Dr Bryan In-ho Kim, senior researcher at Korea Centers for Disease Control and Prevention (KCDC), discusses the methods that helped South Korea achieve remarkable results in the fight against Covid-19.
The Korea Centers for Disease Control and Prevention (KCDC) has played a key role in one of the world’s most successful attempts to tackle the Covid-19 pandemic. Its chief investigator, Bryan In-ho Kim, is a professional who helped lead the fight against the disease.
With his expertise, Dr Kim has advised various governments around the world, including Argentina’s. Although he does not usually grant interviews, he spared the time to detail how his country fought to tackle the virus and what the new post-pandemic global normality should look like.
Has South Korea’s previous experience with MERS [Middle East Respiratory Syndrome, a coronavirus] prepared it and its neighbours better than Western countries [for the Covid-19 pandemic]?
Yes. So the 2015 MERS outbreak experience in Korea was a very hard lesson for us – we had a total of 186 confirmed cases and 38 deaths in total. And actually we were the only country that experienced the MERS outbreak at that time – of course, there were some sporadic outbreaks in Saudi Arabia, but not on a large scale.
So because of that, we had to reform a lot of our emergency preparations against these kinds of emerging infectious diseases. And so we have strengthened our public health emergency operations centre, and we intensified our laboratory testing. We strengthened our collaboration with private healthcare centres and they also strengthened their infection prevention and control capacities in their healthcare facilities.
All these kinds of efforts were a stepping stone for us. And I think it clearly made it better for us, to be prepared for this, Covid-19, for sure. There is no question about this.
In the fight against Covid-19, is it key that South Korea has been the country with the largest number of people tested – 650,000 so far, with days of up to almost 30,000 tests across 120 centres?
Yes, I think this kind of massive laboratory testing capacity is one of the main factors. We were able to somehow be successful in controlling this outbreak. The main reason is that Covid-19 can even spread two days before symptom onset. And already it's also very highly transmissible. So without having this kind of laboratory capacity and decision-making – especially in the field – it [the reaction] can be delayed. So thanks to these capacities, we were able to make a quick decision in the period and we were able to isolate. And also we were able to treat confirmed cases based on their severity of the symptoms.
How important was it to wear a face mask at the beginning [of the pandemic]?
Yes, wearing a facemask was initially kind of controversial in many countries, but normally Asian countries are more willing to wear a face mask voluntarily, because maybe some for cultural reasons.
At this point, it is clear that when there is a wide spread of community transmission, wearing a face mask is very important. It's not just for protecting yourself, but you can also protect others. As I mentioned earlier, Covid-19 can spread two days before symptom onset. Wearing a face mask is very important.
Could there be a second wave of Covid-19 in the near future [in South Korea] or has the battle against the virus already been won?
Yes, I'm very glad that we now have only a single digit number of confirmed, newly confirmed, cases per day. But this does not necessarily mean that we have won this fight against Covid-19. The main reason is because even if we somehow stabilise the condition in Seoul, Korea, other countries are still in the middle of this outbreak. So there is a continuous importation of this virus through travellers. Now, for the last couple of weeks, almost 80 percent of confirmed cases [in South Korea] were actually imported from other countries. So as long as there is a Covid-19 on this planet, we still have to maintain our alert level. This is going to be a long, long term issue for sure.
Last week, the social-distancing stage ended [in South Korea] and the stage of distancing from daily life began. How is it going?
One of the main reasons for lowering this level of social distancing is because of the reduced number of newly confirmed cases per day.
The situation inside of Korea is much more stabilised than before. And so now we are in a transition period in terms of switching from immense social distancing to distancing in daily lives. We are now promoting this because we have to get used to this kind of new normal. This is going to be a long-term issue, people need to get used to this kind of social distancing in their daily lives.
Do you believe in herd immunity? Is this epidemiological position ethical?
Herd immunity refers to the terminology meaning the potential of prevention of the infectious disease due to increased immunity around people, people around you, because of their infection with a virus or or vaccinations.
As Covid-19 is, it’s a new emerging infectious disease. I don't think of using herd immunity strategy. Is that the right thing to do? And then we have seen some of the European countries, they were struggling with their situation because they initially used this herd immunity strategy. As long as a Covid-19 is a new emerging infectious disease, there is not enough information. So it should be very carefully used, only for those infectious diseases that we know very well.
Why was there no quarantine and only social distancing [in South Korea]?
Yes, yes. In Korea, quarantine measures were only applied to someone who had exposure to confirmed cases and [those] who have a higher likelihood of exposure to confirmed cases during travel. So actually, we did not use this quarantine measure at the community level. Only social distancing was used because we were able to control this outbreak with mass testing.
What explanation can you give to explain that in 150 days, the virus was present in all countries of the world, while that was not so with SARS 1 [Severe acute respiratory syndrome]?
I think there's actually many explanations for the difference. And first of all, Covid-19 – and I know in some countries, some experts are actually calling this source Covid-2 – it's clearly a different virus, even if it's the same coronavirus…
There are many things that are actually quite different from stories of SARS back in 2003. And also nowadays, or for a lot of people, because of the development of air traffic and trade, international air traffic and trade, all countries are actually much more interconnected, and because of that, international air traffic must have contributed to, I mean, must have facilitated the spread of this virus, especially in the initial phase, before countries started studies like an entry ban for travellers.
What do we know about the immunity that this virus produces? Will having been infected protect against future reinfections?
Actually, there is not enough evidence to say whether we can confidently say that infection with the Covid-19 can actually prevent reinfection from this virus in the future. A lot of experts are scientists and experts are actually doing some research on this. And at this point, we need more research.
What time frame do you imagine for the development of a vaccine?
There have been a lot of predictions. Therefore, there is a lot of hope for a vaccine against Covid-19. And I know a lot of countries and international organisations and also partner institutions. They are all doing their best in terms of developing this vaccination and some institutions say 18 months from now. And some predicted maybe only by 2021.
At this point, we are not sure, because it's a very time-consuming procedure. It's very complicated. And then once a new vaccine is developed by some partners, there is also kind of like a supply issue. So it's gonna take some time for sure.
South Korea, despite entering the pandemic at almost the same time, has a number of deaths order of magnitude less than that of Italy’s: 250 versus 30,000. Outside the specific topic of Covid-19, both countries have very similar general public health indicators, such as high average survival and low infant mortality. To what do you attribute this enormous difference, which is also reflected in the comparison of all Western powers with the most developed Asian countries?
It's not very appropriate to just compare one country to another based on some similar statistics, because every country has their own healthcare systems and their own characteristics. Even if Italy and Korea are similar to each other in terms of some statistics.
I personally think there is a lot of difference, in terms of structure of the medical healthcare systems, and also a lot of social settings are quite different.
I can only say that one of the reasons that we were successful in terms of controlling this Covid-19 outbreak is because, as I mentioned at the beginning, of the lessons that we learned in the 2015 MERS outbreak… Korea is better prepared. We were very good in terms of implementing testing, tracing and treating procedures. And we also had several simulation exercises too, just to prepare for emerging infectious diseases.
Confirmed cases: 11,018
Confirmed cases: 4.48 million