Disclaimers: (1) This piece is an exploration of considerations to factor into data analysis to arrive at the most effective interpretation of that data. I am not an epidemiologist. (2) This piece is also slightly longer than usual, but it’s a topic that strikes close to home and so I wanted to explore the ideas here in depth, several of which transcend South Korea’s response to Covid-19.
At times when people struggle to make sense of unexpected crisis, nothing provides comfort quite like charts and data. We put our faith in data because we feel it gives us insight and control — but does it really? Only when the data is viewed within the correct context.
The way people respond to a single event is different around the world and reflects our varied cultures and experiences. That’s why it’s so important to first identify cultural variants, and then examine the data through that contextual lens. Without this understanding, we cannot know which data is actually relevant or determine the right questions to ask of the data.
In the case of Covid-19, all eyes are currently on South Korea as the shining example of a pandemic response done right. Korean scientists and business leaders prepared early and acted quickly. They operated under the assumption that Covid-19 was going to hit the country hard. And everyone remembered how South Korea successfully faced off against a MERS-CoV outbreak in 2015 and the lessons learned from that encounter.
But does South Korea offer a reliable model for other countries trying to rein in the spread of the novel coronavirus? Unfortunately, it’s not that simple.
How People Think Matters as Much as the Data About Their Actions
I’ve been inspired to write this piece by Li Jin’s post on technology and life in quarantine for people living in China. I wanted to do a South Korean version to call attention to a simple yet powerful truth about data that is easily overlooked: Understanding how people think is as critical as understanding the data about their actions. In fact, the two are (or should be) inseparable.
How I interpret data about Covid-19 in South Korea is informed by my long relationship with the country’s people and culture, and my own family’s experience with the virus.
I am fortunate to have family members and friends in both Seoul and Busan, and even before Covid-19, I stayed in touch with many on a near-daily basis using KakaoTalk (the Korean version of WhatsApp). Last summer, I spent an entire month in the country and experienced life in its two most populous cities. I didn’t stay in hotels but slept on the floors of family and friends.
So, when Ray Wang (@rwang0) – founder and CEO of Constellation Research, who also happens to hold a Master’s in Public Health from Johns Hopkins – pinged me on January 20 about concerns over what was being communicated about the virus in Wuhan, I paid close attention. “Something doesn’t add up,” he said, “I’m worried.”
As a natural worrier and hypochondriac myself, I did not take these words lightly. That evening I spent hours wading through as much information as possible about the virus. This was January 20 – the day both the US and South Korea identified their first official cases of Covid-19.
The very next morning, my wife received an urgent call from a hospital in South Korea. Her mother was sick – very sick. In a matter of hours, she was on a plane.
My wife spent the next month in Busan. She was there for the big spike in mid-February and I remember being horrified when South Korea experienced 900 new cases in one day. But I also took comfort in the swift action taken by South Korea’s scientists and business leaders. The country began widespread testing quickly – including tests for asymptomatic cases – and started alerting citizens via text message about Covid-19 cases within 100 meters of their location. South Korean leaders also implemented a rigorous quarantine procedure to contain contagious people before they could spread the virus.
Before my wife could get into the hospital to visit her mother (엄마, pronounced “ummah”), she had to answer a questionnaire, have her temperature taken, and apply hand sanitizer. The usage of protective masks was strictly enforced. Thankfully, my mother-in-law fully recovered.
Determining Which Factors Helped to Flatten the Curve
As of this writing, South Korea has successfully “flattened the curve.” But which factors had the greatest impact? Was it the response from top leaders in the government? Fast action by scientists and business leaders? Testing and quarantine procedures? Or something else entirely?
Good luck trying to answer that question with data alone. The X factor? People and culture.
Human behavior and cultural norms seem to play a major role in a population’s ability to prevent the spread of Covid-19. One of the most telling factors, for example, is the delta between longstanding norms relating to physical contact (e.g. shaking hands, kissing cheeks, bowing) and the new realities created by the coronavirus (e.g. physical distancing and the six-foot rule). The bigger the gap, the harder it is to close.
In the US and UK, which currently have the world’s highest death tolls, shaking hands and other forms of physical contact are deeply embedded in the culture. In many Asian countries, on the other hand, physical contact outside of immediate social circles is less common. For Asians with a culture of greeting people with a bow, the six foot rule doesn’t impose much behavior change. For Westerners, it’s highly disruptive.
In this spirit of inquiry, I recently spoke with several people on the ground in South Korea about their Covid-19 experiences – how it is impacting their lives and people’s behavior, which measures are (and are not) working, and more.
Physical and Social Distancing
South Korea is a crowded place, with 70% of the country mountainous and largely uninhabitable for its population of over 51 million people. The population density of the capital city, Seoul, is 60% greater than New York City – 45,000 people per square mile vs 26,403 people per square mile.
The degree that Koreans are practicing physical and social distancing is remarkable when you consider the sheer density of their population and the amount of communal space they navigate from day to day. Koreans tend to live in high-rise buildings and, due to limited storage, shop on a daily basis. When they are out and about, standing shoulder to shoulder in public spaces is common. People bump into each other and don’t say anything. That’s not rude, it’s just life. If anything, staying apart is the real challenge. By these metrics, South Korea had every reason for Covid-19 to hold a death grip over the country. But that’s not what happened.
Jungkook (정국), the owner of an English school in Seoul: We try to keep doing social distancing (사회적 거리두기). At least one to two meters from someone else. We don’t go to restaurants. We don’t go to shopping malls. We try to avoid people as much as possible. Even though we see our neighbors, people don’t talk much. I personally try to get on the elevator after everyone else.
Jisoo (지수), a recent college graduate living on the outskirts of Seoul: People are wearing masks, being more concerned about personal hygiene like washing their hands more frequently and carefully. Hand sanitizer has become essential, there are hand sanitizers in elevators and buses, and people carry their own.
Jungsook (정숙), my sister-in-law who has been living in Busan since January 21: Some churches, restaurants, and other stores opened again for the first time on Tuesday (April 21). Your temperature is taken at most but not all places. Seniors are staying home and not going out. People are going out but keeping their distance and being very careful. People are very tense. If someone coughs on a train, there is a mini panic and people move away fast.
Healthcare and Covid-19 Testing
Koreans are far more proactive about health and wellness than we are in the West. In general, you go to the hospital at the first sign of any physical illness or injury. If you have a high temperature or even just feel exhausted, it’s straight to the hospital without thinking twice.
When flu season comes around, everyone wears respiratory masks outside at all times. Many households even have specialized air filters that are the size of a refrigerator. Here’s the one my mother-in-law (장모님, pronounced “jangmonim”) has in her home.
All year round, shoes come off when entering a home and most people take showers at the end of the day to clean up rather than in the morning to wake up.
Jungkook (정국): I think we implemented diagnosing centers very quickly. We have a drive-through system for testing. We also have “phone booth” style testing. It’s a perfectly sealed booth which is then disinfected after each use. We are testing a lot of people. The City Hall app sends notifications when someone has a new case, and alerts us with an urgent emergency sound. People are told to install another app that will track where they have gone if they have or had the virus. The app ensures they quarantine themselves. They have to stay home for 14 days.
Jisoo (지수): If you want the test and your doctor will not provide a referral, you go and get it for 170,000 WON ($140). If you test positive, the government will pay for the test. Nobody in South Korea pays for a positive Covid-19 test.
“Doomsday prepping” is not part of Korean culture. When Covid-19 arrived in South Korea, there was no hoarding like we saw in the US and other countries. In fact, there was hardly any disruption in their supply chains at all. The country has a long-standing culture of home delivery that dates back to the 1980s, and people commonly have groceries, meals and other items delivered at all hours of the day and night. (Delivery services operate 24 hours a day, 365 days a year.)
While protective masks were in short supply for some people early on in the pandemic, every citizen now has access to brand-new disposable masks every week. In fact, the biggest complaint related to supply chains in South Korea during Covid-19 has been the limit on the number of masks – everything else has more or less been available via delivery.
Jungkook (정국): We have disposable masks, (two per person per week). Based on our social security number and according to the last number of the year of your birth, people can buy masks on a particular day. The masks have gotten more expensive since Covid-19. If we buy them online, we pay 2,500 WON ($2). If we buy them at the store it’s 1,500 WON ($1.22). These masks are government-issued. We have been able to get masks the whole time during Covid-19.
Trust in Data and Science and Apply Cultural Context
In closing, I’d like to share a few words of wisdom from Professor of Infectious Diseases Woo-joo Kim (김우주) of Korea University College of Medicine – the “Dr Fauci of South Korea” – who is the leading voice educating the Korean people on Covid-19 and the science behind the virus and the medical response to this pandemic:
This is science. You have to be humble. The moment we become arrogant, we will lose. Perhaps Europe and the US were overconfident. They may have thought wearing masks does not help. But we have to be humble until the end. It’s not the end until it is over.Professor Woo-joo Kim of Korea University College of Medicine