Lessons from South Korea to control Covid-19 in Latin America
At this time, of the ten countries with the most cases of coronavirus (Covid-19), South Korea has the third lowest fatality rate in the group, only higher than Germany and the United States. This means that for every 100 cases of the disease, 1.3 deaths are recorded in South Korea. This rate is seven times lower than in Italy and five times lower than in Spain. It should also be noted that countries with greater per capita purchasing power than South Korea, such as the United Kingdom, France and Switzerland have higher mortality rates per Covid-19. So, the difference in performance must be based on how things are done, rather than strictly on the resources available.
To get an idea of the impact of the control measures taken by South Korea in the first month of the epidemic, it can be compared with what Brazil experienced in a similar period. The first case of Covid-19 in South Korea was diagnosed on January 20, 2020. By Feb. 19, 31 cases had been reported. In Brazil, the first case was reported on Feb. 26. If the evolution of cases had followed the trend in South Korea, then Brazil would have 120 cases to date (adjusting for the difference in population). However, the number of cases in Brazil today is 1980, which is 17 times more than South Korea. Clearly, in this trend, not unlike that experienced in other Latin American countries, the progression of cases will be dramatic.
It is therefore essential, based on the experience of South Korea, to draw out with the greatest urgency the lessons that can be applied in Latin America. At least five lessons are of great relevance.
The first is preparedness before the emergence of the pandemic. South Korea was affected by the SARS (2002–2003) and MERS (2012) epidemics. As a result, the country updated legislation to incorporate innovations in the treatment of quarantines and isolates, and to modernize decision-making processes in the management of epidemics. Procedures were also established for mobilizing resources for the health system in emergencies, and priority was given to training human resources in epidemiology and infectious diseases. Similarly, links between the national government and local governments and the private sector were improved. As a result, China’s notification of the Covid-19 epidemic at the end of 2019 was assumed by South Korea in better institutional conditions than in previous epidemics by other coronaviruses. In general, Latin American health systems are not in a comparable position to deal with these situations. This is not so much because of the resources involved, but rather because of the medium-term outlook for these issues.
South Korea’s rapid response in the early days of this year, when no cases had yet been reported in its territory, is the second lesson to be taken into account. The government considered the city of Wuhan as an area of spread of Covid-19 cases. Temperature and respiratory symptom monitoring were initiated for people coming from that city. Protocols were also defined to be followed after the detection of cases and a committee was formed to lead the emergency under the Center for Disease Prevention and Control of South Korea. A few days later, this provision was extended to all people from China. Another key measure was the contact of the national government with companies that could develop the diagnostic tests for Covid-19. As a result, the country generated the capacity to produce 100,000 tests per day, to the point that they can now be exported to 17 countries. In other words, case finding was associated with subsequent decision making.
In Latin America, the cases of Covid-19 began to be diagnosed at the end of February this year. In the most positive scenario, this would mean that the respective protocols for case detection were in place. However, events in recent weeks, especially the exponential increase in cases, and news about the limited availability of tests, indicate that the provisions were not made for the rapid screening of cases. We also know that, in the first week of March, when only 15 cases had been reported throughout the region, nine ministries (out of a total of 20) had not posted the protocols for clinical treatment of cases on the respective websites. One week later, no ministry in the region had posted the appropriate pandemic plan on its website.
Thus, in the vast majority of countries in the region, this extraordinary increase in cases is beginning to be recorded without having fulfilled the previous phases. The fact that the diagnosis of cases occurred almost two months after the notification of the epidemic by China, means that there was enough time to have designed the protocols and plans. This was the “window of opportunity” to which the World Health Organization (WHO) insisted. Unfortunately, it seems that this window was not properly used.
These lags may explain the conditions under which the region’s health systems are beginning to face the emergence of cases. In South Korea, detailed preparation made it easier for the health system to identify the first cases and arrange for contact isolation and quarantine measures, complemented by massive diagnostic testing. The outbreaks that occurred in some cities were quickly controlled with the application of public transport restrictions, cancellation of social events, delay in the start of school activities. The results of the diagnostic tests made it possible to separate patients with moderate symptoms in health services for that condition, making it possible to reserve the more complex services for complicated patients. The combined effect of these measures may explain the low case fatality rate already reported.
In the case of Latin America, the growth rate of cases indicates that the possibility of contact follow-up is exceeded in the early stages of change. It is therefore urgent to give priority to these activities. This would mean taking urgent measures to incorporate health personnel who can identify contacts and obtain samples for diagnostic confirmation. It is quite evident that the quality of this process is what will determine the time of control of the pandemic, even with the implementation of quarantines as it already exists in several countries.
A fourth lesson from South Korea has been the development of technological alternatives (applications, practical mechanisms for carrying out diagnostic tests, among others) that have made it possible to link the information of each person to the monitoring of the pandemic. In this aspect, the governments of the region can implement cooperation programs with companies and universities. To the extent that it is possible to identify case by case, contact by contact, and that the management of this information is linked to decision-making, the possibilities of improving control increase.
Providing information to the population continuously and quickly is South Korea’s fifth lesson. This implies that governments, social organizations, companies, public and private health services, and universities promote the generation and use of information that allows the control of the pandemic. Some countries in the region have an excellent record in these initiatives; their application to the specific field of the pandemic by Covid-19 is perhaps one of the most pressing tasks in the region.
At present, given the evolution of the pandemic in each of the countries of the region, the prospects are worrying. The successful experience of South Korea is a useful reference for each country to have as soon as possible a defined, practical strategy, with the respective allocation of resources, to avoid the greatest number of cases, deaths and suffering in Latin America.
Published in Spanish on March 25, 2020 in TalCualDigital.com. See the article in: https://marinojgonzalez.blogspot.com/2020/03/lecciones-de-corea-del-sur-para.html