This is how five countries slowed down Coronavirus
South Korea, China, Singapore, Taiwan and Hong Kong have set instructive examples in containing coronavirus the moment the spread of the outbreak is worsening in other parts of the world especially in Italy. While Taiwan and Singapore have excelled in containing the coronavirus, South Korea and China arguably provide the best models for stopping outbreaks when large numbers of people have been infected. China quarantined confirmed and potential patients, and restricted citizens’ movements as well as international travel. But South Korea accomplished a similar level of control and a low fatality rate (currently 1%) without resorting to such authoritarian measures. This certainly looks like the standard for liberal democratic nations.
South Korea, Singapore, Taiwan and Hong Kong were especially vulnerable to the spread of the infection because of close links with mainland China — especially in early January, as they were prime destinations for Chinese travelers during the upcoming Lunar New Year holiday. Taiwan identified its first case on January 21 in Taiwan and the virus was located in Hong Kong and Singapore on Jan 23. Immediately, the three governments implemented some combination of measures to (1) reduce the arrival of new cases into the community (travel restrictions), (2) specifically prevent possible transmission between known cases and the local population (quarantines) and (3) generally suppress silent transmission in the community by reducing contact between individuals (self-isolation, social distancing, heightened hygiene).
South Korea has emerged as a sign of hope and a model to emulate. The country of 50 million appears to have greatly contained its epidemic; it reported only 74 new cases today, down from 909 at its peak on 29 February. And it has done so without locking down entire cities or taking some of the other authoritarian measures that helped China bring its epidemic under control. South Korea has addressed coronavirus with the most expansive and well-organized testing program in the world, combined with extensive efforts to isolate infected people and trace and quarantine their contacts. South Korea has tested more than 290,000 people, which amounts to more than 5200 tests per million inhabitants—more than any other country except tiny Bahrain, according to the Worldometer website. The United States has so far carried out 74 tests per 1 million inhabitants, data from the U.S. Centers for Disease Control and Prevention show. South Korea’s experience shows that “diagnostic capacity at scale is the key to epidemic control,” says Raina MacIntyre, an emerging infectious disease scholar at the University of New South Wales, Sydney. “Contact tracing is also very influential in epidemic control, as is case isolation,” she says. The second weapon that the century put to use was the country’s heavy use of surveillance technology, notably CCTV and the tracking of bank card and mobile phone usage, to identify who to test in the first place. And this is an important lesson for more liberal countries that might be less tolerant of such privacy invading measures but are hoping to emulate South Korea’s success.
The most conspicuous part of the South Korean strategy is simple enough: test, test and test some more. The country has learned from the 2015 outbreak of MERS and reorganized its disease control system. It has a good, large-capacity healthcare system and a sophisticated biotech industry that can produce test kits quickly. These factors enable the country to carry out 15,000 tests per day, making it second only to China in absolute numbers and third in the world for per person testing. But because COVID-19 is a mild disease for most people, only a small fraction of patients tend to contact health authorities for testing based on their symptoms or known contact with infected people. Many patients with mild symptoms, especially younger ones, do not realize they are ill and infecting others. If these patients cannot be found, testing capacity does not mean much. This is where smart city infrastructure comes in. The aim is to work out where known patients have been and test anyone who might have come into contact with them. There are three main ways people are tracked. First, credit and debit cards. South Korea has the highest proportion of cashless transactions in the world. By tracking transactions, it’s possible to draw a card user’s movements on the map. Second, mobile phones can be used for the same purpose. In 2019, South Korea had one of the world’s highest phone ownership rates (there are more phones than people). Phone locations are automatically recorded with complete accuracy because devices are connected to between one and three transceivers at any time. And there are approximately 860,000 4G and 5G transceivers densely covering the whole country. Crucially, phone companies require all customers to provide their real names and national registry numbers. This means it’s possible to track nearly everyone by following the location of their phones. Finally, CCTV cameras also enable authorities to identify people who have been in contact with COVID-19 patients. In 2014, South Korean cities had over 8 million CCTV cameras, or one camera per 6.3 people. In 2010, everyone was captured an average of 83.1 times per day and every nine seconds while travelling. These figures are likely to be much higher today. Considering the physical size of the country, it is safe to say South Korea has one of the highest densities of surveillance technology in the world.
The combination of these three technologies means two things. First, health authorities can find out who an infected person has had close contact with after infection. There are dead spots without CCTV or mobile phone signal in public buildings, but not that many. Nearly all potential patients can be found and tested this way. Second, a new patient’s movement can be compared against those of earlier patients using geographic information systems. That comparison reveals exactly where, when and from whom the new patient was infected. If they can’t be connected to a known earlier patient, that means unknown patients exist, and they can then be identified using the method outlined above. The number of unknown patients at any time serves as an indicator of whether the virus is still spreading and more cases will occur in coming days, or whether the situation has been brought under control.
The result of the tracking is not only used by health authorities but also made public via national and local government websites, free smartphone apps that show the locations of infections, and text message updates about new local cases. This help citizens avoid hotspots of infections.
As of midday Friday, Singapore had 187 cases confirmed and no deaths (for a total population of about 5.7 million), Taiwan had 50 confirmed cases including 1 death (for a total population of about 23.6 million) and Hong Kong had 131 confirmed cases including 4 deaths (for a total population of about 7.5 million).Travelers coming from affected areas were placed under mandatory quarantine; three university hostels were promptly converted into facilities to host them. The government compensated individuals and employers for any workdays lost.
Singapore authorities undertook especially intensive efforts to trace the contacts of people known to be infected. Hospital staff went to great lengths to interview patients about their recent whereabouts; when information was unclear or unavailable, the Ministry of Health retrieved additional data from transport companies and hotels, including by consulting CCTV footage. Large gatherings have been suspended. But to minimize social and economic costs, schools and workplaces have remained open. Public-health campaigns were also reinforced to further improve Singapore’s already exemplary standards of cleanliness and public hygiene. A special government task force recently recommended five personal hygiene habits: using a tissue when coughing or sneezing; using designated serving spoons during group meals; using trays when eating or drinking to limit contamination in case of spills; keeping public toilets clean and dry; and regular hand washing. From the outset, the government has recommended the use of masks only for people who already are unwell.
Instead of promptly banning travel from China, Taiwan undertook a comprehensive effort to screen newcomers from suspect areas. As soon as early January — just days after the news of the outbreak in Wuhan — Taiwanese medical authorities would board incoming flights from Wuhan and inspect and screen travelers on the planes. It was only after the first imported case was identified on Jan. 21 that four major airlines suspended flights between Taiwan and Wuhan. A ban on all but flights from Beijing, Shanghai, Xiamen and Chengdu was implemented three weeks later. Taiwan has also taken a rather mixed approach in its efforts to reduce transmission within the community. Some state-run facilities have been used for quarantines, but home quarantine has been the predominant method of isolation even when state facilities were available. To ensure compliance, the government has enforced strict penalties against anyone who breaks an isolation order, including fines up to about $33,200.
Starting on Feb. 5, anyone coming across the border — or arriving from elsewhere who had been in mainland China in the preceding 14 days — was required to undergo a mandatory 14-day period of self-quarantine. Extensive efforts have also been made to track down and quarantine the close contacts of confirmed cases. And in the event transmission might occur before an infected person displayed any symptoms, tracing included all contacts starting two days before the onset of the patient’s illness.
With different socioeconomic and political features, China, South Korea, Singapore, Taiwan and Hong Kong have succeeded in slowing down the disease’s transmission which suggests that other governments can make follow them too.
[The author is a freelancer. You may contact him at firstname.lastname@example.org]