Coronavirus cases have dropped sharply in South Korea ...

Europe is now the epicenter of the COVID-19 pandemic. Case counts and deaths are soaring in Italy, Spain, France, and Germany, and many countries have imposed ... Advertisement LogIn BecomeAMember QuickSearchanywhereEnterSearchTerm science.org Custompublishing collections videos podcasts blogs visualizations prizesandawards authors&reviewers librarians advertisers about help TermsofService PrivacyPolicy Accessibility NewsHome AllNews ScienceInsider NewsFeatures GETOURE-ALERTS HomeNewsScienceInsiderCoronaviruscaseshavedroppedsharplyinSouthKorea.What'sthesecrettoitssuccess?BackToScienceInsider ScienceInsiderAsia/Pacific CoronaviruscaseshavedroppedsharplyinSouthKorea.What'sthesecrettoitssuccess? AscarybrushwithMiddleEastrespiratorysyndromeledthecountrytosetuptheworld’smostexpansivetestingprogramforCOVID-19 17Mar2020ByDennisNormile Amedicalofficerpreparestotakesamplesfromavisitoratadrive-throughtestingcenteratYeungnamUniversityMedicalCenter.REUTERS/KimKyung-Hoon Share:TwitterLinkedInFacebookRedditWechatEmail EuropeisnowtheepicenteroftheCOVID-19pandemic.CasecountsanddeathsaresoaringinItaly,Spain,France,andGermany,andmanycountrieshaveimposedlockdownsandclosedborders.Meanwhile,theUnitedStates,hamperedbyafiascowithdelayedandfaultytestkits,isjustguessingatitsCOVID-19burden,thoughexpertsbelieveitisonthesametrajectoryascountriesinEurope.Amidthesediretrends,SouthKoreahasemergedasasignofhopeandamodeltoemulate.Thecountryof50millionappearstohavegreatlysloweditsepidemic;itreportedonly74newcasestoday,downfrom909atitspeakon29February.AndithasdonesowithoutlockingdownentirecitiesortakingsomeoftheotherauthoritarianmeasuresthathelpedChinabringitsepidemicundercontrol."SouthKoreaisademocraticrepublic,wefeelalockdownisnotareasonablechoice,"saysKimWoo-Joo,aninfectiousdiseasespecialistatKoreaUniversity.SouthKorea'ssuccessmayholdlessonsforothercountries—andalsoawarning:Evenafterdrivingcasenumbersdown,thecountryisbracedforaresurgence.Behinditssuccesssofarhasbeenthemostexpansiveandwell-organizedtestingprogramintheworld,combinedwithextensiveeffortstoisolateinfectedpeopleandtraceandquarantinetheircontacts.SouthKoreahastestedmorethan270,000people,whichamountstomorethan5200testspermillioninhabitants—morethananyothercountryexcepttinyBahrain,accordingtotheWorldometerwebsite.TheUnitedStateshassofarcarriedout74testsper1millioninhabitants,datafromtheU.S.CentersforDiseaseControlandPreventionshow.SouthKorea'sexperienceshowsthat"diagnosticcapacityatscaleiskeytoepidemiccontrol,"saysRainaMacIntyre,anemerginginfectiousdiseasescholarattheUniversityofNewSouthWales,Sydney."Contacttracingisalsoveryinfluentialinepidemiccontrol,asiscaseisolation,"shesays.Yetwhetherthesuccesswillholdisunclear.Newcasenumbersaredeclininglargelybecausetheherculeanefforttoinvestigateamassiveclusterofmorethan5000cases—60%ofthenation'stotal—linkedtotheShincheonjiChurchofJesus,asecretive,messianicmegachurch,iswindingdown.Butbecauseofthateffort,"WehavenotlookedhardinotherpartsofKorea,"saysOhMyoung-Don,aninfectiousdiseasespecialistatSeoulNationalUniversity.Newclustersarenowappearing.Sincelastweek,authoritieshavereportedmanynewinfections,including129linkedtoaSeoulcallcenter."Thiscouldbetheinitiationofcommunityspread,"throughSeoulanditssurroundingGyeonggiprovince,Kimsays.Theregionishometo23millionpeople.LessonsfromMERSSouthKorealearnedtheimportanceofpreparednessthehardway.In2015,aSouthKoreanbusinessmancamedownwithMiddleEastrespiratorysyndrome(MERS)afterreturningfromavisittothreeMiddleEasterncountries.HewastreatedatthreeSouthKoreanhealthfacilitiesbeforehewasdiagnosedwithMERSandisolated.Bythen,hehadsetoffachainoftransmissionthatinfected186andkilled36,includingmanypatientshospitalizedforotherailments,visitors,andhospitalstaff.Tracing,testing,andquarantiningnearly17,000peoplequashedtheoutbreakafter2months.Thespecterofarunawayepidemicalarmedthenationanddentedtheeconomy."Thatexperienceshowedthatlaboratorytestingisessentialtocontrolanemerginginfectiousdisease,"Kimsays.Inaddition,Ohsays,"TheMERSexperiencecertainlyhelpedustoimprovehospitalinfectionpreventionandcontrol."Sofar,therearenoreportsofinfectionsofCOVID-19amongSouthKoreanhealthcareworkers,hesays.Legislationenactedsincethengavethegovernmentauthoritytocollectmobilephone,creditcard,andotherdatafromthosewhotestpositivetoreconstructtheirrecentwhereabouts.Thatinformation,strippedofpersonalidentifiers,issharedonsocialmediaappsthatallowotherstodeterminewhethertheymayhavecrossedpathswithaninfectedperson.AfterthenovelcoronavirusemergedinChina,KoreaCentersforDiseaseControlandPrevention(KCDC)racedtodevelopitstestsandcooperatedwithdiagnosticmanufacturerstodevelopcommercialtestkits.Thefirsttestwasapprovedon7February,whenthecountryhadjustafewcases,anddistributedtoregionalhealthcenters.Just11dayslater,a61-year-oldwoman,knownas"Case31,"testedpositive.Shehadattended9and16FebruaryservicesattheShincheonjimegachurchinDaegu,about240kilometerssoutheastofSeoul,alreadyfeelingslightlyill.Upwardof500attendeessitshouldertoshoulderonthefloorofthechurchduring2-hourservices,accordingtolocalnewsreports.Thecountryidentifiedmorethan2900newcasesjustinthenext12days,thevastmajorityShincheonjimembers.On29Februaryalone,KCDCreportedmorethan900newcases,bringingthecumulativetotalto3150andmakingtheoutbreakthelargestbyfaroutsidemainlandChina.ThesurgeinitiallyoverwhelmedtestingcapabilitiesandKCDC's130diseasedetectivescouldn'tkeepup,Kimsays.ContacttracingeffortswereconcentratedontheShincheonjicluster,inwhich80%ofthosereportingrespiratorysymptomsprovedpositive,comparedwithonly10%inotherclusters.High-riskpatientswithunderlyingillnessesgetpriorityforhospitalization,saysChunByung-Chul,anepidemiologistatKoreaUniversity.Thosewithmoderatesymptomsaresenttorepurposedcorporatetrainingfacilitiesandspacesprovidedbypublicinstitutions,wheretheygetbasicmedicalsupportandobservation.Thosewhorecoverandtestnegativetwicearereleased.Closecontactsandthosewithminimalsymptomswhosefamilymembersarefreeofchronicdiseasesandwhocanmeasuretheirowntemperaturesareorderedtoself-quarantinefor2weeks.Alocalmonitoringteamcallstwicedailytomakesurethequarantinedstayputandtoaskaboutsymptoms.Quarantineviolatorsfaceupto3millionwon($2500)fines.Ifarecentbillbecomeslaw,thefinewillgoupto10millionwonorasmuchasayearinprison.Inspiteoftheefforts,theDaegu-Gyeongbukregionranoutofspacefortheseriouslyill.Fourpeopleisolatedathome,waitingforhospitalbeds,wererushedtoemergencyroomswhentheirconditionsdeteriorated,onlytodiethere,accordingtolocalmedia.Still,thenumbersofnewcaseshavedroppedthepast2weeks,aidedbyvoluntarysocialdistancing,bothintheDaegu-Gyeongbukregionandnationwide.Thegovernmentadvisedpeopletowearmasks,washtheirhands,avoidcrowdsandmeetings,workremotely,andtojoinonlinereligiousservicesinsteadofgoingtochurches.Thosewithfeversorrespiratoryillnessesareurgedtostayhomeandwatchtheirsymptomsfor3to4days."PeoplewereshockedbytheShincheonjicluster,"Chunsays,whichboostedcompliance.Lessthan1monthafterCase31emerged,"Theclusteriscomingundercontrol,"Ohsays.Yetnewclustersareemerging,andfor20%ofconfirmedcases,it'sunclearhowtheybecameinfected,suggestingthereisstillundetectedcommunityspread."Aslongasthisuncertaintyremains,wecannotsaythattheoutbreakhaspeaked,"Chunsays.MoredataneededThegovernmenthopestocontrolnewclustersinthesamewayitconfrontedtheoneinShincheonji.Thenationaltestingcapacityhasreachedastaggering15,000testsperday.Thereare43drive-throughtestingstationsnationwide,aconceptnowcopiedintheUnitedStates,Canada,andtheUnitedKingdom.InthefirstweekofMarch,theMinistryoftheInteriorandSafetyalsorolledoutasmartphoneappthatcantrackthequarantinedandcollectdataonsymptoms.Chunsaysscientistsareeagertoseemoreepidemiologicaldata."Weareliterallystampingourfeet,"Chunsays.KCDCreleasesthebasiccountsofpatients,theirageandgender,andhowmanyarelinkedtoclusters."Thatisnotenough,"Chunsays.Heandotherswouldliketostudydetailedindividualpatientdata,whichwouldenableepidemiologiststomodeltheoutbreakanddeterminethenumberofnewinfectionstriggeredbyeachcase,alsoknownasthebasicreproductivenumberorR0;thetimefrominfectiontotheonsetofsymptoms;andwhetherearlydiagnosisimprovedpatients'outcomes.(SouthKoreahashad75deathssofar,anunusuallylowmortalityrate,althoughthefactthatShincheonjichurchmembersaremostlyyoungmayhavecontributed.)ChunsaysagroupofepidemiologistsandscientistshasproposedpartneringwithKCDCtogatherandsharesuchinformation,"andwearewaitingfortheirresponse."KimsaysmedicaldoctorsarealsoplanningtosharedetailsoftheclinicalfeaturesofCOVID-19casesinthecountryinforthcomingpublications."WehopeourexperiencewillhelpothercountriescontrolthisCOVID-19outbreak."WithreportingbyAhnMi-YounginSeoul.*Correction,1September,9:10a.m:ApreviousversionofthisstoryusedanincorrectnamefortheMinistryoftheInteriorandSafety.Italsosaidanewbillwouldincreasepunishmentforquarantineviolatorstoa10millionwonfineandupto1yearinprison.Itis10millionwonorupto1yearimprisonment,butnotboth. doi:10.1126/science.abb7566 Relevanttags: Asia/PacificHealth Coronavirus Abouttheauthor DennisNormile mail Author DennisNormile isacontributingcorrespondentinShanghai,China. 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