What South Korea Teaches the World About Fighting COVID

In a world devastated by the COVID-19 pandemic, the Republic of Korea (South Korea) has been able to effectively combat the disease without ever imposing a full lockdown of its economy.

How did the country accomplish its success, and what can the rest of the world learn?

South Korea initially had the largest number of confirmed cases of COVID-19 outside of China, but new cases have decreased sharply since then. As of May 25, only 16 new daily cases were reported, bringing the cumulative total number of cases to 11,206 and 267 deaths. This represents one of the lowest fatality rates in the world (South Korea: 2 percent vs. world: 7 percent).

Even taking into account the country’s population, South Korea’s number of cases per capita is substantially lower than those of other countries. The United States (with more than 1.7 million cumulative cases) has 5,175 cases per million citizens whereas South Korea has 216 cases per million.

"South Korea created a vast number of testing sites, which included not only big hospitals but local clinics and public health care facilities."

What South Korea teaches us is that proactive testing and tracing, along with the mass production and distribution of face masks and the promotion of their use, are winning strategies in this battle. As other countries begin to reopen their economies, how can they apply these lessons to combat COVID-19?

Proactive testing and tracing

As many experts agree, testing is crucial in combating COVID-19 because it is the only way to identify the whereabouts of the otherwise invisible virus, similar to collecting enemy intelligence in time of war. From its experience with the Middle East Respiratory Syndrome (MERS) outbreak in 2015, South Korea from the very beginning took two unique stances regarding testing of COVID-19.

First, the country made testing available and accessible for everyone. It created a vast number of testing sites, which included not only big hospitals but local clinics and public health care facilities. Anyone could walk into these sites and get tested, mostly free of charge. Also, the country innovated in ways to minimize physical contact during the test procedure, such as drive-through and phone booth testing facilities, which protected both medical staff and other patients. These sites motivated people to voluntarily take the test, without fear of getting infected while waiting in queues or of exposing their private information.

Second, and more importantly, South Korea took proactive measures to test its people, even those without symptoms, through contact tracing. In addition to having every confirmed patient quarantined immediately, the Korea Centers for Disease Control and Prevention—using big data, such as cellular data, credit card usage information, and surveillance camera footage—traced the infected person’s steps to locate everyone that he or she had come into direct contact with. All of these contacts were then tested, even if they had no symptoms.

Figure 1 illustrates the importance of proactive testing in preventing the spread of the virus. Although other countries have increased their sheer volume of testing, most are limited to reactive testing—that is, testing only people with symptoms and quarantining them, if necessary (Figure 1c). Those people likely contracted the virus several days (and up to two weeks) before showing symptoms and, thus, would have been in contact with other people (solid line in Figure 1), unknowingly spreading the virus.

Quarantining an infected person after reactive testing only cuts off future potential ties with other people without considering his or her past interactions. In contrast, proactive testing tests everyone who has come into contact with an infected person in order to quarantine a cluster in a network instead of merely an individual with symptoms (Figure 1d). In a sense, the testing cuts off future interactions of both the infected person and his or her past connections. In addition, because a majority of COVID-19 cases are with no symptoms, they go undetected. Proactive testing can identify the silent spreaders of the virus—those who are infected but without symptoms.

Mass production, distribution, and promotion of face masks

In the absence of a vaccine or a treatment, there are only two interventions that can prevent the spread of the virus—social distancing measures and the use of face masks. Many countries have carried out aggressive social distancing measures over the past several months, with many imposing a lockdown that allows only for essential functions, such as buying food or seeking medical care. At the extreme, China’s Hubei (the greater region of the city of Wuhan) province was under a full lockdown for more than two months. These measures have been effective at preventing the spread of the virus and flattening the curve.

If the sole objective is to prevent the spread of the virus, then a full lockdown, such as the one implemented in China, is likely the most effective solution. However, a full lockdown has significant economic consequences, as most commercial activity comes to a halt. Also, in democratic societies, a complete lockdown is difficult and likely impossible to enforce. This is why the use of face masks becomes crucial. Masks protect not only medical staff (the frontline soldiers), but also other individuals from contracting and spreading the virus. The effective use of face masks can prevent the spread of the virus, while not fully shutting down the economy.

A public’s mass adoption of face masks requires consideration from both the demand and the supply sides of the economy. On the demand side, it requires people to change their behavior. On the supply side, a country needs to mass-produce masks and efficiently distribute them.

South Koreans were familiar with wearing masks from their experience with MERS as well as the need to protect themselves from air pollution. However, in late February, South Korea had encountered problems with its mask supply. As the number of confirmed cases increased, many Koreans vigorously sought out face masks. As a result, the price of masks skyrocketed to as much as eight times their regular price. To make matters worse, several distributors purposely suppressed supply to profiteer, further increasing prices. In response, the government took full control of the production and distribution of face masks. It halted mask exports and rationed and distributed them through pharmacies so that everyone could obtain a fair and adequate supply.

Clarity, transparency, listening to the experts, and leadership

At the beginning of the pandemic, many countries, either purposely or unknowingly, kept the whereabouts of the virus unclear. Basic information, such as the number of tests, infections, and deaths, were largely withheld from the public.

South Korea did the opposite, promptly disclosing all information regarding the virus. Information about the location of the infected cases was communicated via text messages to the public. There were two daily briefings, providing information and clarity in subsequent steps to be taken. The briefings were led mainly by health and epidemiology experts who had limited political affiliation.

There is a saying that every decision is political—not just in terms of ideology of left or right, but also in terms of human nature—or homophily. That is, people want to associate with and to listen to those with whom they are familiar. However, it is essential for decision makers (politicians) to go beyond this spectrum and to be as objective as possible. They must listen to experts before making any decision, especially during a national crisis. The information that experts provide consists of cold, hard facts and not panaceas to placate a frightened public.

In addition, having experts as the main face of the country’s communications, offering sound advice on “what to do” and “what to not do,” provides validity, as they are free from any political agenda. Such objective information helps to gain the trust of the people. And trust in a country’s leadership is vital because any agenda to prevent the spread of the virus—such as social distancing measures—requires the cooperation of the public.

The leadership role in management is to bring the organization together and promote coordination and teamwork. If the organization is a country, then one can only imagine the difficulty of effectively managing all of its individual components.

South Korea’s leadership under president Moon Jae-In brought together the government, all of its diverse agencies, the private sector, and the public. Based on experts’ advice, the country’s leadership communicated a unified message of social distancing, the use of face masks, and the public’s collaboration with authorities to combat the virus.

Much like running a business or any organization, it is one thing to have individual capabilities, such as effective production facilities and distribution channels, but another to be able to bring everything together for a unified cause. In the end, a leader’s role is to perform this complex task.

What can other countries do?

Clearly, South Korea had in place several unique institutional characteristics such as a universal healthcare system that emphasized preventive care and a systematic government protocol of testing and tracing, developed after the MERS outbreak in 2015. Furthermore, face masks were not new to the public because of the country’s experience with MERS and with pollution. So these institutions and behaviors were unique to South Korea. But are there policies that other countries can implement in the short term to combat COVID-19?

First is proactive testing and tracing. Everyone who wants to get tested should be able to do so. Countries need to develop or acquire test kits and deploy testing sites. As mentioned earlier, testing is the only way to identify the whereabouts of the otherwise invisible enemy. Equally important is to trace and proactively test people who were in contact with an infected person. This allows for testing and quarantining a network of infected people instead of just a single infected person. As a majority of the infected do not show symptoms, tracing and proactive testing can also identify the silent spreaders from unknowingly transmitting the virus.

Second, the distribution and promotion of face masks is essential because they are the only protective measure besides social distancing. On the demand side, countries need to promote the use of face masks. Many states in the US have issued executive orders to wear face masks in public, with fines for noncompliance. Changing a person’s behavior by providing a reward or, in this case, a penalty is meant to provoke one’s extrinsic motivation. This type of motivation, while effective, is often more effective if accompanied by intrinsic motivation—the inherent desire to change behavior without external rewards or penalties.

Since the outbreak, most public figures in South Korea, including its politicians, business and religious leaders, and even movie stars, have, for the most part, worn face masks in public. Imposing a fine for noncompliance will likely change people’s behavior, but the change may go further if a country’s societal leaders set an example by wearing face masks in public, thus inciting people’s intrinsic motivation. The media can also help by emphasizing the importance of wearing masks to prevent the spread of the virus.

Getting the demand side right is only one part of the equation. A country needs to secure the necessary quantity of masks (e.g., through mass production) and to put in place an efficient distribution system. Even in a time of crisis, there will always be the presence of adverse economic forces that can lead to profiteering behavior.

Despite the country’s efforts, there were four cases of mass infection in South Korea—a mass religious gathering, a call center, a dance fitness center, and, most recently, a night club. All of these instances took place in closed, confined indoor areas with limited ventilation and with people not wearing face masks. These examples show the importance of both social distancing and masks in preventing the spread of the virus.

Even during the peak of its crisis, when there were about 900 cases a day, South Korea never imposed a full lockdown. Most restaurants and businesses remained open. Life is obviously not normal there, but it is as normal as possible under COVID-19. South Korea, a country of 52 million, recently held a national parliamentary election, with 66 percent of its population turning out to vote. Two weeks ago, South Korea’s professional baseball league opened its season, which ESPN broadcasts live to US audiences. The Phantom of the Opera is playing in theaters—making South Korea the only country in the world to have a live show. Yes, there is the hassle of wearing masks in public and there are potential privacy concerns over contact tracing using location data. But it may be a small price to pay for preventing the spread of the virus while keeping our economies running.

In the absence of a treatment or a vaccine, COVID-19 is likely here to stay. As other countries begin to open up, the policies of South Korea can provide us with clues on how to live and cope with the virus before we are able to develop a cure.

About the Author

Doug J. Chung is the MBA Class of 1962 Associate Professor of Business Administration at Harvard Business School. He teaches Sales Management & Strategy in the second year MBA Elective Curriculum.

[Image: Achisatha Khamsuwan]