Regions of Asia that have relaxed the non-resurgent coronavirus restrictions have done these three things

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Couples wearing face masks amid concerns over the new COVID-19 coronavirus are crossing a market in Seoul on April 22, 2020.

Ed Jones | AFP | Getty Images

Tulips were blooming in Seoul and Dr. Jerome Kim was walking in his government-issued KF-94 mask with his wife when he received a text message alerting him to a confirmed coronavirus infection in his neighborhood.

It was early April and South Korea made headlines around the world to effectively contain the first major epidemic of Covid-19 outside of China by testing extensively in the population and contacting infected people. But now the students were coming back from abroad and bringing the virus with them.

Kim, director general of the International Institute of Vaccines, clicked the alert on her phone and directed her to the municipal website, which has detailed the whereabouts of the infected person for the past few days.

The anonymous man had visited a local supermarket recently between 10 a.m. and 10:15 a.m. to buy hot peppers, which was confirmed by video surveillance and credit card transaction data, Kim said.

Text alerts

“My wife and I sort of looked at each other and said,” Well, we were there … but Sunday “,” he said with a laugh. “It is one of those balances between privacy and the public good, but it is a decision that governments must make, and in South Korea, I think it has made all the difference. “

The alert is one of dozens, if not hundreds, that millions of South Koreans have received since the coronavirus arrived in the country on January 20, said Kim. He added that such information sharing, despite its implications for data privacy, has helped keep the infection rate low even when businesses are reopened.

This photo illustration shows a man holding his phone showing emergency alert messages announcing places where COVID-19 patients confirmed, among other things, in Seoul on March 10, 2020.

Jung Yeon-Je | AFP | Getty Images

While Hong Kong and South Korea have largely succeeded in containing epidemics at their borders without applying the most restrictive political measures, Singapore, Japan and China are all struggling to do the same. The varying results of efforts in Asia to contain the virus and reopen businesses have taught researchers and public health specialists the nature of the virus and given decision-makers proven methods to combat it.

“This virus likes to find opportunities to spread and if these locks are lifted too quickly, the virus can take off,” Dr Maria Van Kerkhove, senior scientist at the World Health Organization on Covid-19 said on Wednesday. . “The only way to control and remove this virus, this Covid-19, is to find [cases], put these contacts in quarantine, isolate cases and it will be under control. “

From data sharing and border closures to targeted contact tracking, some policies have proven to be more effective than others. Countries that have been affected by the virus later are at an earlier stage in the epidemic cycle and have a distinct advantage: a glimpse of what has worked and what has not worked in other countries in Asia. However, public health experts who spoke to CNBC said they are not convinced that US officials take note of what works and what has failed overseas. They predict that the virus will likely rebound in the United States as well as in Singapore and Japan.

Singapore

“It is a very resistant virus,” said Dr. Dale Fisher, president of infection control at the National University Hospital and the National University of Singapore. “It only takes one infected person and it spreads like wildfire. “

Singapore appears to have contained its outbreak in February. After reporting his first confirmed case on January 23, businesses remained open for months as health officials worked out a plan to prevent community-wide transmission by finding and contacting infected people. insulating. The wealthy city-state closed its borders to travelers from at-risk countries to avoid importing the disease on March 23, after confirming its first two deaths on Covid-19, but has yet to close.

As of March 31, the country had reported only 879 confirmed cases and three deaths on the island nation, according to data collected by the World Health Organization. The virus started to accelerate in Singapore in early April. By April 10, the number of confirmed infections had more than doubled to 1,910 and has not slowed since.

A migrant worker wearing a protective mask had his temperature checked by a security guard before leaving a factory-converted dormitory on April 17, 2020 in Singapore.

Ore Huiying | Getty Images

However, Singapore’s response has overlooked a crucial segment of the population, said Fisher: the hundreds of thousands of foreign workers on whom the island nation depends for its low-paid work. The virus has started to spread in the overcrowded and unsanitary dormitories that house these workers, said Fisher, who is also president of the WHO epidemic alert and response network. It has since erupted in the largest epidemic in Southeast Asia.

The country reported 632 new cases on May 6, bringing the total number of infections to 19,410, according to WHO data.

Vulnerable population

The government, assuming the virus has already wiped out a large part of the migrant population, has quarantined tens of thousands of workers in massive factories that have been converted to isolation, Fisher said. He added that the number of new cases per day remains impressively lower than thirty in the general population, but hundreds of new cases are reported every day in the services. Fisher said hospitals in Singapore are now almost full and authorities are scrambling to increase capacity.

Migrant workers wearing protective masks queue to receive SIM card recharge cards given by volunteers in a factory-converted dormitory on April 17, 2020 in Singapore.

Ore Huiying | Getty Images

“You cannot overestimate the ability of this virus to find vulnerabilities in society and it is often vulnerabilities that amplify socio-economic differences,” said Fisher. “Every country that is locked out, I think, has a crucial point in the epidemic, they want them to be able to come back and I guess for the moment, Singapore wants them to be able to come back to the early days in these dorms. “

Fisher said he hoped American policymakers had taken note of the situation in Singapore. However, while officials in places like New York, New Jersey and Detroit are battling the largest epidemics in the United States, the concentration of infections appears to have shifted to vulnerable people in the United States.

In the United States, infections are accelerating quickly among inmates, reports The Marshall Project, with more than 14,000 cases confirmed to date as of April 29.

Smithfield Foods hog plant in Sioux Falls has become the country’s largest coronavirus hotspot and was forced to close last month after confirming 238 active cases as of April 12, accounting for 55% of the state’s total at at the time, South Dakota Governor Kristi Dit Noem. Last week, the CDC said that about 3% of workers in more than 100 meat processing plants tested positive for the coronavirus. As the virus circulates among prisoners and low-paid factory workers, these groups could become vectors of transmission even if the epidemic is wiped out elsewhere.

“Threat of war”

South Korea is one of the few countries that has prevented a sustained Covid-19 epidemic without running its economy. Instead of quarantining entire cities like China and shutting down companies and factories like Europe and the United States, it has implemented the world’s largest testing and tracing program.

Samples of test devices used to diagnose the new COVID-19 coronavirus are checked on a production line as they are ready to be included in test kits for shipment to the biological diagnostic company SD Biosensor near Cheongju, at South of Seoul on March 27, 2020.

Ed Jones | AFP | Getty Images

Between January 19 and February 18, South Korea confirmed a total of 31 cases, most of which were directly linked to travel to hot spots in China, according to data compiled by WHO. In the weeks that followed, the virus spread to several cities across the country. The new cases peaked on February 29, when the country reported 813 new cases, bringing the total to 3,150, according to WHO data.

The total number of cases more than doubled as of March 10, but Korean health officials have put in place an aggressive testing regime that processed the tests for more than 259,000 people and confirmed more than 8,000 infections in mid – March, according to the Korean CDC. The United States, by comparison, then tested about 22,000 people, according to the US CDC at the time.

South Korea has set up hundreds of drop-in and behind-the-wheel screening centers, tracing the origins of local epidemics and isolated people who may have come into contact with the virus. The infection rate reached around 100 new cases per day during most of March and early April.

A medical staff member at a booth takes samples from a visitor for the COVID-19 coronavirus test at a walk-in test station at the Jamsil Sports Complex in Seoul on April 3, 2020.

Jung Yeon-Je | Getty Images

Flattened the curve

Their success was punctuated on April 15 when the country held its legislative elections, which had the highest voter turnout in a national election since 1992. In the days that followed, new daily cases fell to just one figure. On May 6, the country reported only two new cases.

“South Korea has managed to flatten the Covid-19 curve in 20 days without applying extreme draconian measures that restrict freedom and movement of people,” reads a study published by the Korean government last month titled “Flatten the Covid-19 curve: Korean experience. The government has released it as a political guide to maneuvering the pandemic.

Pedestrians wearing face masks cross the road in Seoul on April 23, 2020.

Jung Yeon-Je | Getty Images

Since the South Korean government has never imposed a full foreclosure, voluntary compliance has been key, said Kim. The government has encouraged employers to let non-essential workers work at home, said Kim, and distributes free equipment such as masks to every household that requests it. The government’s messages were clear, consistent and mainly communicated by health officials rather than politicians, he said, which was essential to mobilize the public.

“Koreans have lived under the threat of war since the Korean War and it is like a war,” said Kim. “We will do what we have to do to get through. It’s only part of life here, so people got used to it. The government has brought people together. “

Watching Americans protest the demands for social distancing outside the capitals of the United States, Kim said he was not convinced that American citizens could be as disciplined as South Korea. Mixed messages from the White House and heads of state on the economic reopening have not helped the public, he said.

Data sharing

After the MERS epidemic in 2015, Korean legislators adopted the Infectious Disease Prevention and Control Law, which established not only the authority, but also the duty of the Ministry of Health to collect and share location data of each infected individual in the event of an epidemic. at the established level of severity.

“I think countries have to decide for themselves, but in South Korea, we had this debate between 2015 and 2020,” said Kim. “This is the time to have this discussion, when you are calm and when you have the lessons of a furious epidemic behind you. “

This level of government sharing contrasts sharply with the United States, where some coordination between municipalities, counties and states is often questioned. Some states only populate county-level coronavirus cases and even then, data is several days late and paperwork is processed between hospitals and authorities.

In a country as large as the United States, technology-based contact tracing could be the key to virus surveillance, according to public health officials. Apple and Google announced a partnership in California last month to develop tools to perform exactly this type of tracing, although it is not clear when and if it will be widely adopted across the country.

Hong Kong

Hong Kong has experienced several localized epidemics in the city, many of which were imported from mainland China in February and March, said Dr. Keiji Fukuda of the University of Hong Kong. He added that the city had managed to contain the epidemics through rigorous testing and screening as well as by implementing limited social distancing measures.

As of March 15, the city has reported only 149 cases.

People wearing face masks, facing concerns about the COVID-19 coronavirus, commute on a train in Hong Kong on April 4, 2020.

Dale De La Rey | AFP | Getty Images

However, new daily cases rebounded in late March and early April as travelers, and many students who had studied abroad returned to Hong Kong, said Fukuda, who previously served as deputy director general of the health security at the World Health Organization. Of the 1,045 cases from Hong Kong as of May 7, 619 were imported, according to Hong Kong authorities. Fukuda added that understanding the dynamics of the virus like this is key to adopting an effective policy.

“If you have infections coming from outside, you want to think about it in a way,” said Fukuda, “and if they happen inside the country, then you know it makes sense to get there. think in an otherwise. “

Hong Kong closed its international border to travelers from most countries on March 23. Those who are still allowed to enter are forced into a compulsory quarantine of 14 days. Even though new daily cases have hit zero in recent days, health officials remain vigilant, said Dr. Ben Cowling, professor of epidemiology of infectious diseases at the University of Hong Kong.

“If these border restrictions are relaxed, it will be a big problem,” he said, adding that the selective reopening of the border could be a point of international collaboration in the future.

Release of locks

Just as international travel led to the outbreak in Hong Kong, domestic travel to the United States could stimulate transmission, said Cowling. The very first case of coronavirus in North Carolina in early March was imported from Washington state, officials said at the time. The disparate policies of the regulatory states will only encourage interstate transmission and exacerbate the infection, he said.

People hold signs during a protest against the arrest of the coronavirus outside the State Capitol in Madison, Wisconsin, April 24, 2020.

Kamil Krzaczynski | AFP | Getty Images

“When I think of the exit from the United States of the blockages, I think that transmission across the country will be a big threat and I don’t know how it could be resolved,” said Cowling. “If the places come out of isolation and have a low number of cases, but there are often people arriving from the cities in large numbers, even if only a tiny fraction is infected, this can still be the seeding local epidemics to start again. “

Lack of federal leadership in lifting the restrictions could create a situation in which states will have to lock themselves in again, said Yanzhong Huang, public health researcher at the Council on Foreign Relations. He added that as the population mixes, especially when people currently in tightly restricted states leave for more relaxed states, they could take the virus with them, causing local epidemics in pockets outside of cities.

Epidemics vary by state

“The spread of the virus has varied from state to state, so preventive measures have also varied from state to state,” said Huang. “It means that the plateau, the peak of the virus also varies from state to state. This is one of the biggest problems, how to deal with this variation in terms of the path of spread of the virus. “

The experience of Hong Kong and other cities and regions of China and Japan that have also seen an influx of imported cases raises important questions about traveling in the midst of the pandemic, said Olga Jonas, senior researcher at the Harvard School of Public Health and former World Bank economist. .

She said she hopes there will be enough screening and testing infrastructure in the United States by summer so people can travel. But she said unsuspecting travelers could be vehicles for the virus and if pockets of infection threaten to overwhelm and close society, the economic consequences could be even more devastating.

“The big lesson is that, although the coronavirus pandemic is not under control anywhere in the world, it is a threat to everywhere else,” she said. “Any type of trip will increase the risk of transmission. “

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