rules in place. I am writing this article in hopes of providing yet another resource for reasoned discussions on this difficult topic.

Preparedness: In 2015, Korea was hit by Middle East Respiratory Syndrome (MERS). Koreans realized the entire country (government, private sectors, and local communities) was inadequately prepared to handle the disease. Post MERS, the government created a new set of regulations that include designated hospitals for infectious diseases, a new zoning requirement within hospitals, separate screening tents outside of hospitals, an increased number of negative pressure beds, and many more. The government also implemented an extensive public announcement system. As a result, the Korean CDC gives a detailed summary every day: new confirmed cases, number of testing, number of discharged patients, the source of contagion, and detailed location history of confirmed patients. The government and credit card companies work together to create patients’ location history. People receive the information via SMS as soon as information is made available. Third-party developers are making information aggregation sites (i.e., https://coronaboard.kr/), so people can search and check if they have been exposed to the virus.

A text from local government with COVID19 patients’ location history

Compliance: Korea has a “National Notifiable Infectious Diseases Classification System”. The official classification goes from Blue to Red depending on how severe the situation is. The government has a set of recommended practices at each stage. Companies, churches, local businesses, and local communities draft contingency plans that best comply with the government’s recommendations. My wife and I both work in Korea, and both of us received detailed contingency plans in advance from each respective company. These plans include, but not limited to, changes in work-from-home protocols, changes in office hours, provisions for parents, changes in sick leaves policy, changes to lunch and dinner schedules, and implementation of weekly health status questionnaires, body temperature screening, and mandatory face masks policy. Our apartment complex closed down a gym and placed hand sanitizers and anti-virus sheets on the elevators. Our church also complied with the official government’s guidelines. It reduced the number of chairs, mandated everyone to wear masks, implemented mandatory body temperature screens, and so on.

An anti-virus (Cu+) sheet on a public elevator

The examples I listed above are just a tiny snapshot of what the entire country has been doing. Fighting COVID-19 does feel like a concerted effort from everyone except for a few nutcases.

Velocity: The Korean government is reacting quickly to evolving risks. The whole situation was accelerated by a cult called ‘Shincheonji.’ The members of the cult have been infiltrating regular churches to recruit members, so the cult members are told to lie about their membership. Even after one of the cult’s worship sites was identified as a mega cluster, the cult wouldn’t cough off the full list of the members. The multiple government agencies all pressured the cult. Once the list was obtained, Korea Centers for Disease Control & Prevention (KCDC) carried out the COVID-19 test on everyone (approximately 220,000 people) on the list.

After a while, a call center in Seoul was identified as another cluster. Call centers in Korea are susceptible to infectious diseases as workers are crammed into a small space while talking non-stop. The government issued a new guideline for call centers, and the government officials were dispatched to every major call center in a couple of days.

Korea faced a massive shortage of face masks, so it enacted a face mask ration (2 face masks per person per week) via pharmacies and national prescription drug monitoring system (a relevant detour on rationing in medicine; Who Gets the Ventilator?). The government banned exports of face masks. Face masks are price-controlled. Factories are being monitored. Face mask price gouging is being heavily persecuted.

People waiting in line to buy masks during the first week of face mask ration

In the midst of the crisis, law enforcement realized the existing laws weren’t sufficient, so Korean congress legislated new laws in a matter of days. The new laws can penalize those who refuse testing, self-quarantine, and hospitalization.

Privacy: I personally find the whole situation a bit Orwellian. Public disclosure of patients’ location history and the new laws are especially worrisome to me, but my sentiment is not very common among my Korean friends. I highly doubt these measures will be welcomed in the U.S. where infringing one’s privacy is considered sacrilegious.

Concluding remark: Korea indeed managed to get COVID-19 under control without a totalitarian large-scale shutdown, but it does require a lot from everyone. Although South Korea fared better than most countries, things are still economically, socially, and politically strenuous. There are many attention-seeking armchair quarterbacks criticizing governments for doing too much and doing too little. People are susceptible to misinformation. People are running out of patience. People still argue and debate how to best contain the virus. I recognize my privilege as a salaried worker for a big company that can weather this crisis out okay. My life is disrupted as little as possible, and I am more or less content with the status quo. But I also know a handful of friends who own small businesses that are bleeding out cash. Some desperately need a more aggressive timeline for normalcy. There is a real trade-off between liberty, privacy, security, and prosperity. Unfortunately, it will be impossible to find an optimal balance that satisfies everyone. Even if everyone agrees on what the optimal balance is, everyone will disagree on how to best achieve it. I hope we use this crisis to recognize our privileges to be part of a solution rather than demonizing folks with different views. I sincerely hope everyone stays safe and sound.

My unsolicited two cents: Many experts estimate that COVID-19 will last at least a couple of years. Two years is awfully long time to idle the economy, yet painfully short time to develop a clinically proven vaccine. Barring an exceptionally expedient vaccine development and distribution, the only real solution is ‘herd immunity’ in which most people need to get infected and to develop antibodies. This has to be done without overwhelming the health care system.

  1. High-risk population stays home as long as possible.
  2. Define a set of measures (i.e, number of available ICU beds, number of available ventilators, number of active patients, etc.) that gauge capacity of the health care system. Monitor and update them periodically and publically.
  3. Enact varying degrees of social distancing based on the set of measures. (i.e., if the number of the available number of ventilators is less than X, then we will do Y).
  4. Mandatory installation and usage of bidets.

I think these are low hanging fruits to ensure transparency, clarity, institutional trust, and toilet paper for everyone.

A curious person who would like to observe the world