Perfect storm of coronavirus in Korea

A main street in Daegu is almost deserted after a group of confirmed cases of novel coronavirus was reported Friday. Yonhap

By Oh Young-jin

I spoke with American virology expert Dr. Hakim Djaballah Friday morning about the COVID-19 outbreak in Korea.

In New York, where he is based after stint as head of the Institut Pasteur Korea, he repeated: "This is bad." He was referring to a cluster of cases in Daegu and the first death in Korea from the Wuhan pneumonia epidemic.

Djaballah described the Daegu outbreak as a case of "community transmission," by which the disease can jump to pandemic proportions. It is because members of a community eat, drink and play together and live close, meaning a greater chance of contraction and contagion.

He called on Korean authorities promptly to account for those who the "super spreader" churchwoman in Daegu had contact with or the situation might get out of control. He said it is a race against time.

Djaballah, who proved prescient during Korea's 2015 MERS outbreak, said that with ground zero being a close-knit church, the government could not shut that particular church down or other places of worship without risking being accused of suppressing religious freedom, a basic democratic tenet.

If there is panic, people from Daegu might hit the road by train in an exodus and it would be a disaster. He said that in a worst-worst case scenario, "it could be a Wuhan in Korea."

The Chinese city, the epicenter of the disease, has seen tens of thousands of people sickened or dead. It has been under complete lockdown, a step only possible in an authoritarian country like China but next to impossible in a democracy like Korea.

Therefore, Djaballah raised the possibility of a potential "perfect storm" if tens of thousands of Chinese students return to Korea for a new semester in March.

"Campuses are a lot like churches in terms of the high risk of contagion," he said. "The next couple of days are important to better understand the situation. We had better brace for a worse situation than MERS."

A microscopic picture of the virus SARSCoV2 from patient No. 1, taken by a Seoul National University medical team. Yonhap

The following is what Dr. Hakim Djaballah sent me after our conversation -- ED.

With the number of confirmed cases on the rise and the report of the first death on South Korean soil, is the government's preparedness and response adequate enough to contain the spread of the virus?

The past few days seem to suggest a lapse in the process due to the sudden and unexpected rise in cases on three subsequent days to over 100 confirmed cases. The landscape has changed dramatically with the a "super spreader" churchgoer in Deagu from COVID-19; South Korea has now a first SARSCoV2 cluster outside of China, joining Singapore and Germany. (The World Health Organization named the virus SARSCoV2 and the disease COVID-19).

The government response thus far has been very well balanced as not to upset their Chinese counterpart and at the same time control and reduce the number of visitors who can also be carriers of the SARSCoV2; and efforts to repatriate Korean nationals in the Wuhan region and quarantine them. I am impressed with the government's vigilance at the ports of entry without expensive monitoring throughout the rest of the country, especially rural places; but transparency is lacking in the way information is provided through the Korea Centers for Disease Control and Prevention (KCDC).

Many citizens would like to know the daily numbers of nationals and visitors entering the country and how their number correlates with the confirmed cases and their geographical location. Is this truly an imported virus or the virus has already settled in Korea; and what we are observing is the beginning of a bigger problem of a "local Korean cluster," where the spread is now via "community-based activities." If the upward trend continues for the next few weeks, then the government is heading toward a pandemic with a worse outcome than the MERS outbreak almost five years ago.

Demonstrators set a fire and erect a barricade as they protest the arrival of a plane carrying evacuees from coronavirus-hit China's Hubei Province, in the village of Novi Sanzhary, in the Poltava region. AP-Yonhap

This time, they may not be as lucky as with the MERS outbreak. Closing churches and other places of worship is not the answer and would create unwanted stigmatism against their followers. The counter-argument would be to close all places and spaces where people can gather including airports, train stations, markets, cinemas, etc … The government must be cautious to avoid stigmatization and vulnerabilities.

The SARSCoV2 is similar in genomic content to the other members of the coronavirus family, but at the same time it is different in its mode of infection and, in particular, it seems to infect the pneumonia-causing bacteria colonizing the lungs such as Pneumococcal pneumonia or Streptococcus pneumonia, wake them up from dormancy and make them much more virulent than usual, thus speeding up lung inflammation and destruction, leading to severe pneumonia-associated symptoms. From the death cases in China to date, a common trend is that most of the deaths were associated with the elderly population prone to community-acquired infections and possibly with a history of pneumonia.

It is also important to note that there were not many reports of babies and young children being infected, showing symptoms, or dying from the COVID-19 disease. The reason perhaps why babies and young children are not generally infected with the pneumonia-causing bacteria at such a young age, and therefore seem to be spared, is because the virus is unable to enhance its virulence once it infects them. These children may remain carriers of the SARSCoV2 virus for a long time.

First lady Kim Jong-sook speaks to merchants in a Seoul market affected by the ongoing Wuhan epidemic before having a meal together. Korea Times

As for the 70,000 Chinese students returning to South Korea, it is shocking that the government is leaving it to the concerned universities to use their discretion, and to take the helm and the decisions on what to do with the incoming students. This is a very bad policy on the part of the Moon administration and a recipe for a further spread, and perhaps even resulting in additional clusters in the country. Student life on campuses is the ideal place for community-based infections, similar to churchgoers and mall shoppers.

I urge the Ministry of Health and Welfare to take the lead on this and provide every student with a stringent checkup to include a CT scan of the chest cavity, together with the tests to check for the presence of the virus. Once this checkup is complete and the results are negative, then, and only then, the students could be released to the university administration to keep them under observation; they can also start these students on the experimental drug remdesivir as a prophylactic treatment. This assumes that the current tests are viable and correctly identify carriers without too many false positives or false negatives.

A complete travel ban either by air or sea would have been the best option for the country, but unfortunately it was trumped by neighborly diplomacy, and goes to show that the Moon administration does not seem too concerned with the scale of this outbreak; I suspect they are getting "reassurances" from the Chinese authorities that they are doing all they can to curb this outbreak, but doubt very much their reassurances.

Moreover, I doubt it very much that the Korean government truly learnt from the past mistakes with the handling of the MERS outbreak of 2015; their behavior and the incoming data speak to the fact that they are struggling with this unfortunate situation; it is not a simple task but once again transparency and the unconditional care for its citizens must be the highest priorities right now. The economy is suffering and will continue to suffer more but it will always recover; the Korean people have shown their resilience many times before. Another crisis in the making and it will not be at the same scale as the MERS outbreak.

With the appearance of this first cluster in Deagu and the first death, what are the government assurances to its people? We are almost at the end of the month of February and the newly diagnosed cases in South Korea continue to increase, suggesting that the government course of action is not working to safeguard the interests of the people. The SARSCoV2 virus is adapting and thriving on South Korean soil. Maybe it is time for the Moon administration to concentrate more on containment plans.

Oh Young-jin (foolsdie@gmail.com, foolsdie5@koreatimes.co.kr) is the director of content at The Korea Times.