South Korea and COVID-19

South Korea has not done as well as Taiwan, but its record in fighting the disease seems exemplary relative to other countries. On 23 February when the total number of cases in the world was 78,000 with 76,000 in China (compared to the well over 11 million today), South Korea had over 600 confirmed cases and 5 deaths. Of the cases outside China, 691 were on one crew ship in Japan that was subsequently quarantined. Of the 600 Korean cases, the vast majority, at least 500 in Daegu and immediate environs, could be traced to the Shincheonji religious sect or cult, the “Church of Jesus, the Temple of the Tabernacle of the Testimony.” 

By 10 April, South Korea had almost 10,500 cases and 204 deaths. According to Johns Hopkins University. By 10 May, South Korea had still only over 10,000 cases and only 256 deaths. 34 new coronavirus cases were reported in May when for a month the highest number of cases had been 39 and South Korea reported many days with zero cases. By 5 July, the total number of cases had risen to 13,091 but the death toll to 1,269, still a relatively small number compared to the almost 130,000 in the U.S. This meant that outside China, though South Korea initially looked pretty bad, by May seemed to gain total control. It has had a second spike but still looks good compared to the rest of the world, especially America.

Clearly, South Korea got control of the pandemic early in its sweep across world. With contact tracing, the 34 cases in May were all tied to three nightclubs and bars in the Itaewon district of Seoul and confirmed by the Korea Centers for Disease Control and Prevention (KCDC). Seoul immediately ordered the closure of all bars and nightclubs in the area. A 29-year old male who had visited five nightclubs in the area on 1 May tested positive. It is estimated that he had contact with 1,500 others. Contact tracing became intense and eventually 54 cases, 43 nightclub patrons and 11 acquaintances of the owners. were traced to the event. However, there were bound to be others that showed up later if only because the Itaewon bar establishments cater to the lesbian, gay, bisexual, transgender and queer communities. Clientele and hate speech against LGBTQ people remained rampant. There was little incentive for disclosure.

What initially appeared to be the possibility of a new wave turned out to be a single hotspot. Containment through a rapid and thorough response suppressed the outbreak somewhat. Nevertheless, in spite of this success, President Moon Jae-in predicted a second wave and asked Koreans to be prepared as the country tried to enforce both strict safety standards while trying to restore normal daily lives to South Koreans. The plan to reopen schools on 13 May remained in place with a watching brief. And there was a second wave, but relative to other countries, a relatively small one.

South Korea, like Taiwan, was very quick off the mark. On 16 January 2020, South Korean biotech executive, Chun Jong-yoon, directed his lab to develop detection kits, kits which the U.S. could have adopted instead of its initial failed effort. Further, it almost immediately introduced a system of widespread testing establishing drive-through testing centres. Even more importantly, contact tracing under the authority of the KCDC was developed using a central tracking app that informed citizens of any known COVID-19 case within 100 metres. Phones and credit card data traced their prior movements and found their contacts. Those determined to have been near the infected individual received phone alerts with information about their prior movements. Identified infected individuals were required to go into isolation in government shelters and could be fined if they did not comply.

Thus, although South Korea and the U.S.A. identified their first cases on the same day, 20 January 2020, the U.S. with over six times the population of South Korea had 10 times more confirmed COVID-19 cases by mid-May. As of 12 May 2020, the U.S. had over 1.3 million cases (1,347,881) and over 80,000 (80,682) deaths, the rate doubling every twenty-one days. By 5 July, the number of cases across the world had grown to 11.3 million with 2,852,807 cases in the U.S. and the world death toll of 531,000 with almost 130,000 in America. Further, while South Korea had reduced its rate of new cases to one-tenth of the peak by mid-May, the number of new cases in the U.S. keeps rising. U.S. citizens with a population of 331,002,651 had a 5% mortality rate in mid-May and remained at 4.5% on 5 July compared to only a 0.13% normal flu mortality rate per year.

In contrast, in mid-May in South Korea with a population of 51,269,185 had a mortality rate of 2.4% but by 5 July the death rate had risen to almost 10% of cases. The number of cases were trending much lower but a greater percentage of those who contacted the disease were dying, perhaps because a number of deaths included people who had been suffering from COVID-19 for months.

The major difference for the relatively strong record of success in South Korea was the speed of initiative and thoroughness of action. By the end of January, South Korea had developed successful tests for the coronavirus. A week later, the U.S. Food and Drug Administration (FDA) approved a coronavirus test developed by the Center for Disease Control and Prevention (CDC), but it proved to be unreliable and unusable. It was a month later before the Americans had a successful test, but by then COVID-19 had a huge running head start.

The initial steps in South Korea are telling.

  • 20 January 35-year-old Chinese woman identified with the virus
  • 23 January, 55-year-old man who had worked in Wuhan identified
  • 26 January, a 54-year-old South Korean evidently crossed paths with the second case as he traveled to three restaurants, a hotel and a convenience store; all contacts were immediately traced and tested
  • 27 January, a 55-year old man who had returned from Wuhan
  • 30 January, a 32-year old South Korean who had worked in Wuhan until 24 January
  • 30 January, a 56-year old South Korean who had visited the same restaurant as the third patient above
  • 31 January, five more patients detected, each having caught the disease as a result of communal contact.

The next victims were returning travelers from Japan, Thailand and Singapore. But by mid-February, beginning with the church in Daegu, more incidents of communal infection emerged. The fact that by 19 February, the South Korean Department of Health could trace the source of the infection of over 100 victims identified was telling. Further, because of the huge infection rate from the Daegu church, Daegu was the only municipality that saw extensive closures of restaurants and stores while the rest of South Korea operated close to normality with the exception of large sports and entertainment events.

However, at the end of February, South Korea had 3,700 confirmed cases while the U.S., without testing, had only identified 74 cases. Further, because Trump announced that the disease was “like a miracle” going to disappear, production of tests developed very slowly. When the U.S. had finally tested 3,300 suspected cases, South Korea had tested over 94,000, 10,000 per day by the end of February when the U.S. was only beginning to get its act together.

By March when the disease was racing through the U.S., passing South Korea’s total number of cases by mid-March, South Korea had initiated not only widespread testing but tracing as well, enabling the country to find infections rather than just allow those infected to find hospitals. This prevented widespread community transmission. Further, in March South Korea guaranteed a minimum income to anyone whose life was upended by the pandemic – 454,500 South Korean won or US$371.63 per month. Economic security was made as important as physical security. When Dr. Deborah Birx, the White House coronavirus task force coordinator, boasted on 24 March that the U.S. had finally surpassed South Korea in the number of tests performed (830,000), only 1 in 400 was being tested while in South Korea, 1 of every 130 persons had been tested.

Americans did not trust their government which offered contradictory advice and pushed the professionals into the background. Contrast this with the relationship developed in South Korea between the government and a people which learned to trust and invest in good governance. Even more important than testing and tracing, South Korea practiced separation, not simply people standing five meters from another, but the focus on and separation of sick people from the rest of the healthy population.  Isolate in the grander sense was as important as test and trace. But undergirding the whole effort was a belief in and trust of government.

Raw politics do not enhance health policy. Second, South Korea’s Ministry of Health kept the citizenry fully informed every step of the way, both the steps being taken and the reasons for them. Further, the government trusted the public to comply. Like Taiwan, South Korea never required an almost complete lockdown. Citizens stayed home because it was the responsible thing to do. They washed hands. They wore masks. They kept their distance. Finally, South Korea has a powerful civic ethos and memory. The people remember MERS. They remember SARS. They know everyone in society is in the same fight. They have been collectively vaccinated to follow the government’s lead and fully cooperate in the effort to fight the pandemic.

However, South Korea was not utopia. Religious sects repeatedly undermined government efforts, not only in collecting together, but in adopting harmful methods of treatment, such as spraying salt water into the mouths of parishioners. In late February, there was a sudden jump in cases. “Patient 31” had participated in the Shincheonji Church of Jesus the Temple of the Tabernacle of the Testimony Church in Daegu which taught that illness was a result of sin. Stupid politicians are not the only source of ignorance. Of 4,400 followers of the church, 544 contracted the disease by mid-February and by the third week, 1,261 of 9,336 parishioners were tested positive. There were 245,000 members of the church altogether and all were ordered forcibly tested.

On 6 February 2020, the U.S Commission for International Religious Freedom (USCIRF), an independent, bipartisan federal government entity, issued a declaration stating, “USCIRF is concerned by reports that Shincheonji church members have been blamed for the spread of # coronavirus. We urge the South Korean government to condemn scapegoating and to respect religious freedom as it responds to the outbreak.” In addition to Willy Fautré, Director of Human Rights Without Frontiers, the Commission included Massimo Introvigne, Center for Studies of New Religions, Rosita Šorté, International Observatory of Human Rights of Refugees, Alessandro Amicarelli, Attorney, European Federation for Freedom of Belief and Marco Respinti, a journalist. Fautré criticized South Korean authorities for demonizing the church, for calling it a heretical movement that should be combatted, that taught its members to reject medical treatment, for sitting on the floor during religious services in an unhygienic way, and that Patient 31 abused a nurse in resisting treatment.

The Commission offered no evidence that South Korean authorities had demonized the church nor did it refute evidence that church members took into their own hands the use of unrecognized methods to treat the virus. Further, sitting in large numbers in such close quarters clearly, on the evidence of the infection rate, was unhygienic. Patient 31 may never have abused the nurse, but no evidence was offered that anyone in authority leveled such an accusation. Further, that 61-year-old woman in Daegu refused testing on two occasions and ended up infecting another 37 people. Members and direct acquaintances of the church group make up two-thirds of all COVID-19 cases.

Clearly, this supposed religious rights organization was eager to defend deviant behaviour in the name of religious rights even when that behaviour demonstrably threatened the health of the larger community and was a key reason South Korea did not match Taiwan in the low rate of infections. The law applies to everyone. Under the revised anti-infectious disease law, violators of demands for self-isolation can face up to a year in prison, a 10 million won fine, or, in the case of foreign passport holders, deportation.

In addition, non-South Koreans, especially Chinese, suffered from discrimination. In February 2020, an entrance to a South Korean restaurant in downtown Seoul reportedly had a sign in red Chinese characters stating: “No Chinese Allowed.” There were other “No Chinese” signs reported. Other businesses simply banned all foreigners. Foreigners who were not subscribed to government health insurance were not offered free masks. The main focus remained China. More than 760,000 South Korean signed a petition lobbying the government to ban Chinese tourists from entering the country

As the Oscar-winning film, Parasite, portrayed, income differences create wide life disparities that breed both social distrust and manipulation to foster self-survival.  However, in mid-February, when the director Boon Joon-ho returned to South Korea from Hollywood, he, like many other celebrities, set an example by promising to “wash [his] hands from now on, and participate in this movement to defeat coronavirus.”

What about the reactivation rate in South Korea which by April had emerged as a new problem? Was it because the virus remained active or because the immune system weakened or were the tests inadequate in capturing the presence of all the virus? Success does not mean all questions can be answered but only that a successful program is in place to attack new problems. The key difference between South Korea and Taiwan had been the existence of a large religious cult in South Korea responsible for almost 80% of cases, not the system South Korea had developed for attacking the spread of the disease. South Korea used very similar methods as Taiwan to contain the disease and is worthy of significant credit in fighting the worldwide pandemic.

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