Letter From South Korea: COVID-19 Response And Questions On Quality Long-Term Care For Older Adults
By Sanghwa Lee, International Initiative for Impact Evaluation (3ie)
South Korea had its first case of COVID-19 on January 20, 2020, from a Chinese citizen returning from Wuhan, China . Upon her arrival at the airport, she showed suspicious symptoms and was moved to Incheon Medical Centre, one of several nationally designated hospitals for the COVID-19 response. A month later, there was a sudden mass infection of over 6,000 people in Daegu, in part because of gatherings at the Shincheonji Church of Jesus. Despite this mass event, within three months infection rates have stabilised at 10 or fewer cases a day of whom over 80% had recovered by the end of April 2020 . How South Korea has responded to the pandemic may provide some insights for other countries.
Special measures to support older people and other vulnerable groups
During the 2009 A/H1N1influenza pandemic, there were evident shortages of primary facilities and hospitals which could deal with the condition and this became a high-profile political issue. Subsequently, the national government developed a new network of ‘nationally-designated hospitals’, including outpatient and inpatient facilities with dedicated infectious disease prevention and care units. These hospitals provide care for patients with respiratory problems during normal times and serve as national quarantine hospitals for patients with pandemic-related infectious diseases during crises . As well as additional financial support and incentives for medical facilities and staff, the government targeted groups seen as more vulnerable to the virus, including older people.
This support includes reductions in debts, a monthly allowance and emergency vouchers . Seoul’s city government has developed new older people-focused care services, including real-time personalized care, a rapid reporting system, and changes to how some services are delivered to older people. To date, there have been no recorded infections among older people and carers covered by these new initiatives .
In health facilities, in-patient beds have been prioritized for people more vulnerable to the virus and who have moderate to severe symptoms . The government covers in-patient and treatment costs for confirmed patients, as well as the costs of diagnostic tests for suspected cases . Mild or asymptomatic confirmed cases who have been discharged from hospitals but who find it difficult to get treatment at home can stay at Living and Treatment Centers, Community Treatment Centers which offer 24/7 monitoring and medical support .
Mass, indiscriminate testing to identify people infected with COVID-19
Mass testing did not lead to a health system breakdown. Instead, it helped greatly to identify people infected with COVID-19, including asymptomatic carriers. This permitted speedy management of the crisis before community transmission became widespread . Time and cost-efficient testing systems were implemented, including Drive-thru and Walk-thru testing sites, which other countries such as the US and Japan have since started to adopt.
Figure 1. Drive-Thru and Walk Thru COVID-19 testing sites in South Korea.
Source: Central Disaster Management Headquarters & Central Disease Control Headquarters. (2020). Patient treatment and management. http://ncov.mohw.go.kr/baroView2.do?brdId=4&brdGubun=42
A principal of openness, freedom of movement, and transparency
“To contain the virus, you have to contain people’s movement. … Our default approach has from the very beginning been to respect people’s right to freedom of movement and then to implement measures that are necessary and proportionate to the need to manage risk. Our measures have adapted to the evolving nature of this challenge, but this principle of openness has been preserved to the very best of our abilities.” –Kang Kyung-Wha, South Korea’s Foreign Minister 
While letting people move freely, the government has focussed on identifying and quickly treating people infected with COVID-19. If there is a newly infected COVID-19 patient, the central and local governments track his/her source of infection and isolate their contacts through rapid epidemiological investigations. Private data are carefully managed, as the media and civil society are accustomed to holding the government to account, due to decades of mobilising for democratization.
Remaining tasks: improving the quality of LTC facilities for older people
While South Korea appears to have managed the crisis in a speedy and appropriate manner, there are still some issues of concern for older people. These include quality control of long-term care facilities. Around 60% of deaths due to COVID-19 in South Korea have been caused by mass infections , which occurred mostly at care facilities. For example, Daesil care facility in Dalseong-gun has had 100 confirmed cases . These cases to some extent reveal pre-existing problems of quality and management in LTC facilities in South Korea. The government has now taken measures to strengthen quarantine and care management at these facilities . The mass infection of older people at LTC facilities could have been prevented, however, if the existing quality issues  had been properly addressed before the pandemic.
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