Looking back at how Korea fought first Covid waves

Social Affairs

Published: 14 Jul. 2022, 19:35 Updated: 14 Jul. 2022, 20:03

Looking back at how Korea fought first Covid waves

A Covid-19 screening center in Songpa District, southern Seoul, is crowded with people trying to get tested on Thursday. [YONHAP]

On Jan. 19, 2020, a Chinese woman in her 30s living in Wuhan, where Covid-19 may have been born, arrived at Incheon International Airport to celebrate the Lunar New Year. After Korea, she was planning to travel on to Japan.

But the woman had a fever and a headache. The following day, she tested positive for the coronavirus — becoming the first Covid-19 patient in Korea.

Two and a half years have passed, and from that first case, a total of 18,641,278 followed as of Thursday.

The country has undergone five virus waves, and is probably in the beginning of a sixth created by the BA.5 Omicron subvariant.

The only remaining Covid-related restrictions include an indoor mask policy and a seven-day isolation requirement for confirmed patients.

Is Korea ready for the sixth wave?

A look back at Korea’s Covid-19 strategy over the last two and a half years will give some answers.

Massive testing and tracing

Instead of enforcing a national lockdown or complete travel bans as other countries did, Korea chose to control virus transmission by adjusting social distancing measures.

A foundation was the 3T Model, a strategy to quickly classify confirmed patients through large-scale diagnostic tests (the first T stands for Test); tracking down patients' contacts using technology to cut the infection chain (Trace); and provide appropriate treatment to confirmed patients based on the severity of their illness (Treatment).

The country acted quickly. Korea was the first country in the world to develop Covid-19 diagnostic tests using Real-time PCR technique. Thanks to swift emergency use approval by the food and drug ministry, test kits were used from mid-February 2020 that could obtain results in just six hours. The kits were exported to the United States, Germany, the Netherlands and India.

Creative ideas for testing, such as drive-thru testing and walk-thru testing — which allowed early detection of patients and minimized the risk of transmission to medical workers — were heralded and adopted in countries abroad.

Covid-19 screening centers were set up in neighborhoods to increase accessibility, and mild cases were segregated in a new type of government-monitored center called residential treatment centers that were specially created.

The tech-savvy country also made use of technology for aggressive contact tracing. In March, the government introduced a smartphone app used to enforce isolation of Covid patients, which alerted health workers when patients left home without permission.

Authorities gathered surveillance-camera footage, smartphone location data and credit card purchase records to trace recent movements of patients and establish virus transmission chains. That information was disclosed on a government website and also sent out by emergency text messages, which was crucial for tracking and establishing virus transmission chains. But it raised privacy invasion issues.

"We need to protect who the patient is, but for the public good, we believe we should reveal at least where the patient visited and when, and protect other people who were there," said Son Young-rae, a spokesperson for the Health Ministry, in an interview with the Korea JoongAng Daily.

Vaccine struggles

Unlike Western countries that raced to put in orders for vaccines for the coronavirus, Korea was late in procuring vaccines. Health authorities said they were being cautious and would watch for side effects in countries that were giving the vaccines to their people.

The principle of Korea's vaccine rollout, which started on Feb. 26, 2021, was to classify high-risk groups and elderly people with high fatality rates as priorities for inoculation. First doses of the AstraZeneca vaccine were given to patients and employees at nursing hospitals; workers at high-risk medical facilities; and workers on the frontlines of Covid-19.

Due to a shortage, however, inoculation for people 75 or older was temporarily stopped in May 2020. The interval between vaccine doses often changed to stretch out supplies.

When inoculation of the general public under 60 began, the reservation website crashed. Complaints increased when some people apparently succeeded in booking a shot by hacking the system.

The vaccine pass, which allowed fully vaccinated people or those with recent negative test results to enter public places, was introduced on Nov. 1, 2021.
Despite having one of the highest vaccination rates in the world, the introduction of the vaccine pass sparked a backlash over discrimination against unvaccinated people. Facing legal challenges, Korea's vaccine pass was suspended nationwide even before it could prove its effectiveness.

Social distancing

The term “social distancing” was first used in a government briefing on Feb. 29, 2020, when there were a total of 2,931 accumulated Covid-19 cases. It was merely a recommendation to the public to refrain from going out or having unnecessary meetings.

After Korea's first pandemic wave was driven by the Shincheonji Church of Jesus, the government got more serious about the idea. On March 22, 2020, clubs, bars, indoor sports facilities, and religious facilities were forced to close down for 15 days, which was the first distancing rule accompanied by an administrative order.

On June 28, 2020, the government reorganized the social distancing scheme and introduced business hours restrictions for the first time — curfews.

During the third wave of the virus in the winter, when the number of daily new infections exceeded 1,000 for the first time, restrictions on private gatherings, such as the five-person cap, were first introduced.

The cap on social gatherings and the curfew times constantly changed.

There were a number of distancing rules that utterly failed to win public sympathy or support. The government called for limits on the speed of treadmills at gyms and the beats per minute of music played at them in order to prevent people from panting or sweating in closely packed environments. The government allowed indoor gyms to open, yet banned indoor group exercises like zumba or spinning.

The damage to small businesses shut down by the distancing rules continued to mount. The two goals of “protecting the most people” and “damaging the least” continued to clash.

"Unlike countries abroad, we never implemented a full lockdown, but rather broke down the restrictions into parts, and the number of businesses affected was much lower than in other countries," health ministry spokesman Son said.

"While our distancing system minimized the damage to large companies and production lines, it piled up the damages on small businesses," said Son. "How to compensate the small businesses is still a task to solve."

Living with Covid — or not

If there was a moment that health authorities regret their actions, it was Nov. 1, 2021. That was the day Korea declared a gradual return to normalcy, dubbed “Living with Covid-19.”

They said it was time to treat the disease like seasonal flu and return to daily life, even if the number of infections increased. With a cap on social gatherings remaining in place — ten in greater Seoul area and 12 in rest of the country — all other restrictions including business curfews were ended.

"Looking back, the end of last year is the most regrettable period," Son admitted.

"In terms of timing, more than 70 percent of the population were vaccinated, and among the elderly, the rate was around 90 percent," said Son. "If we didn't push for a recovery of normalcy then, it would have been endless."

Yet the number of severe cases and deaths started escalating following an increased number of patients during the Delta wave. On Nov. 1, the country saw 1,686 new Covid-19 cases, 34 severe cases, and nine deaths; a month later, the daily infection tally rose to 5,123, severe cases to 723 and fatalities to 34.

The number of hospitalized patients in critical condition, in particular, lingered in the 1,000s until early January, and hospital beds for the critically ill ran out. Several administrative orders were issued to hospitals to find additional beds for Covid-19 patients.

"The vaccine immunity of the elderly decreased too quickly," explained Son. "After analyzing it later, both here and abroad, we found out that immunity starts to decline after three months, and the number of severe cases rose beyond our medical capacity."

Eventually, the gradual return to normal was stopped in a month. A series of stricter distancing rules was adopted, but the public's receptivity wasn't the same.

‘Select and focus’

New infections started to hit fresh highs, this time triggered by the Omicron variant, which was more transmissible than its predecessor, Delta.

As the highly infectious but less deadly Omicron variant threatened to overwhelm the public health system, the government judged that the 3T strategy, of which early and aggressive testing and tracking were the main weapon, appeared unsustainable or even pointless.

Officials shifted to a new game plan: “Select and focus.” It aimed to free up medical resources to focus on the elderly and vulnerable.

The government scrapped contact tracing and mandatory self-isolation of close contacts. Instead, confirmed cases were required to fill out a digital epidemiological investigation report by themselves on a website provided by a community health center, and enter information on people with whom they had been in close contact.

From rigorous testing and tracing, authorities turned to provide care only to Covid-19 patients 60 and older or with underlying conditions, while others monitored themselves and sought medical help from designated clinics if their conditions worsened. Over the past two years, the movements of those infected had been monitored by health officials using GPS trackers and twice-daily checks, with a strict two-week quarantine period being the norm. This dramatic change of tack left the public confused.

The Omicron wave hit a peak of over 400,000 daily cases in the third week of March. But from January, the government loosened the distancing rules from a four people-cap and 9 p.m. curfew; to a six people-cap and 10 p.m.-curfew; eight people-cap and 11 p.m.-curfew; and 10 people-cap and midnight-curfew. And on April 18, the social distancing rules were completely lifted after a total of 48 adjustments over the past two years.

"Which country in the world would lift restrictions when it has more than 600,000 confirmed cases?" criticized Kim Woo-joo, a professor of infectious diseases at Korea University Guro Hospital.

"The government said it eased restrictions for small businesses, but it didn't help," Kim said. "Omicron is raging, and who would dine out?"

Why then?

Authorities say they made the decision after seeing cases starting to decline.

On the other hand, some pointed out the government took into consideration a presidential election scheduled on March 9 — prompting criticism that the pandemic policy was not so much scientific as it was populist.

"As the government bet everything on the presidential election, it kept loosening social distancing restrictions to win more votes," said Jung Ki-suck, a professor of pulmonary medicine at Hallym University Sacred Heart Hospital, who heads the National Infectious Diseases Consulting Committee.

Not everyone ready to unmask

Health authorities and experts share a common assessment of face masks: the are the simplest and most efficient device to prevent infection.

Koreans started wearing facemasks since January 2020 even though there weren’t any regulations or fines. In fact, masks were so popular, lines formed outside pharmacies and prices soared. In March 2020, when the first big cluster in Daegu was in full swing, mask purchases were limited nationally.

Following the southwestern city of Daegu, other local governments such as Gyeonggi and Seoul issued administrative orders mandating indoor and outdoor mask-wearing.

In October 2020, an infectious disease prevention law was implemented that made it mandatory to wear masks outdoors nationwide and imposed fines on violators. From April 2021, regardless of the social distancing level, it became mandatory to wear masks indoors and outdoors where a two meter-distance couldn’t be kept.

Following the lifting of business curfews and caps on social gatherings, the government announced it would lift the outdoor mask mandate on May 2 — except at rallies, performances or sports events attended by 50 or more people. The risk of transmission through the air is significantly lower than in indoors, the government explained, while also citing overseas precedents such as France, New Zealand and Singapore.

Two months have passed since the outdoor mask mandate was lifted, yet it is not difficult to find people wearing face masks on the streets. Experts say people recognize that Covid-19 has not ended.

Second Vice Health Minister Lee Ki-il speaks during a video conference of major hospitals' chiefs at the government complex in Sejong on Thursday to discuss ways to secure hospital beds and other medical responses in preparation for the virus resurgence. [YONHAP]

The BA.5 wave

A sixth wave of the pandemic is predicted to sweep the country this summer and autumn because of the BA.5 sublineage of Omicron, the fastest spreading variant to date.

New Covid-19 infections are already doubling compared to a week earlier. On Thursday, the country reported 40,266 new infections, which was 2.12 times larger than the previous week’s 18,504 cases.

In addition, the BA.2.75 variant, called Centaurus, was identified in Korea on Thursday. The variant was found in a man in his 60s living in Incheon, with no travel history.

Health authorities said the resurgence of the virus came two to three months earlier than expected, and in a worst case scenario, Korea could see up to 207,000 confirmed Covid-19 patients a day in mid-August.

Bracing for a resurgence of cases, the Central Disease Control Headquarters announced a new set of health measures Wednesday.

Under the plan, the government lowered eligibility requirements for fourth doses of coronavirus vaccines to people in their 50s and all adults with underlying diseases.

Despite the recent rise in Covid-19 cases, the government nixed new social distancing measures, citing the social and economic damage, and the public’s fatigue.

With a seven-day quarantine rule for infected patients and the indoor mask mandate remaining the only antivirus measures, the government is raising its guard against a possible virus wave.

The vaccines currently in use were made based on the first coronavirus strain to emerge in Wuhan, making it more difficult to prevent infection against BA.5, which already appears to evade vaccine-acquired immunity.

Omicron-specific Covid vaccines produced by Pfizer and Moderna are expected to be ready by October, but it remains unclear how early they can be sent to Korea.

“It is important to procure the bivalent vaccine boosters as soon as possible,” said Jung.

BY SEO JI-EUN [seo.jieun1@joongang.co.kr]