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Alba Iulia
Thursday, April 9, 2020

South Korea’s four reasons for its success in combating the coronavirus: how it managed to lower the death rate

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South Korea became the first country to outnumber China in new coronavirus infections in late February. The epidemic reached an alarming peak on the 29th, when 909 reported cases were reached in a single day.

But the trend began to change from that moment. The Korea Center for Disease Control and Prevention (KCDC) reported 114 additional cases Thursday, the lowest level in three weeks..

Since January 20, when the first patient was announced, 7,869 people contracted the virus, of which 66 died. 86% of these were 60 years or older, and most suffered from other diseases.

It is the fourth country with the most cases, behind China, with 80,932 (3,172 deaths); Italy, with 15,113 (1,016); and Iran, with 10,075 (429). But what sets South Korea apart from the others is COVID-19’s low death rate, which is just 0.8 percent.. In Italy it amounts to 6.7%, in Iran 4.3% and in China 3.9%.

Even countries with fewer cases show higher mortality. In Spain, where there are 2,968 infected and 84 deaths, it is 2.8 percent. In France, which has 2,284 cases and 48 deaths, it is 2.1 percent. Only Germany shows, for now, a lower rate: 0.2% (2,369 infected and five dead). But with a third of the cases and with much more time to prepare for the epidemic, since it came weeks later.

Korea was challenged to run into an outbreak that seemed out of control almost overnight. As of February 18, one, two, or three cases were reported per day, and spread was limited. But on the 19th, 34 were reported, and four days later they became 190.

The common origin is the city of Daegu, where about 75% of those infected come from.. With a population of 2.5 million, it is the fourth most populous in the country and is a stronghold of the Christian Shincheonji sect. Founded in 1984 by Pastor Lee Man-hee, who presents himself as an envoy of Jesus, he claims to have some 245,000 faithful.

The cult has ideal condiments to favor the massive spread of a virus: people crowd in confined spaces to pray on the floor, glued to each other, unable to wear glasses or anything that covers their faces, and are encouraged to attend mass even if they are sick. The South Korean government maintains that more than 60% of those infected are members of or have ties to the religious group.

The congregation’s refusal to cooperate at first made it difficult for the authorities, but did not prevent them from deploying a successful strategy to quell the spread of COVID-19 and, above all, to reduce its lethality. These are the four main reasons:

1. Learned the MERS lesson

In the recent history of South Korea there is another coronavirus epidemic, in which the country did many things wrong. On May 20, 2015, a 68-year-old man from a Middle Eastern country was diagnosed with MERS (Middle East Respiratory Syndrome)., caused by the virus known as MERS-CoV.

That case led to the largest outbreak of the disease outside the region in which it originated, with 186 infected, of which 36 died. The mortality rate was almost 20%, 20 times higher than that of the current coronavirus.

“Korea has experience with managing previous emergencies, including the 2015 MERS outbreak. This recent history has provided important lessons for the Korean population, “he told Infobae Gerardo Chowell, Professor, Department of Health Sciences, Georgia State University and Researcher, Fogarty International Center Division of International Epidemiology and Population Studies.

The initial response in that case was slow. To compound the problem, the Ministry of Health and Welfare withheld information at first, with the excuse of not generating alarm in the population. As a consequence, hundreds of hospitals and local authorities began to receive cases in complete darkness, which seriously affected their ability to react.

On the other hand, patients were not isolated correctly, resulting in several episodes of intra and inter-hospital transmission, something to be avoided by all means. Additionally, the quarantine was only determined for the closest circle of each infected, without worrying about seeing what other people had had contact with before being hospitalized.

The government was widely criticized for treating the outbreak. Five years later, it is clear that he learned from his mistakes.

2. A quick response, with plenty of tests

If anything evidenced the outbreak of COVID-19 in China is the devastating effects of not acting in time and letting the contagion advance without doing anything. South Korea was already forewarned and did the opposite.

The mainstay of the containment strategy was to deploy a large and fast early detection device, distributing in clinics and hospitals across the country the tools to do free tests on people with symptoms or with a simple medical prescription. There were even special cabins available, which allow drivers to test without leaving the car. Up to 15,000 tests are performed per day and more than 200,000 have already been done since the outbreak began, much more than anywhere outside of China.

“I think the death rate is low in Korea because a lot of testing has been done and a lot of mild cases have been found. In most countries, tests are limited to the most severe, making mortality higher. Korea has been successful in rapidly identifying infected individuals and subsequently isolating them to prevent transmission, “said Benjamin Cowling, professor at the University of Hong Kong School of Public Health, consulted by Infobae.

Admittedly, President Moon Jae-In was questioned for minimizing the problem on February 13, when there were only 28 confirmed cases. Then he said that the epidemic was going to “disappear in a short time”. But the system below him was already ready to act. In fact, unlike what had happened with MERS in 2015, the Ministry of Health shares all the information it has available and publishes a detailed balance of new cases every day.

Moon himself radically changed his attitude. This week, even after a downward trend in the number of infected began to occur, He maintained that it was too early to be optimistic and that it was necessary to remain alert.

“Mortality is related to the provision of quality health services and the degree of access of patients to medical services. Of course, in the situation from February 20 to 29, when the number of infections rapidly increased, there was a temporary shortage of hospital beds, leading to preventable deaths. Nevertheless, By rapidly introducing the Classification System for Serious and Mild Patients, hospitalization was limited to the Serious. About 80% of those affected are mild and are in treatment centers with an inpatient regime, in facilities such as corporate training centers, to which medical personnel are sent, “he told Infobae Jaewook Choi, chair of the Scientific Review Committee of the Korean Medical Association and professor at the University of Korea Medical College.

3. A universal and efficient health system

As much as the government has a good containment plan and knows what to do, Without a good basic health system, it is difficult to combat an epidemic of these characteristics. If so few people suffered severe complications from the coronavirus in South Korea, it is also because it has first-rate health.

It is one of the reasons why it is a country with a high quality of life without being too rich: its GDP per capita at constant prices is $ 26,761, very far, for example, from its neighboring Japan, which is at $ 48,919. , or Singapore, which is at 58,247. Nevertheless, It has a Human Development Index of 0.906 (22nd globally) and a life expectancy of 83 years (7th highest).

Korea has one of the best health systems in the world. Patients have access to the best medical equipment, including mechanical ventilators, which are very important in intensive care units, “said Chowell.

One of the keys to the Korean system is the virtuous articulation between the public and private sectors. Since 1989 coverage is universal. 97% of the population pays the National Health Insurance and 3% of lower incomes are beneficiaries of an aid program, financed through taxes. But even though there is only one insurer, which is public, most of the providers are private clinics and hospitals, and citizens are free to decide where to go.

As the system is centralized, insofar as there is only one insurance, the Ministry of Health has access to medical information for the entire population and has powers to exercise a coordinating role. This was very important for the response to the coronavirus to be fast and effective.

85% of hospitals across the country are private, but work closely with the government and the medical community to treat COVID-19 patients Jaewook said. Specifically, public medical institutions are responsible for the operation of screening clinics, confirmatory examinations and the treatment of mild patients, and private medical institutions provide quality and complex medical services. ”

The equipment of many establishments was also decisive. The most delicate patients, detected early, were admitted to rooms with negative pressure, which prevent potentially contaminated air from going outside.

“The coronavirus shows rapid progress and we are also nervous. But we have negative pressure isolation rooms in most emergency medical centers after experience with MERS. That blocked the spread and enabled active treatment by medical personnel, “said Sung Hyuk Choi, a professor in the Department of Emergency Medicine at the University of Korea, in dialogue with Infobae.

Obviously, the system is far from perfect. In Daegu, the facilities were overwhelmed at the worst time of the epidemic. And the inequalities that exist cannot be ignored, since through additional payments people with more resources can access the best clinics. Instead, the majority of the population should go to hospitals where there are delays and other difficulties. However, they are problems that exist in all countries – in most, aggravated – which leaves South Korea in a privileged position in comparative terms.

4. Trust in the authorities

The Korean approach to the crisis is, in many ways, the opposite of the Chinese one. Instead of imposing draconian measures, such as the total blockade of cities, harsh restrictions on the movement of people and appealing by force as a threat against those who do not comply with official regulations, South Korea preferred to persuade its citizens to act with caution. And the results were more than acceptable.

The essential condition for people to follow official recommendations of their own accord, comply with quarantines and restrict their activities is that have a minimum of trust in the authorities. Something the Korean state achieved by being fairly efficient and transparent in reporting what is happening to the coronavirus. At this point, the role of the KCDC is vital.

“The participation and cooperation of the citizens of Daegu allowed a dramatic change, without the extreme blocking measures of other countries”Yoon Tae-ho, a senior health ministry official who is in charge of quarantine, said this week.

Of course, controversial decisions were also made. The clearest example is GPS control of outpatients, which allowed creating a real-time map to verify that they comply with quarantine. But most people consider it a necessary cost to minimize the spread of the disease.

“Active government management is the most important thing. Most of the medical personnel and people trust the authorities and respond well, without fear of cooperating voluntarily ”Sung Hyuk Choi concluded.

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