South Korea’s Covid-19 success story started with failure

This story is one in our six-part series The Pandemic Playbook. Explore all the stories here.

DAEGU, South Korea — Jo Hye-min stepped off the train and into a situation she had only seen in movies: a completely, and eerily, empty station.

It was February 2020, when the threat posed by the novel coronavirus SARS-CoV-2 was only starting to become clear in much of the world. But the situation in Daegu was already dire: Hospitals were overwhelmed and on the brink of collapsing. Hundreds of people believed to have been exposed to the virus were being isolated in private rooms. A nurse’s association in Daegu issued a plea for volunteers to help.

“It felt like war had broken out,” Jo says, and the 28-year-old nurse enlisted. The national disease control agency called her at 10 pm, asking if she could be in Daegu by 9 am the next morning. She dropped off her cat with a friend and made the 60-mile trip from her home in Busan. When she arrived at the isolation facility, she was told it would be at least a month before she could leave.

Jo was joining a frantic, all-out effort by South Korean officials to contain a burgeoning epidemic.

A woman in her 60s, who would later become known as Patient 31, had tested positive for Covid-19. Public health authorities learned she was a member of a secretive religious movement and attended services in the days before being diagnosed, potentially exposing more than 1,000 people.

South Korean officials made a plan. They needed to test as many people as possible, as quickly as possible, to figure out how bad the outbreak was. Then they had to find out who might have come into contact with the infected people. And they needed all of those people — both the infected and the potentially exposed — to isolate themselves to prevent the virus from spreading any further.

It was a three-step protocol: test, trace, and isolate. And it worked. Within a week of Patient 31’s diagnosis, the country was performing the most Covid-19 tests in the world; it implemented perhaps the most elaborate contact tracing program anywhere; and it set up isolation centers so thousands of patients could quarantine.

As other countries saw their outbreaks spiral out of control, measures like these helped South Korea keep Covid-19 in check. On March 1, South Korea had about 3,700 confirmed cases; Italy, the first hot spot in Europe, had 1,700 and the US had just 32 cases, though its dismal testing meant the virus was likely spreading unsurveilled. By the end of April, Italy had topped 200,000 cases; confirmed cases in the US were already above 1 million. South Korea still had fewer than 11,000. Adjusted for population, South Korea’s first wave of coronavirus cases was about one-tenth as big as that in the United States.

Before the Covid-19 pandemic, the US was considered better prepared than any country in the world to stop an infectious disease outbreak. But the first months of the pandemic response in the US were marked by now-familiar stumbles. The virus escaped containment. While South Korea tested, traced, and isolated, the US struggled, a critical early failure that cost lives.

No country had a perfect response to the pandemic. Every approach came with trade-offs and caveats, and even success stories can go awry in the face of global, exponential growth. But around the world, nations took successful steps to limit the pandemic’s damage. We talked to Jo and other South Koreans as part of Vox’s Pandemic Playbook series, which will explore the successes — and setbacks — in six nations as they fought the virus.

South Korea’s early, decisive action was crucial. South Korea was one of the first countries where Covid-19 was seen outside of China, before much was known about the virus at all. It seemed at high risk for an unstoppable outbreak — and instead, it staved off disaster. To date, the US ranks 10th in its total cases per capita; South Korea ranks 145th. Though it has been slower to vaccinate its population than world leaders like the US, South Korea is still seeing fewer than 700 new cases per day on average; the United States, meanwhile, is averaging more than 70,000.

“South Korea was able to flatten the epidemic curve quickly,” researchers from Harvard and Seoul National University wrote in a review of the country’s response. Among the top reasons for its success: “conducting comprehensive testing and contact tracing and supporting people in quarantine to make compliance easier.”

Testing capacity quickly expanded. Contact tracing began. And at the isolation center, Jo settled into a new routine, calling up to 50 patients a day to check on them. If they fell sick, she had no treatment to offer. Nobody knew what would work. They had one option: test, trace, and isolate.

Patients lapsed into depression. They had nothing to do but watch TV and eat out of their lunchboxes; some people would vomit when they took their daily Covid-19 tests, administered through the nose. In the most extreme cases, a patient would stop responding to the nurses’ calls. A nurse in protective gear would enter the room and try to provide the person with more direct emotional support.

“I could see the patients started to lose it mentally and emotionally,” Jo said. “I was always on alert, and the emotional care was really difficult for me.”