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To Win or to Lose: The Battle of COVID: Comparing Methodologies of the U.S., Italy, and South Korea

To Win or to Lose: The Battle of COVID: Comparing Methodologies of the U.S., Italy, and South Korea

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By: Amanda Gach and Samantha Pearse

April 24, 2020

The coronavirus pandemic has infected over two and a half million people, with numbers quickly rising each day. Impacting the respiratory functions of the body, this virus ravages the elderly and those with underlying health conditions such as asthma and diabetes. Since its spread began in December of 2019, millions of people world-wide have quarantined, billions of dollars in business have been lost, and consumers have been directed or forced to stay home. In the U.S. alone, more than twenty-two million people have applied for unemployment, and there are estimates that the unemployment rate could hover around twenty percent for a few quarters. The true impact will remain unknown until the virus has completely run its course. With countries at their tipping point, the U.S. must consider the change of course the virus is taking and the new policies required to combat it.

The pandemic has impacted every country in the world; this post will provide an analysis on the methods and countermeasures used in the United States, Italy, and South Korea. Italy has been one of the worst hit countries outside the U.S., while South Korea was hit hard, yet recovered remarkably well using innovative strategies. In order for the U.S. to move forward in this unprecedented time, certain steps need to be taken: more open communication is needed between the government and population, intensive testing needs to be widespread, aggressive contact tracing should be implemented, certain aspects of social distancing will need to remain in place, and the economy should reopen carefully.

United States

In late March, the U.S. shifted to become the epicenter of the pandemic. The CDC first came out with its National Influenza Pandemic Plan in 2005-2006, with the published plan being updated in June 2017.[1] This plan included basic expectations of a pandemic’s influence and included containment and control strategies. Regardless of any prior knowledge of the timeline and necessities for a pandemic, the key resources, logistics, and communication needed to act quickly in order to curb the number of cases and reduce the spread intensity, were out of place. Doctors and professors across the U.S. stated early in this crisis that there was a limited timeframe to when the U.S. could take effective measures to keep the death toll under 100,000. Dr. Ezekiel Emmanuel from the University of Pennsylvania stated that this window to “win this war” was only a week to two weeks from March 23rd, stating that the U.S. would have to intervene immediately with measures on a similar scale China.[2] With the current Covid-19 death toll rising above 45,000 in the U.S., the situation has become dire.[3]

The U.S. had major setbacks in its efficiency to combat the virus; its shortages and allocation of supplies, public testing delays, and poor public communication and contradictions did not bode well for the future of the emergency. When analyzing the shortage of protective masks to be used in hospitals and by medical professionals, an obvious link can be drawn to U.S. dependency of imports from China. China is the producer of 80% of all masks worldwide.[4] The millions of masks that were in the federal stockpile were never replaced after 100 million were used in 2009 in the H1N1 flu pandemic. There is also a concerning shortage of ventilators. Production of these and other personal protection has been taken over by private firms, including Ford, GE, and Tesla.[5] Ventilators provided by the vehicle giants won’t be available until early June, and although better than not starting production, this is only evidence of the lag in the administration’s response to shortages. These hindrances have been slowing the process down in winning the fight – examples of Italy and South Korea offer insight into preparations the U.S. can make for future waves of the virus.

Italy

The virus struck Italy hard and fast. A worst-case scenario became reality within a matter of months and Prime Minister Giuseppe Conte is criticized for his administrations’ slow response to the virus—often blaming other regional leaders for the outbreak. He additionally blamed the surge in infectious numbers of the virus to intense testing that was taking place in the north. The chain of command slowed down the decision of a country-wide lockdown.[6] When it was decided, the legislation was unclear and not strongly enforced, leading to many finding excuses to leave home and increasing the potential of furthering the spread of the disease.[7]

When the heavy reality of the situation set in, several measures were then used to help curb the virus. Extensive testing was done, and, whenever possible, those who were symptomatic and those who were asymptomatic were tested in order to pinpoint the spread of the virus. Proactive contact tracing was then used. Anyone who was known to have come in contact with someone who had the virus has been asked to be quarantined and monitored for signs of the infection. There has been a large emphasis on home diagnosis and self-care, with more information being offered online to help citizens be able to treat themselves at home when possible. Health care workers have also been going into the homes of those who have the virus and test other members of the household. Monitoring of medical professionals and vulnerable workers such as grocery store workers for the virus has also helped to maintain the spread of the influenza.[8]

South Korea

The main lessons that can be learned from South Korea’s successful fight against the coronavirus can be observed from their strategy of early and aggressive testing and contact tracing. As one of the earliest countries with high coronavirus numbers, South Korea’s tackle of the virus is commendable: limiting the numbers to 10,600 cases and 229 deaths as of early April.[9] The South Korean government published an article titled “Flattening the curve on COVID-19: The Korean Experience,” which emphasized its success as a direct result of using technology to identify infected individuals and communicate updates to their public.[10] They further claimed that flattening the curve of infection took less than three weeks due to these measures. Considering their timeframe, the first case in South Korea was identified January 20th, and by March 17th, already more than 270,000 South Koreans had been tested.[11] Comparatively, the US had tested only approximately 50,000 by this date, and continued to lag in tests per capita compared to less populated South Korea and Italy.[12] South Korea’s effective testing led them to identify potential infected persons while numbers were still relatively low. This success was mainly thanks to 2015 initiatives within the Korean CDC (in response to MERS caused by a different coronavirus) that focused on new methods to quickly produce tests and virtually eliminated the need for a large-scale quarantine or lockdown.[13] As a result of this past scare, South Korea increased its preparedness for future pandemics.

As soon as China publicized the virus’s genome in January, the South Korean government had started working with private biotech companies to develop test kits that were then produced and distributed throughout the country. [14] A swift and vast production of testing kits in over 500 testing facilities[15] enabled South Korea to then begin contact tracing. Infected individuals gave information of any people they were in contact with and locations visited during the time since their initial infection. These individuals were then contacted and tested, and the process repeated. Along with this manual tracing, South Korea is also a pioneer of using digital tracing providing free smartphone apps that communicate numbers of infected people in nearby areas. It also includes the infected patients’ locations visited prior to getting tested. Credit card information and cell phone GPS locations are also shared to confirm information which gives all the information in 10 minutes. [16] These methods are possible because privacy laws were changed after the previous MERS outbreak in the case of a national medical emergency, and most South Koreans see these protective measures as a necessary tradeoff to some privacy limitations. 

Policy Solutions

Learning from how both Italy and South Korea have handled the virus, and how it has been handled so far within the United States, we offer some policy solutions to help combat this influenza.

Open communication is needed in order to curb fear and misunderstanding of the virus. Leaders need to be clear and direct about how serious a threat this influenza is to the population and to the economy. In an analysis of communication in leadership by McGill University, the researchers found that the most effective leaders had clear and concise communication.[17] The administration should be clear and concise with the public about the efforts being undertaken to curb this disease. They should offer fact-based knowledge that does not contradict previous statements. For example, many health experts in the U.S. told the public that masks would not curb the virus unless they were already sick, but recently that message has changed and the CDC is urging for the wearing of masks by everyone when they are in public.[18]

The U.S. can further make improvements in the two crucial fields of diagnostic testing and contact tracing methods. Perhaps one of the biggest lessons the U.S. has to learn lies in its timing. Large-scale testing did not occur until late March mainly because of “technical flaws, regulatory hurdles, business-as-usual bureaucracies and lack of leadership at multiple levels, according to interviews with more than 50 current and former public health officials, administration officials, senior scientists and companyexecutives.”[19] Regrettably, the U.S. missed the best chance of an early containment of the virus’s spread. We suggest that in order to accelerate the process of deploying diagnostic tests, the U.S. must relax its regulations for private companies and clinics. Many researchers at universities, such as Stanford, began creating tests in February that went unused and were not mass produced because of discouragement from strict F.D.A. approval conditions.[20] According to public health experts, the U.S. must double or triple from current testing levels in order to reopen parts of the economy.  Testing can help to track the spread of the virus and those that have come in contact with a Covid-19 patient can be tested as well, as has been done in Italy and South Korea. Testing of ‘essential workers’ also needs to become a priority. Grocery store clerks, postal service men and women, and other non-medical personnel on the front lines of essential businesses are some of the most at risk for contracting the disease. Quick, continual, and effective testing could help stop a grocery store worker, or someone else, from passing on the disease to hundreds of people.

Once testing increases in both scope and timeliness, plans for contact tracing should be implemented within each state – especially those with highly infected regions. Directors of health recognize the need of manpower to do this. Anita Cicero, the deputy director of the Center for Health Security at John Hopkins and author of “A National Plan to Enable Comprehensive COVID-19 Case Finding and Contact Tracing in the U.S.” emphasize the quantity of workers that would be necessary, saying “we need an army to do this.”[21] Because budgets are tight for health agencies, a big potential solution is of the type observed in South Korea. Technology that collects location data could be used to speed tracing of individuals. And although U.S. security and privacy measures would be stricter, Robert Redfield, director of the CDC, stated that technology usage in contact tracing is currently under “aggressive evaluation.”[22] Increasing manual labor tracing and implementation of digital tracing will accelerate the process of identifying individuals who would be targeted for quarantine and treatment as the country reopens.

As questions about when and how to open economies back up start to float around, there are several recommendations we would like to offer. Keeping social distance measures can help to stop the fast and free movement of the virus. Workers who can remain working from home should stay that way until the curve is flatter. Opening up the economy too quickly could cause another spike in the spread of the disease, forcing the current situation to be renewed. Factory workers could potentially work in smaller teams for the time being and teams would work in scheduled and completely separate shifts, not coming in contact with each other to keep a prospective spread from causing a detrimental slow down to some production. Road construction companies in Canada are following this procedure, keeping their crews separate from one another so that if one crew gets sick, the other can keep working and the illness does not take out the whole workforce. It is also our recommendation that schools stay closed for the foreseeable future. While children are less likely to become severely ill from the disease, there is a great concern that they could become super spreaders[23], and infect even more people.

Until there is an effective treatment, or a vaccine, social distance measures may need to remain in place. As long as the critical care numbers are not exceeded, then there is an ability to treat the worse off patients.

Conclusion

The fight against corona is not simple or easy. A pandemic of this scale has not been seen for a hundred years. The unprecedented battle will continue to negatively impact the economy. Though political and economic uncertainty lie ahead, if the U.S. adapts and adds new measures, it can increase the protection of vulnerable population against infection. Considering the methodologies of other nations, and adapting them to the U.S. is a time-honored tradition to change future responses in similar scenarios. A lack of communication, constructive planning, and early action has been the downfall of the U.S. during this pandemic, and the consequences have and will continue to be dire unless changes are made.


[1] https://www.cdc.gov/flu/pandemic-resources/pdf/pan-flu-report-2017v2.pdf

[2] https://www.nytimes.com/2020/03/23/opinion/contributors/us-coronavirus-response.html

[3] https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

[4] https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-masks.html

[5] https://www.nytimes.com/2020/03/24/us/politics/coronavirus-ventilators.html

[6] https://www.nytimes.com/2020/03/21/world/europe/italy-coronavirus-center-lessons.html

[7] https://www.nytimes.com/2020/03/08/world/europe/italy-coronavirus-quarantine.html?searchResultPosition=26

[8] https://hbr.org/2020/03/lessons-from-italys-response-to-coronavirus

[9]  https://www.worldometers.info/coronavirus/country/south-korea/

[10] https://www.cbc.ca/news/investigates/south-korea-covid-19-outbreak-record-1.553763

[11] https://www.nytimes.com/interactive/2020/03/26/us/coronavirus-testing-states.html

[12] https://www.nytimes.com/interactive/2020/03/17/us/coronavirus-testing-data.html

[13] https://www.businessinsider.com/how-south-korea-controlled-its-coronavirus-outbreak-2020-4

[14] http://www.law.go.kr/LSW/lsInfoP.do?lsiSeq=188080&chrClsCd=010203&urlMode=engLsInfoR&viewCls=engLsInfoR#0000

[15] https://www.businessinsider.com/how-south-korea-controlled-its-coronavirus-outbreak-2020-4

[16] https://www.businessinsider.com/how-south-korea-controlled-its-coronavirus-outbreak-2020-4

[17] https://www.mcgill.ca/engage/files/engage/effective_leadership_is_all_about_communicating_effectively_luthra_dahiya_2015.pdf

[18] https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-masks.html

[19] https://www.nytimes.com/2020/03/28/us/testing-coronavirus-pandemic.html

[20] https://www.nytimes.com/2020/03/28/us/testing-coronavirus-pandemic.html

[21] https://www.globalhealthnow.org/2020-04/we-need-army-national-plan-contact-tracing-us

[22]https://www.npr.org/sections/health-shots/2020/04/10/831200054/cdc-director-very-aggressive-contact-tracing-needed-for-u-s-to-return-to-normal

[23] https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30287-5/fulltext

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