COVID19 update, March 28, 2020: South Korea’s experience in more detail

Stephen Park, who runs the YouTube channel “Asian Boss”, managed to secure an interview with Dr. Kim Woo-Ju of the Transgovernmental Enterprise for Pandemic Influenza in Korea. How did the country manage to nip the epidemic in the bud, so to speak? Or, using a different metaphor (see below), skip the “hammer” phase and move straight to the “dance” phase?
https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56

Here is the full video (in Korean with English subtitles) follows at the end of the post (due to a WordPress glitch). The URL is:
https://www.youtube.com/watch?v=gAk7aX5hksU

Below follow my notes from the video:

* Koreans learned from 2009 H1N1 swine flu and 2015 MERS outbreak
Mask discipline, rapid PCR testing capability. Massive investment in R&D of PCR kits
* * MERS: 186 patients, 38 dead. Only country outside Middle East that had an outbreak
* status as of March 24 in South Korea: 8.961 cases, of which 20% asymptomatic. 111 dead.
Case fatality rate by age:
11.6% over 80
6.3% in seventies
1.5% in sixties
0.4% in fifties
0.1% in thirties and forties [but stats of small numbers, since only one fatality of each]
no fatalities (yet) below 40
* reason for age dependence: (a) immunosenescence, natural decay of immune system with age; (b) pre-existing conditions [that become more frequent with age]
* reactivation cases: have seen some cases that were discharged as cured, then came back 5-7 days later
* in South Korea, anyone can get tested on demand for pay: if found positive, gov’t refunds test. Should get tested if feel any of sore throat, fatigue, fever,…
* masks ARE definitely useful, though should go to healthcare personnel in 1st priority[, general public in 2nd priority]. Proved their worth during SARS and MERS outbreaks. Eyeglasses are useful! Infection occurs through mucous membranes (mouth, inside nose, eyes): virus needs ACE2 receptors, none to be had on epidermis of regular skin.
* main vectors: 1st: droplets from cough, sneeze on mucous membranes (can travel up to 2m in Earth’s gravity field); 2nd hands after wiping nose; 3rd droplets falling on keyboard, table,…
* risky locations: isolated gathering places, e.g. places of worship (he hinted at shouting preacher reaching further than 2m)
* presently, 20% of new cases arrive at airport from aborad. Everybody is now tested on arrival, held overnight at a temporary facility. Turnaround time for PCR testing is 6h, but can be overnight due to overload. If found positive, sent to hospital if moderate or severe symptoms, to special treatment clinic for mild cases. If found negative, tracking app installed on cell phone and sent to 14-day (?) home quarantine
* from 20 March, strongly recommended to close bars, churches, gyms, clubs (in “Gangnam” district), and cram schools (after-school college admission prep schools) for 2 weeks. Least successful with cram schools: 90% still open
* How long does he think this will last? Best-case scenario would be like SARS. (November 2002 outbreak killed 776 people out of about 8000 worldwide, fatality rate of 9.6%. Then just… disappeared basically). If all countries work together to whip this, could be gone by July-August; 2nd scenario: sputters out in Northern hemisphere in summer and but flares up “Down Under” during their winter, then comes back to North during winter, and becomes part of seasonal infection cycle; 3rd scenario: develop a vaccine and vaccinate the whole human races. If all goes well, should have vaccine in 18 months.
* drug repurposing: gives Viagra as best-known example. Originally developed for pulmonary arterial hypertension. [Note added: there are many other examples. The ADD drug Ritalin was originally developed as a remedy for hypotension; Antabus was originally a drug for tropical parasites]
* Kaletra and chloroquine somewhat effective
Convalescent plasma: antibodies from blood of patients who have recovered
*Best advice to young people: wash hands carefully, wear masks, practice social distancing

So what options do countries have that missed the bus for early clampdown South Korean style? This is probably best illustrated by a metaphor from Tomas Pueyo, “The Hammer And The Dance

The basic strategy outlined in that long essay is:
PHASE 1: very tight lockdown for a brief(ish) period to “starve the virus of hosts”: the goal is to get the reproductive number R well below 1, so the infection sputters out over a period of 3-7 weeks. (His guesstimate for R under tight lockdown conditions is 0.35.)
PHASE 2: “the dance”, relax lockdown in combination with intensive tracking and monitoring efforts, targeted quarantine, to keep R from exceeding 1 again

Full interview with Dr. Kim Woo-Ju

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