This Evidence Brief outlines how South Korea has successfully maintained one of the world’s lowest rates of COVID-19 infections in health care workers. The culmination of a rapid investigation, completed in less than a month, the research draws on findings from interviews with front line health care workers and system leaders in South Korea, along with an in-depth review of national guidelines from Korea Centers for Disease Control and Prevention (KCDC) and hospital-level protocols.
Healthcare workers (HCW) around the world have been on the frontline of the battle against Coronavirus Disease 2019 (COVID-19). In past epidemics of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), many cases of secondary transmission occurred in hospitals. Given that hospitals are active battlegrounds for HCWs, protecting HCWs has multiple benefits as their safety is tied to the integrity of the medical system and wellbeing of the public. Safeguarding HCWs from COVID-19 allows health systems to:
- Sustain the capacity necessary to care for a surge of patients (both COVID and non-COVID),
- Prevent nosocomial spread to their patients and other staff members, and
- Limit community spread through protection of HCW themselves and their family members.
Unfortunately, HCW infections have been a major problem in many countries. Comparable, up-to-date data are sparse in the matter, but more than 3,000 HCWs have been infected in China and over 4,000 in Italy. Meanwhile, the United States has been estimated by the Centers for Disease Control & Prevention (CDC) to have at least 9,282 HCW infections as of April 9th. This is likely a significant undercount as the State of Massachusetts alone had at least 2,200 infections on May 5th. The staggering numbers should be interpreted with caution given the inherent differences in HCWs per capita, differential access to testing, degree of community transmission, and epidemiological causes of the confirmed HCW cases. Nevertheless, HCW infection is an undeniable challenge that mandates timely deliberation given the anticipated longevity of the pandemic.
South Korea has been recognized for its successes with mass testing and meticulous contact tracing, as well as efficiently flattening the curve of infections from its large outbreak in Daegu in less than a month. There has been less coverage for the way that the country redesigned its health system in order to respond effectively to emerging infectious disease outbreaks and avoid nosocomial infections that plagued the country during the 2015 MERS epidemic. In this evidence brief, we explore and identify the key health systems interventions and protocols that South Korea implemented in order to reduce the nosocomial spread of SARS-CoV-2, the virus causing COVID-19. Moreover, we investigate clusters of SARS-CoV-2 infections that did occur in health facility settings and assess the country’s response and adaptations to such incidents. Through this, we highlight the key lessons and details that other countries facing current and future waves of COVID-19 can utilize to improve their health system response, maintain care for all patients (COVID-19 and non-COVID-19), and protect health care workers.
Rapid completion of the South Korea research was made possible through Ariadne Labs’ collaboration with The Covid Translate Project, a global volunteer initiative founded to quickly translate and disseminate documents published by Korea’s Centers for Disease Control and Prevention in order to help other countries fight COVID-19. To date, materials have been translated into seven languages and shared with partners in Europe, the Middle East and Africa.
Key resources from The Covid Translate Project:
KCDC Playbook (Guidelines for Local Governments) + Appendix
Drive-Through Screening Center Instructions
Walk-Through Screening Center Instructions