Thursday, March 26, 2020

How Korea Flattened The Curve (So Far)

Might be time to revive Mr Rogers week.

A friend, who is a paramedic (and you think your job is stressful) asked me how I think South Korea flattened the CoronaVirus curve, so I wrote this for her. I figured I'd share it because hey, why not? These are thoughts I've had spread out over a number of Facebook comments and things, but seems like a good time to get them all in one place. There are places where I paint with a very broad brush here. Deal with it.

Also... this one ended a little bleakly, so in a follow-up blog, I wrote about what a post-lockdown world might look like, and what leaders should be doing during lockdown, so that they don't just get a repeat of exponential infection once lockdown ends.

Hi [redacted awesome person's name], you have asked me to talk about how Korea flattened the curve, and which actions South Korea took that I think contributed to that. I'm doing this with voice to text, so forgive me if there are weird voice recognition errors.

First, let's be clear, I think South Korea is not out of the woods yet. South Korea's big climb in infections was mostly from one super spreader in a city called Daegu. She went to a mass church service, and declined to get tested for covid-19, and was just generally reckless. At one point 80% of all the covid-19 cases in South Korea could be traced directly to this one woman. Google “patient 31”  to learn more about her if you want. The number of cases in Seoul has been pretty steady rather than climbing exponentially, but also not decreasing.

A Close to home Warning

Having a scare in Daegu may have helped in Seoul because South Korea's media reported on that in such a way that people in Seoul realized, “okay, this is a big deal now and we need to start taking precautions immediately.” We saw how bad it could get, and how fast... but the main center of Korea's population wasn't under the gun yet, and during the Daegu response, we got the mask shortage issues out of the way and found a workable solution that will be important if it gets big in Seoul.

Early response
Next, South Korea’s leadership got on the problem really early. Part of this is because Seoul is such a dense city, the government would be recklessly derelict of duty if it didn’t have a contingency for this kind of thing. Seoul does contingencies -- we’re within range North Korea’s artillery, after all. South Korea also had experience with SARS  in 2003, MERS in 2015,  and Swine Flu in 2009 or so. (And those three test-runs mattered way more to South Korea's response than any bullshit "confucianism" "asian group think" cultural explanation you have heard in Western outlets. South Korea's wired-in, informed population saw what worked and we also saw which government actions turned out to be mistakes during those experiences (basically: transparency transparency transparency). Now those infections look like test runs, but it means South Korean bureaucrats were ready when rumors started coming out of China.  They ramped up testing capacity very early, and checked the disease response systems, to make sure they were all ready when the disease arrived in Korea. South Korea has a very good corps of civil servants, because civil servant is a very prestigious job here. That helps too.

I think there is a cultural element in the fact that South Koreans have gone through a number of traumas within living memory. The Korean War, violent dictatorships, colonisation, the 1997 financial crisis, violent suppression of democracy movements, and the 2008 housing meltdown are all within living memory, and were all cases where South Koreans banded together to get through a tough time. By now, it's like muscle memory. Other than the 9/11 attacks, which had an overseas focus, Canadians and Americans probably haven't been called to band together for a domestic issue like this since World War II - even after 9/11, the instructions were don't take precautions; don't change your routines (or the terrorists have won) - return to normal life to show Americans' indomitable spirit! World War II was probably the last time people were being asked to deal with deprivation for the good of the nation, as they bent the entire economy toward the war effort. Anybody who doesn't remember World War II is basically exercising these muscles for the first time. Not to mention, North America has a lone frontiersman, every-man-for-himself cowboy ethos that pushes against focusing on solidarity.

I think the best thing of South Korea did was ramp up testing capacity really early, and make sure testing was available to anyone who needed it. Having a single-payer healthcare system sure helps with this. The fact testing is available to people who need it, has helped people to remain calm. The number of reported cases always will lag behind the number of actual cases, because of the coronavirus's gestation period.  However, South Korea has taken some steps that have ensured that in my estimation, of all the countries testing for Coronavirus, South Korea has probably identified the highest percent of actual carriers. The real vectors for infection are people who don't know they have it & go about their lives spreading pathogens, so South Korea tries to minimize that number by any means. When I hear about places where it is difficult to get a test, that tells me there are lots of carriers walking around, unknowingly spreading the disease, rather than taking  the precautions they should.

A big part of the Way South Korea has identified a large percent of actual virus carriers is through aggressive tracking. Any person who was confirmed to have covid-19 has been asked to share their movements in order to figure out where they have been and communicate that with the public. The government's emergency communication system has been sending out mass text messages saying “there was a coronavirus case in the Jung-gu district on March 29th. Please visit the district government website for more details.” On the website, it will say which stores the person visited and what time they were there, and what bus number they took, so that anybody else who visited that store or rode that bus can self isolate or get tested. While doing this might raise concerns about privacy for some Canadians, this kind of communication does not reveal a person's specific identity, and the public health benefit is huge because it has greatly reduced the number of people who are infected but don't know it and are acting as if everything is normal. In my opinion the biggest risk for Coronavirus spread is people who don't know they're sick; I think that's what happened in Italy where the response was far too late, and now the same thing is repeating in New York and Florida. It has been badly exacerbated by mixed messages and denialism from people who should be leaders,  especially in the USA.

This kind of extra communication has built trust that Korean leadership is on the problem and knows what it is doing. This has the benefit of helping people to stay calm, and it also has the benefit of sending a message to the people that "your leaders are doing everything they can; now here is your part:  social distancing,  hand washing, etc."  In general, South Koreans have bought into these initiatives because it isn't hard to do your own part when you see your leadership is doing their part.

Safety Supplies
It took a government intervention to stabilize mask Supply, but now mask distribution is organized where people of a particular birth year can get masks at pharmacies on a certain day of the week. This helps people feel like they can get a mask if they need it, so people do not hoard them and hospitals and healthcare workers can get the sanitation equipment they need. I think masks do help, they are good, and people should wear them... but healthcare workers need them more. If there aren't enough to go around, paramedics, doctors and nurses first. Once they have theirs, organized and orderly distribution will prevent panic buying.

All these actions together are the reason South Korea has controlled the virus so far. If you pull out one of those jenga bricks, the whole thing might fall. If I had to choose the most important elements, I would say aggressive tracking and social participation are the two most important (not to mention superhero efforts from South Korea's healthcare workers), and after that I would say over-testing and transparent communication are the keys to building up enough trust to get the amount of social participation needed. People who are calm are not panic buying, and not emptying grocery store shelves. You can buy hand sanitizer in stores if you need it.

That's the end of my message to [Awesome Person's Name Redacted]. Here are a few other thoughts.

Listen folks... it's gonna get worse before it gets better. And say what you want about Europe, it's gonna be worst in the USA. I think Europe has identified a higher percent of the actual cases than in the US, where a lot of people can't even get a test. In fact, by the time this is all finished, we might be calling it the America Virus instead of arguing with racists who want to call it the Wuhan or China Virus.

I have been saying to anyone who'll listen since mid-February that Covid19 is going to be bad in USA. As a country, USA...

1. is politically polarized
2. polarizes and politicizes everything, which leads to gridlock on everything
3. has a big contingent who doesn't trust experts, and hasn't for a while
4. has a big contingent who does trust the world's loudest liar
5. already has a significant anti-science anti-vaxxer population who reflexively ignores/disputes messages from scientists and experts,
6. intersecting with a significant number of conspiracy theorists who completely distrust the media
7. but everybody already kinda distrusts the media
8. has an every man for himself ethos as one of its foundational principles
9. has a healthcare system that doesn't take care of vulnerable people
10. has a social safety net that doesn't take care of vulnerable people
11. has a state-by-state patchwork of labor laws and safety laws and emergency laws that introduce many points of failure for any massive public health response
12. has a divided politics where of the three branches of government, one is run by a do-nothing who seems perfectly content to let the poor rot and cares more about his team winning than the good of the American people, and one is run by the narcissistic personification of the Dunning-Kruger effect, who is more concerned with making himself looking good and finding a scapegoat than fixing problems.
and, oh yeah...
13. owns a huge number of guns

I could not be more displeased about this, because when USA coughs, Canada catches a cold, as the saying goes, and most of the people I dearly love are in Canada. Is Canada ready for American healthcare refugees storming the border? Many other friends, whom I also love, live in the USA and I hate seeing this disaster unfold in slow motion, to their great risk and grief.

On top of that, the rest of the world looks to the USA, still, and how USA responds matters because it's the world's biggest economy, it is the elephant in the room in a lot of global institutions (many of them founded and supported by a previous iteration of the US) that need to pull together to mitigate damage as much as possible.

America might turn out OK, no thanks to the turkey in the White House. If it does, it will be due to the great efforts, wisdom and sacrifice of healthcare workers, state-level and local leaders, organizers and bureaucrats, and the kindness and goodness of regular citizens looking out for each other. Everybody needs to band together now, be a helper, support each other, and follow instructions of the experts and community organizers who are trying to make things better, while looking out for those who have ended up in a bad spot.

One of the weird things about this whole pandemic is that it's hard to calibrate exactly how much is the right amount of scared. Being not scared at all is reckless and endangers people. Being paralyzed with fear and making choices out of panic causes problems in a different way. Somewhere in the middle is responsible fear: scared enough to be careful and smart and calculate risks both to oneself and to those in one's connection webs, but also brave enough to help people, reach out, and support their friends in a dark place, and offer relief to those in a bad spot.

Mr Rogers tells us to remind our kids to look for the helpers.
Adults; that means it's also our job to be the helpers.

Hang in there folks. This is serious. A lot more serious when I started my flip "CoVideo Corner" series. We can get through, but it's gonna take patience, kindness, generosity, as well as prudence and care from everyone on this planet together.

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