To avoid a second wave of coronavirus while we carry on with business and education, we need to step up our technology, our commitment, and bring our unmatched innovation to beat this illness. It can be done. South Korea did it.
They didn’t have to close schools. They didn’t shut down all businesses. And they report a remarkable 1% death rate.
They used aggressive and swift testing, contact tracing, and treatment. They slashed coronavirus cases within a month, saved lives, and they spared the system-wide shutdown that we’ve seen in the US. Their economy even grew 1.3% in the first quarter. More importantly, these tools will serve them again and again, should a second or a third wave of coronavirus be around the corner.
Here is what the South Koreans had going for them that we didn’t.
It wasn’t their first rodeo with a coronavirus. They had witnessed a deadly coronavirus, MERS, which infected 186 and killed 36, all from one single imported case that spurred a chain reaction of transmissions. The government was criticized for its slow response and lack of transparency. They were better prepared this time.
Korea was on their game. While China’s COVID-19 epidemic was brewing in January, they were developing their PCR tests to accurately detect SARS-CoV-2 from nasal swabs. Their very first case was detected January 27th. Government officials met with medical companies to do testing R&D and start building and shipping test kits. They approved their first diagnostic test by the end of January. By February, they had multiple diagnostic tests in circulation as well as drive-through screening centers. They had ramped up their testing capacity to test thousands of people each day.1 By mid-March (five weeks later), they could run 18,000 tests each day.
South Korea contained the virus within one month. In the first two weeks of March, their daily case count fell from 800 to 100 per day. On June 2nd they reported 38 new cases. Meanwhile, the US had 19,662 new cases.
With the motto, “You cannot fight what you cannot see,” S. Korea implemented widespread testing, and early. This helped them get ahead of the virus. It helped them catch asymptomatic carriers. Before the virus had infected thousands of their population, they were already hard at work stamping it out.
They developed “walk-through” testing facilities at the international airport, set up in open-air outdoor space. With wind and ventilation, the infection risk was very low, and could accommodate large numbers of people safely. They had drive-through facilities modeled after Starbucks and McDonald’s and they went door-to-door with diagnostic testing. They set up screening clinics at public health centers and healthcare institutions to eliminate the possibility of contaminating healthcare institutions.1 This reduced the risk of transmission, the burden on the healthcare system, and also eliminated the need for disinfection measures between patients. That’s sharp!
They aggressively tested, traced, and treated travelers. They even tested the bodies of the deceased for coronavirus if the cause of death was unknown and they had COVID-19 symptoms.
By March 17th (when the US had not yet implemented shutdown), South Korea had tested more than 5,000 people out of every one million. At that time the US had tested only 100 people per one million. By March 23rd, South Korean health authorities had already run 338,036 tests total. 1 Wow!
The US has since ramped up testing and has surpassed South Korea (according to worldometers.com). It’s just that it was too late to effectively “nip it in the bud,” the way that South Korea did. And without contact tracing, it couldn’t effectively break the cycle of transmission. As of June 2nd, S. Korea reported testing 18,333/1 M people. The US reported 55,921 tests/1 M people. Based on these current numbers, the US should have tremendous testing capacity right now and we should be using it along with aggressive contact tracing and treatment.
|Tests Per 1 Million People
|May 1, 2020
|June 2, 2020
Aggressive Contact Tracing Using Sensitive Personal Data
Korea stamped out coronavirus by using sensitive personal information. It makes any red-blooded American recoil in terror, but it worked for them. How did they do it? Once a person was found positive for coronavirus, the health authorities retraced all of their recent movement to find and isolate anyone they had been in close contact with. They used citizens’ GPS data from their cell phones and cars. They used security camera (CCTV) footage. They used credit card transactions.1 Travel history was given to hospitals and pharmacies, particularly travel to countries with high infection rates1.
With this information, they could precisely trace a person who was infected and everyone they came into contact with in real time. They could break the cycle of transmission.
South Korea has policies to protect private information. However, after the MERS outbreak, they made exceptions to the privacy laws in the event of a serious infectious disease outbreak. In that scenario, the Korea Centers for Disease Control and Prevention (KCDC) can collect, profile and share seven specific categories of personal information:
- Location data (including from mobile devices)
- Personal identification information
- Medical and prescription records
- Immigration records
- Card transaction data (credit, debit, prepaid cards)
- Transit pass records for public transportation
- Closed-circuit television (CCTV) footage
This data sharing made it possible for epidemiology investigators to immediately carry out contact tracing on a near real-time basis. Even more, the health department shared anonymous but relevant details of known coronavirus cases with the public: how a patient travelled and where, what medical institutions they visited, the health status of their close contacts, sex, nationality, and age. They even sometimes mentioned the names of restaurants, shops, or businesses the infected person visited. If citizens thought they had been exposed to confirmed positive patients, they could get themselves tested.
This was not without criticism even in South Korea. A more balanced compromise has been suggested to carry out aggressive contact tracing and contain an infectious outbreak while protecting individual and business privacy concerns.
If someone asked you where you had been in the last 5 days, would you remember perfectly? Let alone the last 2 weeks. This is where personal data helped the public health authorities track down COVID-19 cases, and potential cases, and isolate them from society so that they weren’t infecting their families or others, unknowingly.
We should consider permitting the use of personal data to stop the spread of COVID-19 for a limited time. Yes, it would be an infringement of our privacy. But wouldn’t you be willing to give up a measure of your freedom to gain back the freedom that COVID-19 has stolen from us?
Rigorous Treating and Isolation
When positive coronavirus cases were identified, they were categorized and treated. Moderate and severe coronavirus cases were immediately hospitalized for treatment.
Mild cases were isolated and monitored at a living and treatment support center. They were given free temporary living facilities so that they didn’t take it home to their families. These techniques helped prevent spreading the virus even within homes.
“Contacts” of recently diagnosed cases were asked to self-quarantine at home and use separate bathrooms, dishes, and towels from their family members. Health workers checked in on them about their symptoms twice daily.
And they meant business. If you broke your order of self-isolation, you could be fined up to $8,100 US dollars or imprisoned for up to one year.1
Awareness, Trust, and Cooperation from the Public
Perhaps it’s culture; perhaps it was fear of another epidemic like MERS or SARS; the S. Koreans trusted their government. So, before the bottom fell out and COVID-19 started spreading like wildfire the world over, S. Koreans were following their government leadership. The public health authorities were providing free testing, free masks, and free isolation with consumables.
The public was cooperating in step with the government. They were getting tested. They were using masks. In fact, that part was easy. They were already accustomed to wearing masks due to air pollution.
The Korean Centers for Disease Control said, “There would not be enough medical personnel to measure the health conditions and body temperatures of all citizens if the virus had spread nationwide. The high level of civic awareness and voluntary cooperation is the most important factor in containing and fighting coronavirus.”
Innovation and Technology
Impressive collaboration between the South Korean government and the biotech private sector helped detect and contain coronavirus. Kogene Biotech launched the first approved PCR nasal swab test in South Korea by February 4th. It was quickly running thousands of tests, even before they reached 30 confirmed coronavirus cases in the country (February 10th). Seegene was close on its heels. And SolGent and SD Biosensor developed tests. All of these were available and approved by February 27th.
South Korea used cell phone apps to contain coronavirus. For people who were self-quarantined, they were assigned to a one-on-one government staff person to monitor their symptoms twice daily and make sure they weren’t breaking quarantine orders using the self-quarantine safety app. This required consent from the individual and used the phone’s GPS data. They also used a self-diagnosis app to update their health status during 14 days of quarantine.
How Has the South Korean Economy Fared?
“The world should look at South Korea as an ‘exit strategy’ to recover from the pandemic,” says Trinh Nguyen, a senior economist at a French investment bank.
South Koreans did not have to shut down businesses or schools. Their economy grew 1.3% in the first quarter compared to last year, which was better than expected. However, it still signified an economic downturn, mostly due to decreased exports.
While they didn’t need to shut down all businesses and schools, they discouraged business operations that involved close contact between people in closed spaces.
Much like we do now in the US, they recommended:
- Checking all users for fever or respiratory symptoms
- Keeping a log of all users
- Requiring facemasks
- Keeping distance from each other
- Disinfecting and ventilate the space
How to prevent a second wave of coronavirus and keep businesses open (lessons from S. Korea):
Our goal is to adapt to COVID-19, minimize risks, stay economically viable, and maintain some semblance of normal life. Unlike the South Koreans, those of us in the United States have never experienced a coronavirus epidemic in our lifetimes. There’s a learning curve for us.
Test, Test, Test.
This is like a holy grail to me, having a long history in the lab industry. We have two main kinds of COVID-19 tests: nasal swab and blood antibodies (see my blog for more on this). If you have symptoms, test with the nasal swab. If you have been exposed to someone with it, you may want to get the nasal swab test.
If you had COVID-19, you are believed to be safe around others once you’ve had two negative nasal swabs (over 24 hours apart). I would give it another two to three weeks before assuming you are safe to go out and about. You can shed virus in the stool for weeks after symptoms of infection.
All doctors’ offices should be testing for COVID-19, especially prior to invasive procedures.
I basically think everyone should have a blood antibodies test. Assuming you use a high quality, reputable diagnostic laboratory, that gives accurate results, then this test tells you if you already had COVID-19. You may want to run the test with two different labs, to verify.
Return to Work and School
If we want to open schools and businesses, we must have testing, contact tracing, and isolation facilities.
I’ve had my daughter at home for months longer than I would like. She misses her school as well as her friends. Working, parenting, and teaching is absolutely insane and we are liable to burn out our already tired parents. Parents like myself can do nanny-shares; partnering with one to three families who have been carefully vetted to maintain social distance and hand hygiene. Schools and childcare would have to keep to small groups, less than ten. Open doors and windows for ventilation. Hold classes outdoors when possible.
Katherine Baicker, dean of the University of Chicago Harris School of Public Policy, says that we could reopen more of the economy safely by focusing “on those businesses that provided the greatest benefit at the lowest risk.”
People who have IgG antibodies to COVID-19 could in theory return to work, have contact with the general public, and would be safe in healthcare settings. A lab test showing positive IgG antibodies would be like a return-to-work pass.
Same thing with schools. Kids that have IgG antibodies would be safe in public situations. It’s very similar to being vaccinated.* A positive IgG test result could be a return-to-school pass. In a perfect world, the parents and the kids would have test results to prove they are immune- or not.
Young people without co-morbidities, who live alone, can go back to work but shouldn’t have contact with the elderly or sick. People over 60 and those with co-morbidities- sorry. You need to stay home unless you have already had COVID-19 and are immune (see testing). People who live with someone over the age of 60 or with co-morbidities should be very cautious about work and social exposures. People who have no symptoms, including family members and grandchildren, can infect others without anyone realizing it.
Why don’t we hear more about contact tracing from the news and government? This is extremely hard work but it’s necessary to control outbreaks in real time. If we open up society, businesses, and schools, then we need to stamp out outbreaks in real time. The South Koreans did it exceptionally well. That means our governments should be ramping up people, man-hours of investigation, and one-on-one health workers to trace and monitor positive cases and their contacts.
Katherine Baicker, dean of the University of Chicago Harris School of Public Policy says that it’s possible to do contact tracing without violating individual confidentiality. It would require large-scale public cooperation and voluntary data collection through technology.
Like the South Koreans, we should temporarily sacrifice some of our private information for this infectious emergency situation. It would be worth it to regain our freedom from coronavirus and start repairing our economy. There are contact tracing cell phone apps that we could opt into. This might be a good compromise for our fiercely private culture and the need to prevent a second wave of coronavirus.
Treat and Isolate
We need government-sponsored facilities people can use as temporary living quarters for two to three weeks while they wait out mild illness. College dormitories or corporate training facilities could work. We can mimic South Korea’s self-quarantine and health monitoring apps for keeping tabs on positive coronavirus cases, potential cases, and those in isolation or quarantine.
Small groups <10 and Fresh Air
Small social gatherings can be held outdoors with social distance and a hand-washing station. Now is the time for a backyard barbecue or a small gathering on a covered porch or garage. Have a back-up plan for excessive heat or rain; you do not want to be forced into closed spaces with others due to inclement weather. Keep distance and keep fresh air circulating. Wear masks if possible.
Boost Your Immune System. Don’t just sit by and wait for illness to strike. Boost your immune defenses with these natural treatments.
And of course, keep doing what you’ve been doing….
6 feet of distance
Don’t touch your face
- Tackling COVID-19: Health, Quarantine and Economic Measures: Korean Experience. In: Finance DFBaMoEa, Prevention KCfDC, eds. The Republic of Korea2020.
Cass Nelson-Dooley, MS, is a researcher, author, educator, and laboratory consultant. She studied medicinal plants in the rain forests of Panama as a Fulbright Scholar and then launched a career in science and natural medicine. Early on, she studied ethnobotany, ethnopharmacology, and drug discovery at the University of Georgia and AptoTec, Inc. She joined innovators at Metametrix Clinical Laboratory as a medical education consultant helping clinicians use integrative and functional laboratory results in clinical practice. She owns Health First Consulting, LLC, a medical communications company with the mission to improve human health using the written word. Ms. Nelson-Dooley is an oral microbiome expert and author of Heal Your Oral Microbiome. She was a contributing author in Laboratory Evaluations for Integrative and Functional Medicine and Case Studies in Integrative and Functional Medicine. She has published case studies, book chapters, and journal articles about the oral microbiome, natural medicine, nutrition, laboratory testing, obesity, and osteoporosis.