What the U.S. can learn from South Korea's COVID strategy
Can a country ease its COVID restrictions as new cases are exploding?
Well, in South Korea, they’ve done exactly that.
“[In the] beginning of the pandemic, Korea was very focused on the mitigation strategy — on clamping down each and every case — just like China or Hong Kong right now, pretty much close to the zero-COVID policy,” Sangmi Cha, Seoul Bureau reporter for Bloomberg, says.
“For some time now, they have shifted that strategy,” she adds. “And they are focusing solely on minimizing the mortality rate and the rate of people getting severely ill, especially among the elderly and those vulnerable groups who have underlying conditions.”
In fact, even as Korea’s COVID case counts are a hundred times higher now than in January, but the country’s fatality rate has gone down.
Today, On Point: The pandemic’s trajectory in South Korea has been completely different from what the U.S. has experienced. What can the U.S. learn?
Jerome Kim, director general of the International Vaccine Institute (IVI). Adjunct professor at the Graduate School of Public Health at Yonsei University. (@drjeromekim1)
Gihyun Yang, rising senior at Boston University who’s been in Korea since April 2020.
MEGHNA CHAKRABARTI: South Korea … has been on a completely different trajectory during the entire course of the COVID-19 pandemic. And we’re looking at what lessons the United States can learn from South Korea’s example. And I’m joined today by Sangmi Cha. She’s Seoul bureau reporter for Bloomberg News with us from Seoul. And also joining us now is Dr. Jerome Kim. He’s director general of the International Vaccine Institute. Dr. Jerome Kim, welcome to you.
JEROME KIM: Hi, Meghna.
CHAKRABARTI: So first of all, can you tell us a little bit more about what changes regarding COVID restrictions the government in South Korea might make? As Sangmi Cha said, that might happen on Friday.
KIM: So the government has taken a very incremental approach to releasing the controls that were put into place. As Sangmi had noted, when the government made the decision to start loosening the controls and to stop tracking and tracing as intensively as they had before, they did that, essentially, for practical reasons. When they hit a certain number of infections per day, that kind of intensive follow up became nearly impossible.
So what they did to prepare for that, which is actually probably the most important thing in a pandemic response preparation, is that they ensured that as much of the population that was eligible for vaccination would be vaccinated and that a majority of people would again be boosted. So that as Omicron started in Korea, which is January, you know, 95% of the eligible population had a full course of vaccination and probably on the order of 80 to 85% of people who were eligible were boosted. That meant that as Omicron took off, even though the number of people who had been infected in Korea was minuscule at that point, people were protected against the most important thing, which is hospitalization and death. And that’s what vaccination does.
So if you combine that, if you think of this as a layered defense, the first layers distance and hygiene, that’s masks and hand-washing and things. And it still kind of works in Korea, as opposed to other countries. Then you have vaccination as the very strong second line of defense, that really significantly reduces hospitalizations and deaths. And we’ve seen data not only from Korea, but from Europe, from Israel, from South Asia, and from Korea, that it really does work and do what we want it to do. But then there are always going to be people who get infected and will progress. So it’s really important then, to have a backup system and the Korean government did a good job of that.
So if you test positive on your rapid test at home, you’re over 60, you go to the health care center, they confirm you with a PCR. They then give you a kit that has a thermometer and a pulse oximeter and meds for symptoms. And you download an app that basically tells people at the health center how you’re doing on a daily basis so that they can kind of monitor you at home and take care of you at home. And if you progress, then you come in and you start getting the treatments that will keep you from requiring going into an intensive care unit.
CHAKRABARTI: Can I just jump in? They just hand you this kit. … If I’m stumbling over my words right now, it’s the sound of an American feeling a little bit of disbelief. Although I do believe you. Is this because Korea have universal health care? Because you’re describing a scenario that that I find unimaginable in the United States.
KIM: Yes, so Korea has national health care, but also the government is actually for COVID, not necessarily relying on the insurance system. But is covering the cost of COVID care. And you realize, I mean, the Kaiser Family Foundation put this out, the cost of unvaccinated people in the United States during the Delta, and then the Omicron outbreaks was over $30 billion. The hospitalization costs, so the government’s policy in Korea of vaccinating as many people as possible, voluntarily, really helped to reduce the impact of the surge that we’re seeing now.
Although … the peak was not so long ago. And you remember that from the peak of infections, it’s another week to two weeks before you see the peak in hospitalizations. And right now intensive care units are a bit over 50% occupied. And so the government is watching very closely to see that the intensive care units are not going to become full again. Now, they have backup as well. And again, this is a part of planning. When you’re planning a release, you have to make sure that you can take care and prevent people from going to the hospital. And you do that by having progressive care in place to take care of people as they’re breaking through, as they’re developing more symptoms.
CHAKRABARTI: I’m so sorry, Dr. Kim, to interrupt here, but I want to turn back to Sangmi Cha for a moment because I know you’ve reported on this. Can you talk a little bit more about what you’ve learned and seen regarding that progressive care that’s going on right now that Dr. Kim was talking about?
SANGMI CHA: Right. I mean, the Korean government has been preparing for this actually for some time now, and they’re really focused on the preemptive testing and treatment of the patient. According to the severity of the symptoms. And a lot of the experts have mentioned that Korea has very good ICU capacity and the hospitals have the resources to help prevent death. And so the government added more of that ICU beds and now runs about 2,800 ICU capacity. And as Dr. Kim mentioned, they are now 68% of them are in use. But these are not all. The government has more of those beds for milder symptoms. And again, most of the people who have the mildest symptoms or asymptomatic cases, which is about 1.8 million people, are treating themselves at home right now.
CHAKRABARTI: So what I’d like to do actually is almost sort of look at South Korea’s response to COVID layer by layer, working our way from sort of the public health infrastructure that South Korea has down to … the nation’s current very high vaccination rate. So Dr. Kim, let’s start up at that higher level, about public health infrastructure. Because while South Korea’s response to COVID is exemplary from what you’re both describing, it wasn’t that long ago, what it was in 2015, when there was a MERS outbreak, the Middle East respiratory syndrome in South Korea, where things went a little bit differently. Can you remind us what happened then?
KIM: A Korean citizen was transiting through the Middle East and acquired another coronavirus, the Middle East respiratory syndrome, which differs from SARS-CoV-2, in that it is less transmissible, much less transmissible, but has a much higher mortality rate. So at that time, we were looking at mortality rates reported of between 30% and 40%, compared to what we know now with SARS-CoV-2, it .12%. But, you know, it was a severe outbreak. In the end, about 236, 237 people were infected. But at that point, you know, the government had screened off people. They were yellow tape around things. You know, the government was trying everything possible to track and trace, but they didn’t have the tools, and it was often deemed a failure of the hospital system, of the isolation system, of isolation practices.
And so the government internalized all of that and changed the law. So they put in place the law that allowed them at certain at the highest level of pandemic operations. So when the government declares a pandemic emergency, then they can access credit card information and cell phones, and they use it under particular circumstances.
So, for instance, there was a large outbreak in some gay dance clubs. And people didn’t want other people to know that they had gone, and there were some issues, and the government couldn’t get people to come in for testing. So they activated and the … companies keep this information for 30 days. Again, this is all a part of the law. And so the government said we’re activating this set of cell phone towers and we’re going to find everyone who turned on their cell phone for a four hour period on the following nights.
They found the telephone numbers. They sent out emails or text messages to people saying, you might have been exposed, please come in and be tested. When people didn’t, they said, OK, we understand, we’ll make it anonymous. So you just came in and they sent the result back to a cell phone number, there were no names. But it got to the idea that they needed to be able to identify people if the strategy was going to continue to work. But it developed and all of the laws were put into place in the inter-pandemic period in between outbreaks, which is when you probably can do your lessons learned and then think about what would work better in the future.
CHAKRABARTI: Dr. Kim, I’m just going to jump in here because today I am in the role of the American whose mind is blown. Everything that you described just now. I mean, we have more or less, not everywhere in the United States, but similar technology to achieve that here in this country. Granted, there’s cultural differences, legal differences, etc. That would have to be addressed. But you’re painting a picture of a whole approach to pandemic control that was never even … vigorously discussed in the United States.
And it goes even further than that. Because I understand that you were talking about that inter-pandemic period. And what was it in December of 2019? So a couple of months before COVID really broke onto the world stage, there was a tabletop exercise with health officials in South Korea. Can you tell me about that?
KIM: Yes. And so as a part of the pandemic planning, they would do these occasional tabletop exercises. And in the December version of it, and this is anecdotal, I’ve never heard a person, actually an official, actually tell me this. But there was a tabletop exercise and they actually use academics around Korea, as well. A man and a woman returning from China with an unknown respiratory illness. And that tabletop exercise occurred, you know, a month before the first cases started to appear in Korea.
But that was an important part. You know, the government internalized the failure of the system in 2015 and came up with a series of changes that were then passed by, after debate in the National Assembly. So, you know, and I have to say, as an American looking and working in Korea, it was very interesting. You know, I came back and I, you know, one day got a got a text message from our local health center that someone appeared at our supermarket between 10:00 and 10:15 after having returned from this place has now tested positive. If you were at the same supermarket between 10:00 and 10:15, you should. If you develop symptoms, you should go in and be checked.
CHAKRABARTI: Sangmi Cha, jump back in here. Tell me more about the about … that sort of inter-pandemic period that Dr. Kim described that seems to have played a big role in setting up Korea for much greater success when COVID came along.
CHA: I actually did hear what the government officials said about that tabletop exercise, so I can actually confirm that. And the KDCA had said multiple times that that’s one of the lessons that they have learned from the MERS outbreak and also, as you said, that period where we had no pandemic. But the government keeps telling us that it is one of the key lessons that they have learned during that time is to continue to officially diagnose most of the infections in the country, to identify the at-risk cases, the vulnerable groups and preemptively hospitalized and treat those patients before their conditions become worse.
And we have to talk about the vaccination rate, which is very high, as you said. It’s also one of the highest booster shot take-ups … in the world, precisely 89% for people aged 60 and above, which is remarkable. So that has definitely lowered, has been the key reason behind the declining rate of the death rates and the hospitalization rates. So even though we are seeing more of the death toll right now, obviously because the cases are high, the daily cases. But again, when compared to the fatality rate and that’s again one tenths of that of the U.S. or the U.K..
CHAKRABARTI: So I definitely do want to talk about Korea’s high vaccination rate. We’ve got about two minutes before our next break. But let’s start doing that, because did I hear correctly that the number of it may be as high as 95% of Koreans are fully vaccinated? Dr. Kim, is that right?
KIM: Of the eligible population. So the children don’t start their vaccinations until tomorrow, I think the 31st or the 1st of April.
CHAKRABARTI: Children of what age?
KIM: Of the five to 11 year olds.
CHAKRABARTI: OK. So but 95% of the eligible population. Fully vaccinated or at least one dose?
KIM: Fully vaccinated.
CHAKRABARTI: So that’s 30% higher than here in the United States, I think. And I mean the question is how? How did South Korea achieve that rate? We’ve got a minute before our next break, Dr. Kim. But how would you begin to answer that question?
KIM: There was a lot of anticipation, people wanted to get the vaccine. You know, they understood that the pandemic restrictions were there. They hoped that the advent of vaccination would allow people to go out to do more of the things that they had done before. They looked on it as a solution to the restrictions that were still in place.
You know, never a lockdown. But it wasn’t like it was in December of 2019. So people looked on this and the government talked about it. As you know, this is the way out. And the problem here again, and this gets to, as you’re looking at the statistics and the numbers, there were 500 cases, 1,000 cases, 3,000 cases and it would go back down. And once you achieved a certain level of vaccination, it was kind of clear.
And the government was hinting that at some point they were going to switch and stop looking at infections and start looking at other things, other metrics the same way.
Bloomberg: “How One Country Is Beating Covid Despite 600,000 New Cases a Day” — “South Korea has reached two seemingly contradictory pandemic milestones: It recorded more than 600,000 new Covid-19 infections on Thursday, the most of anywhere in the world. At the same time, the country has one of the lowest virus death rates globally.”
This article was originally published on WBUR.org.
Copyright 2022 NPR. To see more, visit https://www.npr.org.