As the novel coronavirus (COVID-19) sweeps across the globe, its ugly and deadly consequences are presenting governments around the world with an unprecedented test. For some states, COVID-19 came as a slap in the face, exposing the painful inefficiency and fragility of their governance and healthcare infrastructure. However, for others, the ongoing pandemic represents an opportunity to try out bold, innovative new measures.

Over the past weeks, as cities have gone into lockdown, transportation systems have shut off, mass gatherings have disbanded, and schools have been canceled, two countries are taking drastically different approaches to curb the spread of COVID-19, and the success or failure of their methods could be valuable lessons for the rest of the world.

Courtesy of Our World in Data

South Korea’s Maxim: Trace, Test, and Treat

Although COVID-19 looked like it was spiraling out of control in South Korea just a week ago, the number of confirmed cases actually tell a deceptive story. By early March, infection rates in the country had slowed considerably. Moreover, many experts are applauding South Korea’s swift handling of the outbreak, and President Moon Jae-in has offered to share his government’s experience in containing the coronavirus with fellow world leaders.

The Asian country’s success appears even more resounding when contrasted with Italy’s apparent ineptitude. Both countries were first hit with the disease in early January. However, by mid-March, confirmed deaths in Italy had soared past the 1,000 mark, while that same statistic hovers below 100 in Korea. Additionally, the Italian government was compelled to put its whole population on lockdown; whereas, South Korea has imposed relatively few restrictions on movement, only quarantining a few thousand people near the peak of the outbreak.

So why is South Korea, a country that’s only 1,250 miles away from Wuhan, the Chinese city at the center of the first big outbreak, faring so well compared to its less fortunate European counterpart? It is mostly thanks to the government’s strict adherence to a simple maxim: trace, test, and treat.

Forewarned is Forearmed: The Importance of Aggressive Testing

With the start of the outbreak, the government swiftly rolled out—and largely paid for—an aggressive testing policy, putting an “emergency approval system” into action on February 4 that guaranteed testing kits a fast track to approval. As infection rates peaked, four companies manufacturing the kits ramped up production to allow for up to 15,000 tests per day.

Courtesy of Our World in Data

All around the country, hospitals, clinics, and dozens of drive-through testing kiosks are working to diagnose potential coronavirus patients. In fact, drive-through sites that have popped up across South Korea have proven particularly effective, and they are quickly becoming a model for other countries to emulate.

"It takes at least ten minutes to disinfect the waiting room between visitors," says Dr. Liu Jaehong, who works in one of these temporary testing facilities. However, because patients stay in their cars, “we don’t need that process.” Indeed, the innovative method lets him test up to 10 people an hour, double the capacity he can handle in an indoor clinic.

Drivers pulling up for the test find workers in head-to-toe white clothing and surgical masks approaching them with long swab sticks, which collect a sample from patients’ mouths. Then, the samples are sent off to a negative pressure laboratory where machines are busy carrying out polymerase chain reaction (PCR) tests in search of COVID-19 samples. The entire process from the swab stick to the laboratory takes under six hours, and the next day, the test subject receives a text message for negative results or a phone call if he or she has the virus.

Aggressive testing appears to be saving lives. South Korea’s case fatality rate (the number of confirmed deaths divided by number of confirmed cases) in mid-March was only about 0.9 percent, compared to Italy’s whopping seven percent.

Putting the total tests and confirmed deaths over time graphs side-by-side tells a similar story:

Statistically speaking, aggressive testing could also explain why South Korea’s number of confirmed cases skyrocketed in February and March—because unlike in other countries, even patients with very mild symptoms were tested and reported as confirmed cases.

The figure plots tests/million people on March 9 in South Korea, the U.S., the U.K., Italy, Switzerland, France, Belgium, Australia, and Israel against the percent growth in confirmed cases between March 9 and March 21. Sources of data: Sources of d… — The figure plots tests/million people on March 9 in South Korea, the U.S., the U.K., Italy, Switzerland, France, Belgium, Australia, and Israel against the percent growth in confirmed cases between March 9 and March 21. Sources of data: Sources of data: Worldometers/Our World in Data

The government’s swift approval of test kits and rapidly expanding testing capacity represent a hard-learned lesson from the 2015 Middle East Respiratory Syndrome (MERS) outbreak. MERS took 36 lives and brought the South Korean government under criticism for its lackluster response. As a result, the country’s Centers for Disease Control set up a special department to devise countermeasures for future epidemics.

This time, it appears as if the entire country was more prepared. Indeed, according to Kogene Biotech director Baek Myo-ah, her company started developing the coronavirus testing kit as early as January 10, more than a week before the virus hit Korea. The government’s emergency approval system also helped.

“Putting out a novel pathogen test kit can take as long as a year, but we jumped into production within weeks thanks to the emergency approval system,” said Baek. “But our lesson from developing MERS [sic] test kit in rush was that forewarned is forearmed for an epidemic.”

Health vs. Privacy: The Dilemma of Tracing Virus Carriers

Beyond its swift testing procedures and its drive-through facilities, South Korea is receiving attention for another pandemic-inspired creation: a travel log that publishes the movements of coronavirus carriers by tracing their phones and credit card records and by monitoring surveillance video feeds.

A look at the government website that tracks coronavirus patients.

This way, the government can let people know if they ever came into close contact with coronavirus carriers by communicating via an official website and frequent text messages. Additionally, many private developers—including tech-savvy college students—have created apps pinpointing those who are infected, drawing millions of downloads.

A look at coronamap.site, a website built by a Korean college student that uses publicly available information about patient locations.

However, the government’s widespread tracking of its citizens comes with a big caveat: even with the guarantee of anonymity, many coronavirus carriers are still deeply unsettled about having their private lives laid bare to the public.

Indeed, among the string of alerts sent to millions are notifications about patients who previously visited karaoke bars, got foot massages, and even spent time at pay-by-the-hour “love hotels.”

After a Busan resident filed an appeal, the National Human Rights Commission of South Korea also appeared to criticize the government for tracking citizens, saying the release of personal information was “beyond necessity.” Nevertheless, many others believe that the movements of coronavirus carriers are not being shared fast enough.

“The phone is ringing off the hook with nervous citizens demanding that more is shared about confirmed virus cases in a faster manner,” said Park Wyul-bohk, who heads the disaster team in Cheonan.

Great Britain’s Fiasco: Herd Immunity

Like South Korea, the U.K. tried to refrain from imposing any hard restrictions on the movements of its citizens. However, instead of being applauded for its swift actions, Britain’s “herd immunity” strategy—while it lasted—frequently came under fire for its supposed recklessness.

Having accepted the fact that the spread of the virus could not be stopped, Boris Johnson’s administration decided to go with a policy framework even bolder than locking down the entire country. For weeks, the British government sought to develop “herd immunity” among its population, relying on the belief that the virus would cease to spread once a sufficient proportion of the population contracts COVID-19. This means that rather than shutting down large gatherings and encouraging social distancing, most schools, restaurants, sporting venues, pubs, and airlines remained open, and only elderly people exhibiting coronavirus symptoms were asked to quarantine themselves.

Illustration of herd immunity, a concept most often used to explain the effectiveness of vaccines. Courtesy of Tkarcher/Wikimedia

In an interview with BBC on March 13, British chief scientific adviser Sir Patrick Vallence pointed out that the U.K.’s first order of business should be to “reduce the peak [of the outbreak], broaden the peak, not to suppress it completely,” alluding to the popular concept of “flattening the curve.”

Therefore, he advised the need to “build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission, [and] at the same time, protect those who are most vulnerable from it."

Britain’s approach to the crisis also stems from the government’s frequent reliance on behavioral modeling and data science, which worked in the favor of many government advisers when they helped carry out the successful Brexit campaign. Specifically, prominent figures in Johnson’s administration like Dominic Cummings justify Britain’s laissez faire strategy by citing the “behavioral fatigue” theory, which posits that people would become tired of a prolonged strict quarantine and would proceed to defy restrictions on movement.

Sir Patrick Vallance, the govt chief scientific adviser, says the thinking behind current approach to #coronavirus is to try and "reduce the peak" and to build up a "degree of herd immunity so that more people are immune to the disease". #R4Today

More: https://t.co/1FmqX3WPh7 pic.twitter.com/pMHknCAobr
— BBC Radio 4 Today (@BBCr4today) March 13, 2020

However, the effectiveness of herd immunity hinges on the virus’s basic reproduction number (R0), or how many people a carrier infects on average, and its herd protection threshold (HPT), or the percent of the population that needs to be infected to ensure herd immunity. With an estimated basic reproduction number of two to 2.5, approximately 60 percent of the population (equivalent to about 36 million Britons) would need to catch COVID-19 and recover for Britain’s policy to work.

Source of data: ResearchGate/Imperial College London

Experts warn that a sizable number of people—up to 250,000—would die if such a large percentage of the country catches COVID-19. Not only could hospitals be overwhelmed, the vulnerable people who are encouraged to self-quarantine may find themselves even more susceptible as waves of younger, healthier people are infected. There’s also the troubling uncertainty about whether people can contract coronavirus a second time. Notably, according to Japanese authorities, a man who had already recovered from the disease supposedly tested positive again after a few weeks. If the test results are accurate, this possibility could doom Britain’s herd immunity ambitions.

"Intentionally allowing the virus to spread requires accepting that people will die in the short term, in part due to hospitals and the health system being overwhelmed," says Dr. Diego Silva, a lecturer at the University of Sydney.

Moreover, Queen Mary University virologist John Oxford was emphatic in his agreement with Silva, saying, "I feel nerve-wracked about it, I think it's kind of a huge experiment when you're indulging letting the virus go like this, rip through the community. People will die. What will their relatives say? The whole thing is a bit of a farce—and a dangerous farce."

An open letter signed by 200 behavioral scientists makes the scientific community’s objection to the herd immunity policy even more apparent. In the document, the scholars collectively expressed their skepticism toward the behavioral fatigue theory and emphasized the need to take urgent actions in this high-stakes crisis.

Finally, on March 16, after receiving a report that up to 30 percent of hospitalized coronavirus patients may need intensive care, Johnson appeared before the country in a press briefing and ended Britain’s bold herd immunity strategy. He acknowledged the necessity of “drastic actions” and strongly encouraged working from home and practicing social distancing. Furthermore, British schools, colleges, and nurseries would close starting March 20.

It seems that after weeks of maintaining a go-it-alone attitude, the British government has finally decided to join its fellow European nations in the brutal war against the novel coronavirus.

Uncertainty Ahead

There’s no telling how long the outbreak will last, how big it actually is right now, and what its ramifications will be. Political and economic fallout could be on the horizon, but no one knows for sure. However, one thing seems certain. As the novel coronavirus continues to spread, the disease is putting governments around the world through a demanding trial, and how each state fares in this battle could tell us a lot about what it takes to govern with efficacy and competence.