South Korea has reached two seemingly contradictory milestones in the COVID-19 pandemic: It recorded more than 600,000 new COVID-19 infections on Thursday, the most anywhere in the world, while also having one of the lowest virus death rates globally.
Anywhere else, an infection surge of this size would signal an out-of-control outbreak soon to be followed by a spike in fatalities. In South Korea, the picture is more complex.
The sky-high caseload reflects the nation’s consistent deployment of mass testing, largely abandoned by many places as COVID-19 becomes endemic. However, testing is a key factor behind South Korea’s sliding death rate, according to its virus fighters.
Continuing to officially diagnose most infections allows the country to identify at-risk cases and preemptively treat or hospitalize those patients before their conditions become severe.
Combined with an 88 percent vaccination rate — and one of the highest booster shot take-ups in the world, especially among the elderly — it has delivered a fatality rate of 0.14 percent. That is one-10th of the rates in the US and the UK, and down from 0.88 percent two months ago, even as cases have surged 80-fold in the same time frame.
The unorthodox approach is typical of South Korea’s response to the pandemic, which has been prescient from the beginning. The country pioneered the use of quick testing and high-tech contact tracing early on, using lessons learned from previous epidemics.
While it has recorded more than 8 million cases since the start of 2020, South Korea did not institute lockdowns, and managed to overcome a slow start to vaccination by looking beyond those first shots to prioritize supplies of boosters, which have been targeted at the elderly.
The focus on testing has been expensive. The nation has spent about US$1.3 billion on PCR testing, the Korea Disease Control and Prevention Agency said.
The country has the capacity to conduct 1 million PCR tests a day.
However, the payoff is immeasurable, as hospitals have not been overwhelmed and the healthcare system remains intact, government officials said.
Despite daily cases spiking to 621,328 on Thursday — from fewer than 9,000 before emergence of the Omicron variant of SARS-CoV-2 in late January — hospitalizations have only doubled, with intensive care unit capacity at 65 percent.
“Another critical point in preventing deaths is the ICU capacity, and South Korean hospitals generally have a good handle on the situation,” said Choi Jae-wook, professor of preventive medicine at Korea University College of Medicine.
REFINING STRATEGY
Despite the world-leading caseload, the falling fatality rate has the government considering further easing of pandemic restrictions, including lifting a six-person limit on private gatherings and extending restaurant hours.
South Korea’s health officials said they have been better prepared to deal with the ebb and flow of the COVID-19 pandemic partly because of lessons learned during its botched handling of a Middle East Respiratory Syndrome outbreak in 2015.
Among the key lessons: Stay nimble and respond quickly.
As Omicron took hold in late January, rather than being overwhelmed, South Korea doubled down on testing. As in many countries, the testing strategy was expanded to include rapid antigen tests. However, unlike elsewhere, those who test positive at home still must go to a government-run PCR testing center for confirmation.
From there, positive cases who are asymptomatic or have mild symptoms are required to quarantine at home, while those deemed at high risk of serious illness are sent to hospitals for care and treatment.
“It is more ideal to use PCR tests with high accuracy in as many places as we can, yet the adoption of the rapid antigen test is a measure to protect the high-risk group that has a greater risk of getting severely ill,” the disease-control agency said in a statement.
At the same time, South Korea stepped up its vaccine rollout after initially lagging behind, focusing particular attention on getting elderly and high-risk individuals inoculated. Nearly 86 percent of the population had been fully vaccinated when Omicron began to spread, with more than 90 percent of people aged 60 years and above also boosted.
“The mortality rate is close to zero among those 60 and under who have completed the third vaccination,” said Park Hyang, the health ministry’s anti-epidemic prevention and response management department director general.
Most of the deaths have been among the small group of elderly who have not been vaccinated. People who are over age 60 and were not inoculated are 10 times more likely to die than those who have had boosters, she said.
However, despite the falling death rate, Choi said that social distancing and other pandemic curbs should not be lifted too soon.
Other countries, including the US and the UK, are abandoning restrictions as populations become more comfortable living alongside COVID-19, even as their caseloads and deaths rise again.
“Easing virus-prevention measures now will inevitably lead to more deaths and critical cases, and the government shouldn’t be the one judging that this is OK yet just because there is enough ICU beds,” Choi said. “They should notify and pass along precautions in advance to the public.”
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