Fighting the Coronavirus Pandemic, East Asian Responses - Republic of Korea: Mass-testing, targeted investigations and the transparency issue

On January 3, enhanced screening measures, including quarantine, are adopted for travelers coming from Wuhan. To prepare for the Lunar New Year inflow of Chinese visitors, the KCDC also instructs health facilities to enhance infection prevention and control practices.

The emergence of suspected and confirmed cases in Korea in January and the absence of travel restrictions lead to public outrage. A petition on the Presidential Blue House website calling for a ban on all Chinese travelers receives 540,000 signatures. However, public pressure does not change the prevention centered Korean strategy, enforced through screening, local quarantine and self-quarantine recommendations. KCDC conducts epidemiological investigation and contact tracing for confirmed cases, as well as for travelers coming directly from Wuhan. The ROK is among countries having conducted an evacuation from Wuhan. On January 31, two chartered flights evacuate around 700 South Korean nationals from Wuhan and send them in designated facilities for 14-days isolation.

This early response fails to prevent a sudden increase of the contagion in mid-February. A "super-spreader", otherwise known as Korea’s "Patient 31", creates a major cluster in the city of Daegu. As of March 24, 71.28% of Korean confirmed COVID-19 cases are located in the Daegu area. A member of a religious cult called Shincheonji Church of Jesus, the middle-aged woman came into contact with more than 1,100 people during a religious gathering in the southeastern city of Daegu, a city of 2.5 million inhabitants. She refused a coronavirus test 3 times, under the pretext she had not recently traveled to China. A Ministry of Justice investigation revealed that the sect had a secret office in Wuhan and 42 members traveled from there to Korea in the previous 6 months; a criminal investigation is launched. By early March, the Daegu cluster results in multiplication of cases in Korea by 100 times. The extremely fast number increase brings a high number of patients with mild symptoms in hospitals, while at the same time, on February 21, 1,800 patients are at home waiting for hospital beds and two of them die in the process.  

In practice, KCDC describes the new approach as a mix of both "containment and mitigation". From February 24, in the infected municipalities of Daegu and Cheongdo, the focus is on isolating and treating potential cases rather than tracing. In other regions, "epidemiological investigation and environmental disinfection are conducted to find Shincheonji-related cases as well as to prevent sporadic community spread". Even though tracing is not prioritized in the biggest cluster, the government does not let go of the tracing strategy to identify cases outside of the region.

Indeed, the Korean government engages in a targeted nation-wide testing campaign of Shincheonji cult members. On February 25, KCDC acquires the full list of the 210,000 Shincheonji members, present in 12 branches across the country, and starts testing and tracing members. This targeted testing campaign implies a coordination effort between the national and local levels. Local governments are given lists of Shincheonji members in their areas, and contact them via phone one by one. On March 9, KCDC declares the testing of the 10,000 Daegu Shincheonji members is almost complete.

After another cluster is discovered on March 16 in a church in Seongnam, near Seoul, the government launches on March 22 a two weeks "social distancing campaign" (‘사회적 거리두기’ 캠페인) to incite religious, sport and entertainment activities to shut down, and the Seoul mayor decides the closure of several churches. The Seongam church had not respected previous government recommendation to avoid religious gatherings, resulting in an infection of at least 51 people. According to a study from the KCDC published on March 23, people in their teens and 20s represents 34% of total infection in Korea. It could be because, like in Singapore, young people respect less social distanciation than older generations.

Thanks to this new system, on February 4, only two weeks after China releases the genetic sequence of COVID-19, a virus testing kit developed by Korean company Kogene Biotech Co Ltd is granted an emergency use authorization by the Ministry of Food and Drug Safety. The test kit, which gets results in six hours, becomes available in 50 clinics just three days after its official approval. Korean health authorities are thus able to test hundreds of thousands of citizens for the virus in the space of a few days. As of late March, five Korean companies were producing test kits and Korea had started exporting tests, including to Europe

The COVID-19 testing campaign is a mix of free testing and intense compulsory tracing. Testing is free of charge for suspected cases (i.e. in the presence of symptoms or of a link to a confirmed case) since January, including for foreign nationals. Government covers hospitalisation costs, treatment and provides compensation for people living in self-quarantine. After the Daegu outbreak, the Korean government creates "Drive-through Test Centers" , where people can be tested for free and on demand inside their own car. Results are later sent by text message. The aim of those structures is to limit contact between patients and medical workers, as well as gaining time on the testing process, since it is possible to test 10 persons an hour. Within one month, a total of 40 drive-through facilities is active nationwide. In addition, to face the wave of incoming infected travelers returning or visiting Korea after mid-March, the government decides to test for COVID-19 all incoming travelers from Europe at the airport on March 22. In practice, passengers arriving from EU countries, if tested positive, are transferred to a hospital and treated immediately. Passengers testing negative still need to undergo a period of quarantine; Korean nationals must undergo a second examination within three days after returning home.

The Korean government also conducts intrusive contact tracing to track known and suspected cases alike, without the need of individual’s approval. At first, KCDC uses mostly mobile phone records as well as CCTV camera footage to determine who has come in contact with a confirmed carrier. The newspaper Chosun Ilbo describes the tracing process as: 1/ identifying people who came within a 2-m distance of a confirmed case a day before the person started displaying symptoms, and 2/ narrowing down depending of the conditions of contact (if the person was wearing a mask, sneezed, etc). Suspected cases are then put in self-quarantine for 14 days, regardless of if they are displaying symptoms or not (testing is done if symptoms appear, except for “high risk groups” related to major clusters). Credit card records are also used to improve tracing, as these records are more precise than phone records (roughly 80% of transactions in Korea are now made with credit cards). This tracing is done in collaboration with credit card companies: the KCDC sends information about a case with the date of first symptoms, and the companies send back data. According to Korean law, this kind of information is usually given upon court approval or personal consent, but in case of a national crisis, the KCDC is able to skip this step. Article 76-2 from the “Infectious Disease Control and Prevention Act” states that, if necessary to prevent infectious diseases and block the spread of infection, the Minister of Health and Welfare and the KCDC can request administrative agencies, local governments, public institutions, medical institutions, corporations, organisations and individuals to provide personal information on confirmed and suspected cases (including information related to movement paths of patients). This article was added in July 6, 2015, after the MERS outbreak in Korea, to provide the MOHV and KCDC with legal authority to collect private data without a warrant (health authorities, under the previous law, struggled to understand the path of infection during MERS outbreak, which was heavily criticized).

But what is more specific of the Republic of Korea is the controversy regarding disclosing to the public the identity and the location of patients and quarantined individuals. On its website, KCDC provides extended lists of confirmed cases. Even though the names are not revealed, a wide range of personal information is disclosed: age, sex, neighborhood, where the infection took place. Local governments relay those information through local and social media. Some cities even release "emergency alerts" through text messages to inform inhabitants of confirmed case in their vicinity. Names are not mentioned, but information such as occupation, employers and travel history are relayed, and even translated in English for foreign inhabitants. Private initiatives emerge, such as an aggregation of KCDC data through the website Coronamap.

The invasion of privacy becomes so extreme that the National Human Right Commission expresses concern about the excessive disclosing of private information of patients, which are easily identified by their workplace or travel history. On March 10, KCDC sets new guidelines preventing regional governments from leaking information (such as address or employer)  that could lead to identification of patients. However, an exception is made for cases where a patient has infected large numbers of colleagues at work. On March 26, the government launches a new digital contact tracing program using big data, which reduces the time for epidemiological investigation to 10min. Only KCDC is allowed to access data - no other government agency.

The Korean government, like Taiwan, has adopted an industrial policy to support and control mask production and distribution. The country has a daily mask production capacity of 10 million units, yet 90% of the raw materials are imported from China. This explains why the Korean policy to boost production centered on the local production and retail of the key raw material for mask production, melt-blown nonwoven fabric filters. According to Finance Minister Hong Nam-ki, the ROK targets an increase of its daily mask output from 10 million to at least 13 million. To avoid shortages, the government first limits mask exports to 10% of the output before completely banning mask exports from March 5. On the same day, to prevent hoarding situations faced earlier in the month, the Korean government decides rationing and control of their national distribution. Prime Minister Chung Sye-kyun announces that masks will first be provided to the medical, quarantine and law-enforcement sectors, and then evenly distributed to the general population. Korea Post is put in charge of distributing 650,000 masks though all its post office, with buying limited to five masks by person at a price of 1,000 won per mask (around US$ 0.75). Overall, compared to Taiwan, the mask production and distribution strategy has been much less successful, leading the vice-minister of Health to state on March 1: "We apologize deeply to people regarding mask issues".

The ROK is now associated in the media with mass-testing, and indeed the free testing possibility, including the drive-through testing, has been a major feature of the government’s response, emulated today by other governments. Yet neither the number of available masks, nor the quantity of tests are enough to cover the entire population. Two features are actually more significant. First, the massive investigation conducted to address the emergence of the Daegu cluster and avoid contagion along the national network of the Shincheonji sect, making use of all available data. Second, Korea displays features similar to the other Asian dragons: a quick reaction centered on tracing and monitoring to avoid a major contagion, targeted border controls expanding over time, and a strict quarantine policy. Finally, there is tension around leaking of the identity of infected patients to the wider public, and how the central government places local governments under control to avoid such practices. This raises the question of the deterrent effect of naming and shaming risks on the social behavior of the population, vs. the impact on privacy and individual rights.

Mathieu Duchâtel, François Godement, Fiona Trichard, Viviana Zhu - Institut Montaigne’s Asia Program

Copyright: ED JONES / AFP