South Korea’s COVID experience – so far
I’ve read quite a bit about South Korea’s approach to COVID, which involved neither a lockdown nor a shelter-in-place edict. Despite that, South Korea got good results in terms of slowing its deaths down, even though it was stricken quite early and hard.
But there are several aspects of their response that were unique and probably will not be replicated. I’m not sure that most people are aware of them. One factor was that South Korea’s outbreak centered within a particular religious group. Another factor was that although there wasn’t a widespread lockdown or shelter in place, there was a very aggressive form of contact tracing and isolating, made easier by the fact that the outbreak centered on that group (the article quoted is from March 11) [emphasis mine]:
South Korea’s cases of infection had been minimal until the third week of February when cases suddenly exploded in the country’s southeast – a result of chain infections in crowded services held by the secretive Christian sect, Shincheonji.
Some 63% of Korea’s cases hail from the sect, according to government data.
While Shincheonji members are scattered nationwide, the government demanded – and received – its membership list. Contrary to widespread rumors and accusations, a senior government official said the church has cooperated…
The government implemented widespread testing of the church’s 211,000 followers. Those with symptoms were triaged as priority testees; once they were cleared, tests were conducted on those who showed no symptoms to ensure they were not latent carriers.
“From the containment phase, we tried to implement case isolation and case tracking, and this was done in a very aggressive manner,” Kim Dong-hyun of the Korean Society of Epidemiology said.
“We have legal grounds for cohort isolation,” said Kwon. “Rather than being an infringement of human rights, this was for the prevention of epidemic.” Related laws on the books date back to the MERS outbreak and further legal changes take effect in April…
Case tracking was done via CCTV data mining and credit use patterns…
…Korea was lucky in another respect: Its core cluster infected an age range with strong resistance to Covid-19, for Shincheonji concentrated its recruitment efforts on students and the young.
“When you look at the age and the distribution of confirmed cases in Shincheonji you see high portion of those in the 20s and 30s,” said Kim. “Therefore, the fatality rate in this cohort is low.”
Much more at the link.
Most people say “well, South Korea did it,” without having a clue what special characteristics were present there. This is the kind of thing that makes meaningful comparisons difficult unless they include a correction for these factors.
Interesting video regarding hospitals
https://www.youtube.com/watch?time_continue=1&v=5pIMD1enwd4&feature=emb_title
You see people pointing out that the ordinary flu in this country results in somewhere between 20,000 plus to 80,000 plus deaths each year, depending on conditions.
Then, contrasting this with the 3,600 plus deaths so far from Coronavirus, they argue that our national, state, and local reaction to the Coronavirus has been far too draconian, and far more damaging to us–to our society, to our country, and to our economy–than it needed to be.
Others argue that we still don’t really know a lot of critical things about this Coronavirus—how easily communicable it is, how lethal it ultimately is–what percentage of those who contract it will die, what percentage who contract it will survive, and (something that I’ve never seen talked about) what percentage of those survivors will be left with permanent, possibly disabling lung and other damage because of it.
Thus, in view of the startlingly large number of infections and deaths we are seeing in other countries, they argue that it is wise to take draconian steps to get out in front of, and to aggressively and comprehensively combat this Coronavirus.
One thing that strikes me is that, in the case of the Coronavirus, according to reports–a person can have been infected but have no immediate symptoms and unwittingly (or stupidly, selfishly) spread it, explosive community spread is apparently frequent, and given reports that it’s acute onset is sometimes so sudden and overwhelming–the resultant numbers of victims needing immediate, urgent, and intensive care are so large that—in contrast to what I remember about our past experiences with seasonal flu—this flood of seriously ill people can overwhelm existing testing capabilities, hospitals, number of hospital beds, doctors, caregivers, ventilators and other supplies, and the time needed to react and to save lives.
Thus, unless you do mount a massive, national level, “all hands on deck” operation to deal with this flood of infected patients, many, many of those acutely ill with Coronavirus will die who could otherwise have been saved.
It is reported that the leaders of Sweden–with a population of a little over 10 million–have decided on a policy of essentially carrying on business as usual, and letting the Coronavirus just roll through their population.
The key question thus becomes how many deaths and permanent disabilities are too many? How many deaths and potential disabilities are national policymakers willing to absorb?
The President’s Coronavirus Task Force estimates–of those who would have died in this country of 331 million under a policy like Sweden’s of essentially doing nothing to combat the Coronavirus–would result—on the high side–in an estimated 2 million or more dead.
President Trump has obviously decided that 2 million dead is far too many and, thus, his full court press to try to “flatten the curve,” and to drive that number down to an estimated 100,000 to 200,000 deaths under mitigation measures, and as much below that already horrendous estimate as possible.
Its going to be bad, but—absent such draconian efforts–it likely could have been so, so much worse.
I would argue that when it was largely confined to nursing homes in Seattle we had a similar chance to keep it in check. Perhaps even a better one, since the infected people were confined to a few buildings.
Though flights from China were cut off early, we started importing lots of cases from Italy after the breakout in Seattle. We were too slow to shut off travel from Europe.
On the other hand, it’s possible it’s been endemic around the country before that and it spread invisibly before we got a chance to contact-trace.
Willis has an excellent article up at WUWT. He presents a very strong argument, based on data. Bottom line if you don’t feel like reading it: the lockdowns do not do anything except destroy economies. What does work? What Japan does: screen at ports of entry, AND everyone wears a face mask while out in public. Simple as that.
https://wattsupwiththat.com/2020/04/01/do-lockdowns-work/
Given the data out of Italy, I do wonder if a better strategy might have been to attempt to isolate the population over 60 while the rest of the population carried on as normal with heightened sanitary measures.
I do think S. Korea’s very early and aggressive testing was exemplary and can and should be replicated by other developed or developing countries. It’s something that the U.S. partially missed out on. Which doesn’t minimize Neo’s points.
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It’s clear now that there will be much public angst over ventilators. In an interview with the NYC critical care doctor Steve Kassapidis, he mentioned a few noteworthy things. He has something like 4 levels of respiratory aid for patients, with the last most aggressive one being the ventilator.
He had many people on ventilators and he had many deaths, but he had only two ventilator patients successfully come off the ventilator. Maybe most of his patients were relatively new patients and given time many will successfully come off the ventilator. Or maybe most ventilated people will die on the ventilator.
“Simple as that.”
Well, maybe.
But it does seem that all one has to do is wait a bit, or a bit longer than that (which may be a very difficult—if not impossible—thing to do for so many of us in our impatient culture, expecting—hence requiring—results/news/messages/information NOW!!…and then forgetting it so very quickly, which I guess is the opposite side of the coin, given so much information overload.)
https://time.com/5812376/tokyo-olympics-coronavirus-infections-spike/
physicsguy–I’m beginning to suspect–given that you can reportedly contract the Coronavirus but not show symptoms for several days, and given international travel–that when all of this is over, we will likely discover that the Coronavirus was probably present–and spreading–in the United States for quite some time before we became aware of it.
Ann in LA:
Too slow to cut off Europe? I believe we were one of the first countries to shut off travel from Europe. And I know we were among the very first to cut off travel from China. The left and the MSM howled with rage and accusations. I think it amazing that Trump was brave enough to do it as early as he did, amidst the intensity of criticism and the unknowns involved in terms of results. If he had done it any earlier pretty much no one would have agreed with him.
South Korea’s contact tracing was done at grave expense to civil liberties involving cell phones and the like. I believe that “cohort quarantines” basically means temporary leper colonies for those who test positive – in other words, housed together in special buildings and not allowed to mingle with anyone not positive. I doubt anyone here would have tolerated those sorts of things at the outset.
Many deaths occurred at that nursing home first because the patients were vulnerable, so it was noticed. I believe the virus as already in the community at the time and not just in Washington state, either.
Snow on Pine:
Indeed. And it works both ways.
Those who think the intervention was too much say “see, it’s not too much worse than the flu.” They ignore the fact that it’s highly possible it’s only that way because of the interventions, and that it could have been far far worse without them.
But those who think the intervention was necessary say, “see, we reduced the deaths greatly though these interventions and therefore they were needed.” But we don’t have a control USA to compare with, where the interventions didn’t happen.
How can we know which is correct? Later on, different countries with different interventions can be compared. But the comparisons will all be iffy, because countries vary so much in so many other ways.
I believe the virus as already in the community at the time and not just in Washington state, either.
That’s been proven.
I now have a handle on this 100k deaths. I was able to fit the “serious cases” with a power function; it’s definitely not exponential. Then looking around it seems that MAYBE 20% of those serious cases die. It’s then just a matter of extrapolation. In about 3 weeks this predicts a cumulative death total of around 100k. I wonder if this is what the CDC is looking at. I wish I had a better number for the serious cases that don’t survive. Any health care workers have any idea? Higher percentage we reach 100k in two weeks.
I repeat a couple points I already suggested here and elsewhere, thinking about what I’ve seen around me here in Lombardy:
First, this virus is very, very infectious: unchecked, it can spread rapidly and render some place a focus of infection in a few days; I believe that this happened both in Whuan, Bergamo and now New York;
Second, for reasons which are clear to nobody (it’s useless to pretend we know much) the effects of the virus are not uniform, and this on two levels:
– geographic: there are areas terribly hit in terms of deaths and chaos in hospitals – while others, possibly very close to the former ones, are almost normal;
– human: as my nephew told me today, “it seems that everybody reacts to the infection in its own way”; of course, old people are more affected and women are more resistant, but she told me that beside that doctors have really few clues.
Given this largely unpredictable situation, it’s not easy to find the wisest policy.
I’m trying to be as objective as possible, and obviously I can be wrong. I personally favor a flexible approach, similar to the one adopted in Sweden and South Korea, where strict closure is not imposed a-priori in every situation, but people and institutions are ready and prepared to react swiftly whenever an emergency starts. Tests and isolation are really important, I am convinced.
This is more easily said than done: in a country like Italy, where people behave erratically and trust in government is minimal, it’s more difficult. Sweden, South Korea and Germany, instead, are countries of very obedient and disciplined people, which in this case helps.
In any case, even with the best policy and intentions, a disaster could still arise and we all need to embrace a spirit of mutual collaboration and generosity. I’m disgusted to see politicians trying to advance their partisan interests in such a situation.
There is a saying to the effect that, “one death is a tragedy, a million deaths are just a statistic.”
In all this bandying about of numbers of projected deaths, the thing is, it’s all an intellectual game until one of those projected deaths is you, someone in your family, or a close friend.
From this perspective, any and all deaths are tragedies, tragedies that ripple outward from the actual death, and effect an ever widening number of people and relationships.
If you take this view, wouldn’t your goal be to use your every effort and resource to reduce that number of such tragedies to an absolute minimum?
Put very starkly another way,” how much is an individual human life worth?”
“Given this largely unpredictable situation, it’s not easy to find the wisest policy.
I’m trying to be as objective as possible, and obviously I can be wrong. I personally favor a flexible approach, similar to the one adopted in Sweden and South Korea, where strict closure is not imposed a-priori in every situation, but people and institutions are ready and prepared to react swiftly whenever an emergency starts. Tests and isolation are really important, I am convinced.
This is more easily said than done: in a country like Italy, where people behave erratically and trust in government is minimal, it’s more difficult. Sweden, South Korea and Germany, instead, are countries of very obedient and disciplined people, which in this case helps.” – Paolo
As usual, I appreciate your insightful reports from Italy.
IMO, the key to the effectiveness of different response protocols is the bolded statement, which is obvious, and the next paragraph, which is not.
In the USA, there wasn’t the necessary preparation and swift response in the beginning (due to depleted emergency supplies and ego-heavy institutions, plus hostile media and #Resistance), and Americans are much more like Italians than Swedes.
And all of those countries together will fit inside TX-NM-OK (because of Germany, and might need to add LA for Italy).
You just can’t do the same things here, even just in a single state, because of the nature of the Republic (border checks in NJ – next they’ll want a wall), although it’s interesting that so many governors are setting up competing experiments within the context of the federal response.
It will be a long time before all of the experiments will be analyzed, but we can watch the interim lab reports and get some idea of the trends.
They ignore the fact that it’s highly possible it’s only that way because of the interventions, and that it could have been far far worse without them.
this is untrue neo… the interventions will not leave pockets of people who will not get the virus… that is rare, at best it just extends the period so that people dont get sick at once…
if you watched that excellent simulation video, no matter what the idea almost none in a population are spared… the only simulations that mitigated the whole population getting it till herd immunity happened were the most draconian where a sick person and contacts were put in holding till it was over.
given that we periodically go to the store, and that we cant stay in longer than the disease can float around… there is no such idea as people actually avoiding it… almost everyone will get it before its over…
Artfldgr:
By “far worse” I don’t mean fewer people will get it, necessarily.
I mean any or some or all of these:
(1) It happens more slowly and doesn’t overwhelm the system because we’re more prepared by the time cases increase.
(2) Some effective treatments are found during the time it is slowed down and/or postponed.
(3) We do more studies and find what is most effective short of shutting things down (for example, face masks) and thus when we go out again it doesn’t spread as far or as fast.
(4) While we wait, the virus mutates to a somewhat less lethal form.
(5) Ultimately, a vaccine (although that will be a later development).
physicsguy on April 1, 2020 at 4:53 pm said:
Willis has an excellent article up at WUWT. He presents a very strong argument, based on data. Bottom line if you don’t feel like reading it: the lockdowns do not do anything except destroy economies. What does work? What Japan does: screen at ports of entry, AND everyone wears a face mask while out in public. Simple as that.
https://wattsupwiththat.com/2020/04/01/do-lockdowns-work/
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The argument unravels a bit in the comments, because Japan is also a very germophobic culture in general, and less “handsy & huggy” than, say, Italy.
😉 to Paolo.
Here are a few chunks of information via some of the sub-arguments.
https://wattsupwiththat.com/2020/04/01/do-lockdowns-work/#comment-2953211
Kernodle: Keeping your masks clean and uncontaminated is not easy.
“Describe the procedure, step-by-step, that you would go through to produce and use/reuse an “ordinary cloth” mask.
How do you insure that it is virus free, upon its first application? Spray with alcohol, maybe? Then how long would you wear it at a time? Are your hands completely sanitized when you touch it the first time? How exactly do you place it on your face? How exactly do you take it off your face? Where do you place it, after you take it off your face, so as not to contaminate a surface? Do you answer all these questions in such a way that the chain of contamination is completely sanitized, each and every step of the process, … each and every time you place the mask and remove the mask?”
https://wattsupwiththat.com/2020/04/01/do-lockdowns-work/#comment-2952974
rah: “Some people are denying this is the real deal. It’s real.
My daughter in-law is an ICU nurse in Indianapolis. Talked to my son today and he said she had a crying jag last night. She is doing COVID-19 only…”
https://wattsupwiththat.com/2020/04/01/do-lockdowns-work/#comment-2953191
Kevin kilty: isolation of immunocompromised child worked for 20 years so far
“My wife’s family had a child who was an early test subject of transplant therapy. They lived in a city of 30,000. The city did not shut down each time there was an outbreak of flu or the cold to protect this person, and the family itself even suffered bouts of flu and colds — the mother even had a bout of bronchitis. Instead, they observed a strict protocol when disease broke out. Inside/outside shoes. Confinement of the vulnerable person, and confinement to room of any sick person in the family. Pretty strict flow of trash, dirty dishes, etc. Sterilizing lots of things using just using 4 hours of good old sunlight. The child was kept safe for nearly two decades, and went out on his own to college and then into society with care. Heck of jazz guitar player.”
https://wattsupwiththat.com/2020/04/01/do-lockdowns-work/#comment-2953170
Loydo: “[masks are] one factor, but as this excellent interview shows South Korea was ready and that is what made the difference.”
This comment from the WUWT is for Tom Grey — is this all correct?
https://wattsupwiththat.com/2020/04/01/do-lockdowns-work/#comment-2952929
Peter April 1, 2020 at 11:01 am
One of the WUWT commenters linked this story, which ought to give some interesting new data points IF the hippies are right.
https://www.haaretz.com/israel-news/.premium-the-coronavirus-hug-fest-israeli-hippies-brazenly-flout-the-rules-1.8731032
The idea that flower power is prophylactic for viruses may be true (or more likely not), but just gettin’ down and partyin’ has negative consequences.
https://libertyunyielding.com/2020/03/31/a-neologism-that-shouldnt-exist-but-does-coronavirus-party/
Unhappily, another new coinage has recently joined their ranks: coronavirus party. Headlines are now cropping up increasingly about get-togethers, sometimes made up of dozens of people, who are either ignorant of the health risks of COVID-19 or merely defiant of directives to avoid social contact.
AesopFan: As I recall from “The Band Played On,” a book by a gay journalist about the early days of AIDS, some gays flirted with the disease in group settings as a kick.
Since the anti-retroviral cocktails against AIDS were developed, some gays have returned to indiscriminate “barebacking” — unprotected anal sex.
Humans are complicated and at times self-destructive.
The shutdown is excessive
In Italy, all those who die in hospitals with Coronavirus will be included in the death numbers. In the article, Professor Walter Ricciardi, Scientific Adviser to Italy’s Minister of Health, reports, “On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88 per cent of patients who have died have at least one pre-morbidity—many had two or three.”
Recording the numbers of those who die with Coronavirus will inflate the CFR as opposed to those that died from Coronavirus, which will reduce the CFR.
of course more at link
https://www.independent.org/news/article.asp?id=13094
“And I know we were among the very first to cut off travel from China.”
This is a spectacularly “clueless” statement for someone who points to others and claims “Most people say “well, South Korea did it,” without having a clue”
The ONLY travel that was cut off from China were Chinese nationals – even then, who knows how “complete” that was. Flights have been, and still are, coming in.
https://www.bloomberg.com/news/articles/2020-02-02/coronavirus-these-countries-airlines-restrict-travel-to-china
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If y’all want to forgive Trump for the lack of leadership on this, fine. Argue, he didn’t have a clue – though he has at his beck and call all the information, scenario projections, and expertise, etc., etc. There was plenty to see that something big was coming.
Even now, if we have this much debate about the potential impact and what to do (given what we already have seen coming), that means we either have great uncertainty, or we have a mass conspiracy to fake up global news.
This is a fat tail event that has a high risk of high impact.
Seems to me the do nothing approach (“hey, it is no worse than the flu or car accidents”) is foolish.
Why?
It is all about “flattening the curve”!
What happens if we overwhelm the medical system? I think we are seeing that now in several places, and that is with the shut in orders in place now.
I’m sure those who pre-maturely die are on board with the sacrifice to save their grandchildren’s future.
What about second and third order effects?
What about regualr everyday medical emergencies as people carry on “normal life” – are they supposed to take one for the team too like some suggest the elderly should?
Imagine police, EMS, prison guards, border guards, etc getting sick en masse (especially since they would lack protective gear) – sure most will survive, many might have few simptoms, but there will be enough who do get sick and hospitalized, some may die anyway, and some more will die simply because the medical system cannot take them.
What happens if it all reaches a critical mass in a relatively short window?
Think about other services we rely on if that happens?
Banking, supply chains for groceries and pharmaceuticals, transportation and maintenance, oil at the pumps, you name it.
Doing nothing IS a HUGE gamble!
Oh, but the shut in has it’s own cost too ! Sure, it does.
But, how certain can we be that the economic impact wouldn’t be worse and the deaths much higher “doing nothing”?
The people who were telling us it was “no big deal”, the impact is “no worse than the flu” haven’t been right.
Not like anyone really has a firm handle on this.
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And, that is the point.
It is the combination of uncertainty and risk of a high impact that we need to shut in – to lower the curve – until we have better capacity to deal with those impacts (medical capacity, PPE supplies, treatments, etc), MUCH better clarity on the disease virality (for lack of a better word) itself, and to better understand when we are in a good spot to lift the orders.
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There are plenty of suggestions for partial measures.
Maybe we isolate only those people 60 and above. Maybe only people who have a “pre-condition”. Etc
How would that all get administered and enforced?
These are only half measures that sound nice in theory, but are much harder to accomplish vs a general order.
It would be nice if we could design something that is tailored for this situation, but how long would that take? Is concensus under this uncertainty even possible?
And, even with a general order recommendation, we have some states/countys who seem/ed to think they don’t/didn’t need to because of “yesterday’s” numbers, or for poorer reasons.
This is all like trying to chlorinate only one half of the pool, it won’t work with a contagious disease like this, and will only prolong the disruption and worsen the impact.
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The South Koreans were aggressive early on. Maybe their specific circumstances made it easier. So what?
This country has been laxadasical in comparison. Now we are behind the eight ball and have an even bigger disruption than we would have otherwise.
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It comes back to leadership.
Trump alone has had the biggest influence in how this country has responded to this. His messaging from early on sent a signal to his own Cabinet and government operations. It sent a signal to his political allies. It sent a signal to his favorite media and his base of fans. It sends a signal around the globe!
You cannot carry on with this messaging up to Mar 24 saying the economy will “reopen” by Easter (contrary to what, by then was obvious) without sending the wrong signal.
Sure, the media would treat him unfairly, even if he provided the leadership. So what?
Shouldn’t stop the President from leading the country through these times.
Thankfully, for now, he’s changed his tune and we see state and local governments changing in kind.
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And, let’s be honest here.
If this was on Obama’s watch, would there be blog posts like this research detailing how the South Koreans had special circumstances?
Would there be a little more content with a critical eye to the messaging since January? The leadership, or lack thereof?
Maybe our obsession with how bad the Dems and MSM are has blinded us to some large parts of the bigger picture.