Europe’s grim Covid choice: Who lives and who dies

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South Korea is a benchmark for pandemic management but European levels of infection could cripple its systems

by Andrew Salmon   – Asia Times

A traditionally attired guardsman – wearing an appropriately designed face mask – stands guard outside Seoul’s Gyeongbokgung Palace. Photo: Tom Coyner

A South Korean academic has grim advice for Western European health officials swamped by Covid-19’s second wave: Triage.

The term, often used in military and disaster medicine, means those most likely to live get priority treatment while those with the least chance of survival are abandoned to their fate.

“If there are confirmed cases of dozens of thousands per day, there would be severe shortage of medical resources,” the official, who was speaking on condition of anonymity due to the extreme sensitivity of the issue, said in Seoul on Wednesday.

“We would have to prioritize patients and make a choice. If you gave me that choice, I would focus on women and children, because we are in a war [with the virus],” he said.

Currently, mid-sized Western European countries are teetering on the brink of those “dozens of thousands” of cases per day.

The United Kingdom, which has been hardest hit in Europe in terms of mortalities, suffered a record 22,961 new infections on October 5 and is seeing a seven-day rolling average of  11,993 cases per day according to research site Our World in Data.

France, meanwhile, suffered a record 32,427 new cases on October 17 and a seven-day rolling average of 17,387 daily infections.

South Korea, meanwhile, remains one of the developed world’s benchmarks for Covid-19 pandemic management. Using the same data set, it suffered its highest number of cases on February 29 with 909 cases. Its seven-day rolling average of infections is fewer than 100.

While Korea’s 55 million population is smaller than that of the UK’s 66.5 million and France’s 66.9 million, its deaths per million people – just nine –  fall far below that of the two European nations. The UK has had 646 deaths per million and France 519, according to data provider Worldometer.

Inside Korea’s successes

At a Wednesday briefing offered by Seoul’s national insurer the Health Review and Assessment Service, or HIRA, which is set to hold an international online symposium and training course from October 26-28, Korean officials and academics offered analyses of their country’s successful pandemic management.

Korea was the second country to suffer a Covid-19 outbreak after China, and has so far undergone three “tipping points.” The first was an outbreak among a Christian sect, Shincheonji, in February-March in the southeast. That was followed by a second in gay nightclubs in Seoul’s Itaewon district in April-May.

Most recently, after a series of clusters nationwide following an anti-government rally in Seoul on August 15, the country managed infections via a policy of flexibly tightening social distancing measures, then easing them once weekly target numbers were met. The approach suppressed infections while ameliorating economic damage.

Seoul has managed the virus via an active program of widespread testing, aggressive contact tracing and early treatment – a process with a target time from positive test to hospital treatment of 72 hours.

Briefers said it has operated these tactics under three principles: transparency, openness and democratic processes. As a result, Korea – in stark contrast to multiple developed nations – has managed the crisis without a single lockdown.

In a country armed with one of the world’s most impressive digital backbones and a population of early adopters of digital devices, high technology has been highly leveraged. It has been most successfully applied via a synchronization of databases – immigration, police/CCTV cameras, credit card companies and public transport operators – that enables fast, accurate contact tracing and related public information sharing via app.

HIRA manages real-time databases monitoring nationwide supply and availability of drugs, medical equipment and hospital beds. With effective national oversight, HIRA could swiftly assign patients needing urgent treatment to ICU beds – even if those beds were in a distant city or province.

A system of non-hospital quarantine facilities was also established.

“We have residential care centers in metro areas that are not hospitals,” said Lee Jin-yong, a preventative medicine specialist and epidemiologist at the elite Seoul National University. “We can send patients with lighter symptoms there.”

Data shows that 30-40% of Koreans who tested positive suffered no symptoms, Lee added.

In the early stages of the outbreak, HIRA set up a nationwide process under which every citizen could buy two masks per week from local pharmacies. To enable social distancing outside pharmacies, citizens were assigned different purchase days, based on the numbers on their national ID cards.

With mask supply eased now that manufacturing has ramped up, Seoul has mandated mask wearing in public – outdoors, indoors and on public transport.

Test kits were also thrust on to a super-fast track approval process. “Usually, it takes time for government to do anything, but it shortened the period of approval from 140 days to two days,” Lee said, adding that treatment drug approval processes had also been accelerated. “We will continue this when a vaccine appears – we will make it quickly available for the market,” he said.

However, related officials in Seoul say South Korea does not anticipate a national vaccination program until the end of next year.

Lee allowed himself some pride in Korea’s success – notably, the communitarian, rather than individualistic spirit of its society.

“Since the [1950-53] Korean War, this may be the first time Korea society is reaffirming social values and social solidarity,” he said. “This is our first time to realize we are doing something better than advanced countries.”

Don’t crack the champagne yet

Even so, government voices have warned of quarantine fatigue. One official speaking on the sidelines of Wednesday’s event admitted that some citizens fear that contact-tracing systems – which have run into few of the rights-to-privacy barriers encountered in Western nations – will become a “big brother” tool of government, post-pandemic.

And experts concede that even the vaunted Korean approach could crack under the stress of the numbers ravaging Western Europe.

“In my opinion, if there were 20-30,000 confirmed cases per day I would say there would be a meltdown in the medical system. We could not handle that,” Lee said.

Asked about the controversial Swedish strategy of building herd immunity, he hedged.

“Everyone says Sweden failed, but maybe they have 10, 15 or 20% herd immunity. It is too soon to tell,” Lee said.

“If there is a vaccine developed in early 2021 and Korea has 50 million doses then we can call this success, but if there is no vaccine and treatment by this time next year, and if Sweden has formed a high level of herd immunity, you can call Sweden a success story.”

Broadcaster CNN said Wednesday 44 human vaccine trials were underway in 16 nations.

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