How South Korea Is Winning the COVID-19 Battle

In its unsettling global conquest COVID-19 has taken full advantage of unprepared governments and impoverished populations. In a few rare instances it has encountered well-led jurisdictions with a high degree of consensus among its elites, and petered out.

This explains why Brazil is failing badly, why South Korea has adopted “an everyday life quarantine,” and why isolated New Zealand has scored a success with its viral elimination plan.

We continue our weekly series on the progress of six different nations, and their unique responses to a novel virus. Find all the pieces in the series so far here.

All six experiments hold important lessons for Canada, which is still struggling with testing, equipment, data collection and a co-ordinated strategy. For reference, here are relevant statistics for the nation:

Canada: 49,686 cases; 2,841 deaths; 35.6 million population. Deaths per million: 79.6

A caution: Statistical comparisons among nations are imperfect due to accuracy of reporting by each government.

New Zealand: 1,472 cases; 19 deaths; 4.9 million population. Deaths per million: 3.9

New Zealand’s unique elimination strategy, which many experts viewed as risky, continues to move from success to success. Based on rapid response (it closed its borders to China on Feb. 3) and strict lockdown, the country has among the lowest cases per capita in the world. As a result Prime Minister Jacinda Ardern is now preparing to reopen businesses, kindergartens and elementary schools next month.

Her firm leadership has played a pivotal role in uniting the island nation. She never defined the outbreak as a war, but as a communal struggle. She urged people to "Unite against COVID-19" and called the country "our team of five million." In contrast to Canada’s passive message to “Stay Safe," she has ended her broadcasts even on Facebook with a simple admonition: “Be strong. Be kind.”

New Zealand also credits its success to strong ties with the nation’s health scientists as well as clear and organized communication strategy. Unlike Canada or the United States it developed a no-nonsense four level alert system for the pandemic. The system provides clear directions on how the government will proceed given certain levels of infection. New Zealand is now moving from Level Four (strict lockdown) to Level Three where “low-risk local recreation activities are allowed” and public venues remain closed.

To achieve elimination the government is now putting an extra $55 million into its contact tracing operation with the goal of being able to trace 5,000 contacts a day.

Dr. Siouxie Wiles, a public health expert at the University of Auckland, told BBC News that she credits the government’s success to visibly putting people's health first.

Wiles noted that other countries that delayed imposing physical distancing measures for economic reasons (Canada, the Netherlands and England are among them) are now having a much harder time controlling the virus. "Surely, a dead or a dying population is bad for the economy," she told the BBC.

Brazil: 63,328 cases; 4,298 deaths; 210 million population. Deaths per million: 20.5

Brazil, a sprawling nation as divided and dysfunctional as the United States, has become what most of its scientists feared: another deadly global hotspot for the virus. The country didn’t test, and now it is under-reporting deaths.

Manaus, the biggest city in the Amazon, is now digging holes and filling them with 100 bodies a day.

Health officials in Rio de Janeiro and four other major cities now report that their hospitals are on the verge of collapse. According to Brazilian Report, in many states such as Ceara and Amazonas intensive care beds are all occupied with COVID-19 patients. In Para more than 200 health-care workers reported being infected. To date the federal government has delivered less than 20 per cent of 2,000 intensive care beds it promised.

Brazilian researchers complain that the government has under-tested and that the number of infected people has probably topped a million. That means death rates could soon skyrocket the way things did in Spain and Italy.

Nearly 80,000 Indigenous people could be wiped out by the pandemic and are listed as “critically vulnerable.”

The pandemic continues to illuminate social and racial inequalities throughout the country. Wealthy Brazilians have dismissed 45 per cent of their domestic servants or housekeepers without pay. Yet one of the first casualties of the pandemic was a housekeeper who contracted the disease from a wealthy family returning from Italy. Twenty to 40 per cent of Brazilians are at high risk for infection due to other medical conditions.

Meanwhile the embattled presidency of Jair Bolsonaro, an unrepentant coronavirus denier, has erupted into a dangerous and lasting tropical storm.

Last week the justice minister Sérgio Moro, the former judge who lead the famous Car Wash anti-corruption crusade in the country, resigned after delivering a blistering speech basically accusing the president of being a crook. Bolsonaro, the Donald Trump of Brazil, had asked Moro to fire the federal police chief so that Bolsonaro could replace him with an official who would obey the president's wishes instead of Brazil’s laws. Moro refused and resigned.

The Supreme Court is now investigating the allegations. Eight ministers have left the chaotic and explosive government of Bolsonaro in the last 15 months.

One of Bolsonaro’s right-wing supporters, businesswoman Cristiane Deyse Oppitz, proposed last week that Brazilians who support physical distancing be separated from COVID-19 deniers by putting a red mark on their door.

“You will not be able to see a doctor, go to the pharmacy, or the supermarket (...) because of the mark on your door. You will be in total isolation until the big virus passes. So all the food produced goes to people who are contributing and not to people who do not want to contribute,” she said.

Bolsonaro has staked his political future on his fantastical belief that COVID-19 is nothing more than a “measly cold.” After firing his health minister and replacing him with a compliant puppet, Bolsonaro said if the pandemic exploded, as it is now doing, accountability “lands on my lap.”

South Korea: 10,738 cases; 243 deaths; 51.6 million population. Deaths per million: 4.7

The nation’s case load (ten a day) and death toll has barely changed in the course of a week. Physical distancing still remains the rule in South Korea but many of the restrictions on shops, restaurants, bars, gyms, cram schools and religious services have been loosened.

As a consequence South Korea has entered a new phase of living or what the government calls “everyday life quarantine.” The proposed code of conduct governs all aspects of life. People should bow instead of shaking hands. Book a seat on public transport. When dining in public, make it quick. Wear face masks at church. Stores should appoint quarantine managers. Sports fans should not cheer loudly to avoid spreading aerosols. Hugging and high fives are, of course, discouraged.

Thanks to a rigorous test, trace and contain strategy, South Korea now records cases in the single digits. With a relatively young population it also boasts one of the lowest rates of people with COVID-19 dying from the infection, at 2.23 per cent.

The government hopes that its new code of conduct and sustainable routine distancing will keep the virus at bay. "The biggest sign of danger in our society is becoming careless that the risks of infections are gone," Korea Centers for Disease Control and Prevention director Jeong Eun-kyeong said.

Germany: 158,142 cases; 5,985 deaths; 83 million population. Deaths per million: 72.1

Germany, which has the fifth-highest number of confirmed coronavirus cases in the world, continues its cautious and staged approach to easing restrictions. But Chancellor Angela Merkel warned the leaders of its 16 states last week not to surrender what the nation had gained: “We are still far from out of the woods. We are not in the final phase of the pandemic, but still at the beginning.”

Last week Germany allowed small stores, car and bicycle dealers and bookstores to open provided they observe strict distancing and hygiene rules. Schools will open in May and new rules make mask wearing mandatory on public transport and in shops. But the country won’t allow more mobility till the number of cases has fallen from 2,000 a day to a few hundred.

Germany continues widespread testing (260,000 a week) and averages nearly 400 new cases a day, which is less than Canada.

Lars Schaade, vice-president of the Robert Koch Institute (Germany’s centre for disease control), remains opposed to opening shopping malls and larger stores. “It is a paradox that due to the success of the measures that have been taken... these very same measures are now being called into question,” he told the Guardian. “More contact will mean more infections... which, in the worst case, could bring us to a point where the epidemic is no longer manageable.”

Some experts are expecting a second wave in May and June if the densely-populated nation lets its guard down too quickly.

Sweden: 18,926 cases; 2,274 deaths; 10.2 million population. Deaths per million: 223

Sweden, a radical COVID-19 experiment, is staying the course with its “light touch approach.” Unlike much of Europe the government embraced voluntary physical distancing and declared no national lockdown. Bars, schools and elementary schools remain open with the goal of slowly exposing more people to the virus to build herd immunity.

To date this approach, which most Swedes support, has garnered the nation a COVID-19 fatality rate of 223 per million people, compared with 38 per million in Norway or 34 per million in Finland.

As in Canada, 50 per cent of Sweden’s deaths have occurred in nursing homes. In an interview with Nature last week Sweden’s chief epidemiologist Anders Tegnell admitted that the Public Health Agency “registered very unfortunate outbreaks of the coronavirus” in care homes for older people. “This accounts for Sweden’s higher death rate, compared with our neighbours. Investigations are ongoing.”

Tegnell expects to see a lot more cases in the next few weeks — “with more people in intensive-care units — but that is just like any other country. Nowhere in Europe has been able to slow down the spread considerably.”

He believes the disease can be eradicated without a vaccine. Asked if his approach of gradually building herd immunity in the population was working, Tegnell replied, “It is very difficult to know; it is too early, really.” Many admiring Swedes have tattooed their arms with images of Tegnell’s face.

Researchers calculate that one third to half the population of Stockholm will have been infected by the end of May.

Carina King, an infectious disease epidemiologist at Stockholm's Karolinska Institutet, has been critical of Tegnell’s approach.

"The concept of herd immunity — which I know the government has said is not the strategy, but will be a result of the strategy — is problematic because there is just not enough information yet to know that we can achieve it.”

South Africa: 4,546 cases; 87 deaths; 58 million population. Deaths per million: 1.5

Although South Africa continues to see the highest rising number of cases in Africa, it is doing more testing than most of its neighbors.

During a national lockdown the country has approached COVID-19 the same way it has tackled HIV and tuberculosis infections: screen, test, diagnose, contact trace, isolate and treat with mobilized teams of health-care workers.

Nearly 30,000 workers are going door to door or have established pop-up clinics in the nation’s poor and densely-populated townships. To date the country has screened four million people and tested 150,000 in the nation’s nine provinces. Despite recording more cases, the government will ease its lockdown in five stages in May.

The nation’s prevalence of poverty and inequality still remain the nation’s greatest obstacles. One small store owner told the Washington Post that he supported the government’s strategy. “But I don’t know if it will work, as many people here are less concerned with COVID than wanting to just survive.”