Two weeks before China disclosed it was investigating a cluster of mysterious pneumonia cases in Wuhan in late 2019 — what the world now knows as Covid-19 — South Korea’s top health officials gathered for a quarterly table-top exercise to plan their response to a theoretical health threat.
The hazard? A never-before-seen pathogen emerging in China that was causing a spike in pneumonia cases.
The timing was a fluke. But the war-gaming, and choice of subject, wasn’t. Korea had learned painful lessons from an outbreak just four years earlier of Middle East Respiratory Syndrome, or MERS. The country overhauled the way it responds to diseases, giving it a global edge when Covid hit.
In a world that’s trying to move on from the virus, even as it still kills thousands of people a day, Korean officials are once again reviewing their approach, seeking insights for the next pandemic — which they say could hit within a decade.
The foundations for Korea’s Covid strategy, viewed as a global success for avoiding lockdowns and widespread deaths, lay in an excoriating 466-page audit report on the response by the Korea Disease Control and Prevention Agency and other health authorities to the MERS crisis. In its raft of criticisms, the document noted inadequate testing and isolation of MERS patients had fueled the spread, as had deficiencies in information-sharing within the health-care system.
“We learned the importance of quickly finding patients and segregating those exposed to a virus before they show symptoms,” said Kyong Ran Peck, commissioner at the KDCA, which oversees public health including infectious diseases and vaccines.
Because of MERS, when Covid appeared, Korea had already built a vast test-and-trace system that enabled officials to zero in on and contain outbreaks before they spread more widely.
Still, the KDCA’s review of its Covid response has unearthed shortfalls that will inform officials’ approach to the next health threat, which they say is likely to be a respiratory virus.
“We are evolving our policies based on the past data to target high-risk groups of people and high-risk facilities,” Peck, 60, said in her first interview with international media since taking the helm of the agency in May. Previously director of the Korea Society of Infectious Diseases, Peck was a professor of infectious diseases for more than two decades.
Measures like curfews, deployed in many parts of the world in the early days of the pandemic, weren’t effective at containing what was a much more contagious virus than MERS.
The onset of even more transmissible Covid variants meant limits on gatherings and social-distancing measures also became less potent, Peck said from the agency’s leafy 98-acre headquarters in Osong, about 45 minutes by bullet train from Seoul. It’s also home to the National Institute of Health and Ministry of Food and Drug Safety, Korea’s FDA, as well as other research institutes, making coordination during the Covid response easier.
Ventilation systems across Korea, particularly in high-risk places like nursing homes, need to be improved. Ways of better supporting health-care workers also need to be addressed, Peck said, given the burnout they experienced during Covid.
As part of the review, the agency is also evaluating other hot-button topics: including whether schools needed to close, the efficacy of travel curbs and gathering restrictions in halting a new threat — and masks. Their findings are set to be released in a white paper on Korea’s Covid response, according to Peck, who didn’t give details on timing.
It’s worth listening to what these experts say. South Korea had one of the world’s lowest Covid fatality rates, with the third-fewest deaths per 100,000 people out of the 38 members of the Organisation for Economic Co-operation and Development. It ranked only behind Japan and New Zealand, according to the World Health Organization. Still, Korea detected a total 26 million infections, the fourth-highest in the OECD, due to its enormous testing program.
Importantly, the country never had a large-scale lockdown. Its vaccination rate was the highest in the world this summer, before widespread monitoring abated, with 2.4 shots on average for every person, according to the WHO.
That success is due in large part to that preparation done back in December, 2019.
“At the time, we thought the next virus would be influenza or coronavirus,” said Cheon-Kwon Yoo, director of the Bureau of Infectious Disease Diagnosis Control, an agency within the KDCA. “We had been preparing for the next pandemic, but we didn’t know it would come so soon.”
Crucially, experts devised a lab test that ruled out coronavirus strains responsible for the common cold, plus the SARS and MERS viruses. Approved within weeks, it meant Korea could diagnose Covid even before its genetic composition was known, putting the country well ahead of other nations that struggled to get testing off the ground.
An elite epidemiology investigation group followed up on those diagnoses, tracing every exposure and ultimately slowing the spread of infections, said Ki-suck Jung, a lung specialist at Hallym University and a member of Korea’s Covid-19 task force.
Initially that involved a phone call to every Covid-positive person to discuss their movements, followed by calls to venues for confirmation. But the workload became untenable as cases grew, so authorities switched to a QR-code check-in system, and looked at credit card spending and mobile phone location data — another strategy locked in due to the MERS outbreak — plus CCTV footage to track people.
A bevy of specialized hospital beds that isolate patients and control air flow were put into medical facilities across the country following MERS, helping Korea avoid the waves of Covid deaths seen in other parts of the world.
With the world seeking to put Covid in the past, the KDCA is determined to learn from the worst global health crisis in a generation. While the threat was worldwide, the responses to Covid were remarkably disparate. International communication and co-operation on tackling pandemics is key, said Peck. “We also learned we can’t do this alone.”
The next challenge may come sooner than we think.
While pandemics previously came in 20-to-30 year increments, said Peck, it was only a decade between the emergence of swine flu in 2009 and Covid-19.
The rise in global travel and climate change are making the pandemic cycles shorter than ever, and it’s imperative the world collaborates to prepare.
“No one knows exactly what the next pandemic will look like, but it’s proper to prepare for a worst case scenario,” Peck said.
“It could be another SARS-CoV-2,” she said, referring to the virus’s scientific name. “It could be worse.”