There are sharp differences in the way countries have responded to the global pandemic caused by the COVID-19 virus. A comparison of the recent experiences of South Korea, widely recognized as having the best organized COVID-19 defense, and Brazil, a strong contender for having the worst defense, presents a dramatic contrast in results.
South Korea experienced the first large outbreak of the virus outside of China, registering a peak of more than 900 cases a day at the end of February. New reported cases were doubling every few days. Still, it took South Korea only one month to effectively contain the virus. By June 25, the total number of deaths reported by South Korea since the virus first arrived was a remarkably low 282.
South Korea’s public health officials were better prepared than those of most other countries because they had learned from previous serious disease outbreaks: the SARS outbreak in 2002, the H1N1 influenza of 2009, and the Middle East respiratory syndrome, or MERS, of 2015. In the wake of these challenges, South Korea better understood the importance of early testing, accurate tracking, isolation of new patients, and full transparency across all levels of government. Infectious disease prevention legislation was revised to meet these objectives. With COVID-19 the government moved rapidly to design, manufacture, and distribute accurate tests through some 600 testing centers including pop-up drive-through centers. They developed high-tech methods for rapid contact tracing through patients’ phones and CCTV footage. South Korea has not experienced the need for full lockdowns, keeping most companies and institutions open. Instead they depend on mandatory isolation of patients, either in hospitals or, for the moderately sick, in isolation dorms. Asymptomatic contacts are expected to self-quarantine.
Another important factor behind South Korea’s relative success is the willingness of the population to follow the advice of the country’s health experts. These officials have been full supported by the government, which has avoided political interference. The population, too, has learned from the difficult experience of past major disease outbreaks.
While the disease peaked more than three months ago, South Korea’s recent experience shows that governments should remain vigilant and ready to adapt, as new infection outbreaks can develop. South Korea has experienced a number of small but persistent outbreaks in the greater Seoul area, beginning with a holiday in early May. The government responded by tightening some restrictions, including closing bars and night clubs in the area, and moved rapidly to trace and test thousands of contacts, isolating those found to have the virus.
The quite different situation in Brazil was discussed in our May 20 commentary, “Cry for Brazil and Also for Latin America.” Over the past month, Brazil’s experience with COVID-19 has deteriorated further as quarantines have been lifted despite the number of cases continuing to grow rapidly. Brazil’s confirmed fatalities now exceed 53,800, second globally only to those of the US; and the country has more than one million confirmed infections to date. It is believed that the actual numbers are considerably higher. The president, Jair Bolsonaro, continues to obstruct most efforts to contain the virus, urging governors and mayors to end their lockdowns and other restrictive measures. Fortunately, many have resisted these demands. There are no nationwide rules for social distancing. The president is unwilling to wear a mask, nor does he recommend mask wearing. A federal judge has ordered Bolsonaro to wear a mask while in public in the Federal District, but he is resisting. The president says the extent of the disease is being exaggerated, and he even tried to end reporting of virus data. It is impossible, however, to hide what is happening as the virus surges with few restrictions through the poorer communities in the country, which are ill-equipped for this increasingly severe medical crisis. The situation is made even worse by widespread corruption that affects the allocation of limited medical resources.
It is true that even if the Brazilian government had followed smart policies, including adequate prior investment in the public health infrastructure, the nation’s extensive poverty, with a large portion of the population working in the informal sector of the economy and living in densely packed favelas where social distancing is impossible, would have permitted the virus to spread and cause widespread fatalities. The difficult experience of Peru illustrates this. But what is happening in Brazil looks like a worst-case scenario for a pandemic. In the end Brazil’s death toll may surpass that of the United States on a per capita basis. The simple lesson from comparing the experiences of South Korea and Brazil is that smart government policies at all levels and smart practices by citizens can be expected to save many lives.
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