In the weeks before she was diagnosed with the novel coronavirus, South Korea’s Patient No. 31 busily went about her daily life.
The 61-year-old resident of Daegu traveled to Seoul’s bustling Gangnam district to visit her company headquarters. She commuted to her work selling mobile gift certificates, ate her fill at a hotel buffet and went to a traditional medicine clinic after getting into a minor car accident.
Twice, she attended Sunday services at the Daegu branch of the Shincheonji Church of Jesus, where she prayed shoulder to shoulder with hundreds of other followers.
Within hours of her positive COVID-19 test on Feb. 18, South Korean authorities released a detailed accounting of her whereabouts and addresses of each location she’d visited. “Patient No. 31 movements” shot up as a trending search topic on South Korean web portals. Authorities then set out identifying, locating and testing the hundreds of people who’d crossed paths with her — and when they found those she’d infected, the thousands more who’d crossed paths with them.
Patient No. 31 is not alone in having her comings and goings mapped. Through smartphone push alerts, blog posts and regular briefings streamed live on YouTube, authorities here are publicizing the whereabouts and movements of the more than 1,000 confirmed COVID-19 patients. It’s a contrast to governments elsewhere that have been wary of disclosing too much identifying information out of privacy concerns and for fear of stoking panic.
Governments around the world are scrambling to slow down, if not stop, the spread of the virus that’s ravaged China and has sprung up in 40 countries and counting. With scientists and public health officials still learning about how and when the virus spreads and just how dangerous it is, South Korea is proving an early — if invasive — experiment in how to deal with a fast-evolving epidemic.
Largely informed by public criticism of how it withheld information during a local outbreak of the Middle East respiratory syndrome in 2015, South Korea is erring on the side of radical transparency: aggressively and almost instantaneously pushing information out to the public about each active case.
The efficacy of South Korea’s approach remains to be seen. Containment still appeared far off as South Korea’s Centers for Disease Control said Wednesday that it had confirmed 12 fatalities and 1,261 cases, nearly 600 of which were associated with the cluster relating to the Shincheonji church. A U.S. soldier stationed at a base near Daegu has also tested positive for the virus, becoming the first service member to be infected, the U.S. military said Wednesday.
South Korea accounts for the largest number of patients outside of China, yet may not be alone — public health experts suspect other countries may have hundreds or thousands of undetected infections because they’ve been less aggressive than South Korea in contact tracing and publicizing instances of potential exposure. Other nations may also lack the testing capacity. South Korea has run about 30,000 tests, many of them over the last week.
The zealous effort to identify all potential cases has meant a granular level of detail. Based on interviews, credit card statements and CCTV footage, officials are retracing the steps of each infected patient and asking the public to get tested if they may have been exposed and were experiencing symptoms.
Emergency push alerts accompanied by screeching alarms asked: Were you at the hot springs in the city of Yeongju at 5:30 p.m. on Feb. 17, or at a particular yoga class in Andong after 2 p.m. on Feb. 18? Were you at a singing class in Busan on Feb. 22, or in Gimhae on bus 128-1 between 8:36 a.m. and 8:52 a.m. on Feb. 17?
“It’s very good from a public health perspective, having that kind of contact tracing,” said Michael Mina, assistant professor of epidemiology at Harvard’s T. H. Chan School of Public Health, who said the detailed data will be crucial to experts around the world studying how quickly and through what routes the virus transmits. At the same time, he said authorities should be sensitive to the varying degrees public tolerance in releasing potentially identifying details.
“That can be very cultural. The U.S. has a really strict culture of wanting very, very limited information shared,” he said. “Whether to make the information truly public or to people who need to know, that balance needs to be struck.”
Dale Fisher, a Singapore-based physician and chair of the World Health Organization’s Global Outbreak Alert and Response Network, said the best way to curb the spread of the epidemic might be different in each country.
“It’s all contextual. In Korea it might be acceptable, in California that might cause an outrage,” he said. “Community engagement is so critical in this response, the community needs to be part of the solution when you’ve got a community spread epidemic like this.”
In South Korea, the woman known as “Patient No. 31,” suspected of being a super-spreader behind a massive surge in cases in the southeast of South Korea, has become a point of intense public interest, scrutiny and criticism. She was vilified online after reports that she had refused to be tested despite showing symptoms. Many questioned whether she could be criminally prosecuted. Fake photos, identifying details and rumors about the woman rapidly circulated on social media.
The woman has given interviews to several local news outlets saying that although she wasn’t given detailed instructions, she sought out testing for the virus.
“We don’t want to put a stigma on these people,” said Ian Mackay, a virologist and associate professor at Australia’s University of Queensland. “People won’t come forward if they think they’re going to be held to blame for an infection they didn’t intend to get or want to get.”
Much of the public outrage over the sharp increase in cases has been centered around the Shincheonji church that Patient No. 31 attended. A religious sect with 12 branches around the country, the church has been described as a “cult” for its messianic leader. It has been criticized for reportedly infiltrating other churches and its domineering hold on its members.
Even a public health official in charge of infection prevention in Seo-gu in Daegu was revealed to be a member of the church after he was diagnosed with the virus. Many members hide their affiliation with the controversial church.
More than 750,000 signed a petition to the South Korean president urging that the church be disbanded. Authorities in Gyeonggi province raided the group’s headquarters in the city of Gwacheon, alleging that the church had been slow to turn over its list of members. South Korean officials said they would track down and test all 245,000 members of the church.
Katherine Gibney, an infectious diseases specialist and epidemiologist at Austin Hospital near Melbourne, Australia, said as the virus continues to spread globally, each government will determine how best to prepare its citizens for a potential outbreak without infringing on individual rights or heightening panic.
“It’s really important to get risk communication right. That’s a challenge with every outbreak, especially with a novel virus,” she said. “It’s important to balance when it’s potentially useful for someone to know, versus when it might just cause panic and without much actual risk of contracting it.”