Interventions

South Africa

South Africa received much praise for their early management of the pandemic. The first case arrived in the country on March 5th and the government acted quickly, with President Cyril Ramaphosa declaring a level 5 National State of Disaster on March 26, 2020. South Africa's early pandemic response leveraged its experience in treating HIV/AIDS and tuberculosis to set up mobile testing units, which kept the growth rate in the early days of the pandemic below a 3% daily increase (Devermont and Mukulu). The government also focused on a science-based approach, frequently consulting with scientists and projections from modeling consortiums. The government also followed the guidance of scientists when they mobilized over 28,000 healthcare workers, allowing them to efficiently test large parts of the population. They also reached out to the WHO for assistance, with thousands of healthcare professionals and public health experts receiving training (Kaluwa and Ramadan).

However, the country began easing restrictions quickly, following the timeline shown in the figure below (Worldometers.info).

As can be seen in Figure 1, the alert level continuously decreased throughout the entire first wave of the pandemic, even though cases and deaths were on the rise (Government of South Africa). This can be attributed to the very negative response that developed to the lockdown measures over time, pressuring the government into relaxing restrictions. The lockdown was incredibly mismanaged, with rampant corruption and discrimination regarding the allocation of emergency funds and overly strict lockdown enforcement. Additionally, as the lockdown went on, increasingly unnecessary and nonsensical policies were implemented such as a ban on the sales of alcohol and tobacco and a ban on e-commerce sales (Naudé). Early lockdown measures were supported by businesses and the public, but as people became fatigued, they became increasingly antagonistic towards them. By May 2020, business owners responded to these unpopular policies by forming the "Business for Ending Lockdown" campaign, where more than 50,000 businesses declared the lockdown as a "humanitarian disaster" and urged the government to ease or even end the lockdown (Naudé). The government kept easing lockdown measures during the original variant outbreaks but were forced to raise alert levels at the end of 2020 due to the rise of the delta variant (Government of South Africa). However, by then the government developed new "adjusted alert levels" with concrete guidelines and rules for lockdowns. These new guidelines were used for the rest of the pandemic, being raised up to level 4 during the outbreaks of the Omicron variant in late 2021 and early 2022. The State of Disaster was lifted on April 5th, 2021, marking the end of the unpopular lockdowns in South Africa.

South Korea

Unlike South Africa, South Korea was mostly able to avoid some of the stricter measures such as lockdowns. The government was able to leverage its experience dealing with MERS in the past to effectively contain COVID outbreaks during the first year of the pandemic. They were achieved this success by adhering to the three aspects of pandemic preparedness (detection, containment, treatment) and giving concrete safety guidelines for people to follow (Kim). 

South Korea's robust national strategy to contain COVID within its borders consisted of what the government called the 3 T's: testing, tracing, and treatment (FDA). The most impressive and important aspect of South Korea's plan was the extensive testing infrastructure the government was able to quickly set up. The government quickly used its emergency authorization powers to approve the use of several test types, with the first molecular diagnostic tests being used starting February 7, 2020 (FDA). These tests were distributed to testing centers, which ranged from locations such as medical institutions, research labs, and high-traffic businesses like restaurants and coffee shops. By the end of April, Korean institutions were capable of running an average of 15,000 tests every day, with this number reaching 110,000 tests per day by November (Kim). Korean contact tracing efforts were similarly effective, as the government had access to enormous amounts of data collected from the public. After getting hit hard by the 2015 MERS outbreaks, the Infectious Disease Prevention and Control Act (IDPCA) was amended to allow the government to collect personal data such as credit card statements, location data, and CCTV footage to precisely track the whereabouts of infected individuals for 14 days post-infection (FDA). This robust contact tracing method ended up being among the most successful in the world, as health agencies like the Korean Disease Control and Prevention Agency (KDCA) could use automated methods to identify possible transmission events within minutes. The testing and tracing efforts combined to allow Korean health officials to control the spread of the disease very effectively, as they could identify and isolate positive cases very quickly, preventing COVID from spreading too much.

After a person tested positive, they were then subject to spend 14 days in self-quarantine. People who tested positive were given an official "Notice of Isolation/Quarantine," after which they were assigned a case officer that would monitor symptoms twice a day. Patients also downloaded the government-developed Self-Quarantine Safety Protection App and were subject to random inspections (FDA). Those who were found to violate the self-quarantine were fined over $8000 USD and could face imprisonment. While these methods may seem harsh, those who were put into self-quarantine received much support from the government, which would perform two checks daily to deliver food, provide psychological counseling, and give patients options for entertainment (Kim). 

Because Korea entered the pandemic very prepared and was able to quickly "flatten the curve," the country was mostly spared from business closures and stay-at-home orders. The country focused more on social distancing measures, implementing a three-tiered system that gave social distancing guidelines based on the current situation in the country and mandating the use of masks (Kim). The social distancing tiers were activated at remarkably low case counts, with level 3 restrictions being implemented with 100 daily cases. South Korean citizens followed guidelines very well and resisted the limited lockdown measures very little, likely due to the recent MERS outbreak causing more fear of COVID than found in other countries (FDA).

South Korea was able to rest COVID patients very well, as the country has some of the highest rates of hospital beds per capita in the developed world, with 12.3 beds per 1,000 people (Kim) Bed shortages were seen in the early pandemic, as was seen in the hotspot of Daegu. During this outbreak, a triage system was set up to sort patients into mildly ill, moderately ill, and severely ill groups (An). This triage allowed doctors to treat patients effectively while still protecting healthcare workers. The lack of hospital capacity was partly due to inefficiencies in transferring patients between care centers because of decentralized jurisdictions. To solve this, the government restructured the healthcare system from 17 state and city jurisdictions to 6 regional clusters (Kim). This allowed patients to be moved easily between hospitals, ensuring beds were always available.

South Korea was able to keep its case counts to a few hundred cases per day during the first 2 years of the pandemic, but cases began to skyrocket in February 2022 due to the Omicron variant (Mathieu). The variant was too infectious to prevent spreading through social distancing methods, but the lowered mortality of this variant meant that hospitals stayed under capacity. South Korea continued to use the advanced testing, contact tracing, quarantine, and treatment methods they developed, as they continued to be effective in limiting the spread of COVID from being much worse.

South Korea's main difference from South Africa is how they were able to avoid strict lockdown measures by carefully controlling the number of cases through extensive testing, tracing, and treatment efforts. There was also much more support from the public due to transparent and well-studied restrictions being placed.  Government officials' extensive planning and preparation after dealing with MERS ensured that they had the resources and knowledge needed to ensure the safety and health of Korean citizens.