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Response to COVID-19 in South Korea and implications for lifting stringent interventions

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Title: Response to COVID-19 in South Korea and implications for lifting stringent interventions
Authors: Dighe, A
Cattarino, L
Cuomo-Dannenburg, G
Skarp, J
Imai, N
Bhatia, S
Gaythorpe, K
Ainslie, K
Baguelin, M
Bhatt, S
Boonyasiri, A
Brazeau, N
Cooper, L
Coupland, H
Cucunuba Perez, Z
Dorigatti, I
Eales, O
Van Elsland, S
Fitzjohn, R
Green, W
Haw, D
Hinsley, W
Knock, E
Laydon, D
Mellan, T
Mishra, S
Nedjati Gilani, G
Nouvellet, P
Pons Salort, M
Thompson, H
Unwin, H
Verity, R
Vollmer, M
Walters, C
Watson, O
Whittaker, C
Whittles, L
Ghani, A
Donnelly, C
Ferguson, N
Riley, S
Item Type: Journal Article
Abstract: Background After experiencing a sharp growth in COVID-19 cases early in the pandemic, South Korea rapidly controlled transmission while implementing less stringent national social distancing measures than countries in Europe and the US. This has led to substantial interest in their “test, trace, isolate” strategy. However, it is important to understand the epidemiological peculiarities of South Korea’s outbreak and characterise their response before attempting to emulate these measures elsewhere. Methods We systematically extracted numbers of suspected cases tested, PCR-confirmed cases, deaths, isolated confirmed cases, and numbers of confirmed cases with an identified epidemiological link from publicly available data. We estimated the time-varying reproduction number, Rt, using an established Bayesian framework, and reviewed the package of interventions implemented by South Korea using our extracted data, plus published literature and government sources. Results We estimated that after the initial rapid growth in cases, Rt dropped below one in early April before increasing to a maximum of 1.94 (95%CrI; 1.64-2.27) in May following outbreaks in Seoul Metropolitan Region. By mid-June Rt was back below one where it remained until the end of our study (July 13th). Despite less stringent “lockdown” measures, strong social distancing measures were implemented in high incidence areas and studies measured a considerable national decrease in movement in late-February. Testing capacity was swiftly increased, and protocols were in place to isolate suspected and confirmed cases quickly however we could not estimate the delay to isolation using our data. Accounting for just 10% of cases, individual case-based contact-tracing picked up a relatively minor proportion of total cases, with cluster investigations accounting for 66%. Conclusions Whilst early adoption of testing and contact-tracing are likely to be important for South Korea’s successful outbreak control, other factors including regional implementation of strong social distancing measures likely also contributed. The high volume of testing and low number of deaths suggests that South Korea experienced a small epidemic relative to other countries. Caution is needed in attempting to replicate the South Korean response in populations with larger more geographically widespread epidemics where finding, testing and isolating cases that are linked to clusters may be more difficult.
Issue Date: 9-Oct-2020
Date of Acceptance: 22-Sep-2020
URI: http://hdl.handle.net/10044/1/82854
DOI: 10.1186/s12916-020-01791-8
ISSN: 1741-7015
Publisher: BioMed Central
Start Page: 1
End Page: 12
Journal / Book Title: BMC Medicine
Volume: 18
Copyright Statement: © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Sponsor/Funder: Wellcome Trust
Medical Research Council (MRC)
Medical Research Council
Wellcome Trust
Medical Research Council (MRC)
Funder's Grant Number: 203871/Z/16/Z
Keywords: COVID-19
Contact tracing
Public health interventions
Reproduction number
South Korea
Bayes Theorem
Clinical Laboratory Techniques
Contact Tracing
Coronavirus Infections
Disease Outbreaks
Pneumonia, Viral
Republic of Korea
General & Internal Medicine
11 Medical and Health Sciences
Publication Status: Published
Article Number: 321
Online Publication Date: 2020-10-09
Appears in Collections:Department of Infectious Diseases
Faculty of Medicine
School of Public Health
Imperial College London COVID-19

This item is licensed under a Creative Commons License Creative Commons