[세션1-3]코로나19와 정부의 대응_정기석_코로나팬데믹, 한국의 대응과 과제_covid-19

We learned about the WHO’s responses to the COVID-19 pandemic and how Korea has responded in this global order, as well as what to expect in the future. The third speaker is Professor Jung Kisuck. He is a professor of respiratory medicine at the College of Medicine at Hallym University. He also served as the director of the KCDC, just before the current director, Dr. Jung Eun-kyeong. As such, he was practically in charge of designing the measures taken by the KCDC during this pandemic situation.

00:40 - One can say that the measures he designed are being put into operation by the KCDC now. So, let us narrow the discussion down a little further and hear about how the KCDC’s responses can be assessed and what Korea can do to deal with infectious diseases in the future. Please take the stage. Hello, I am Jung Kisuck. I am very happy to be able to share my experience with you. Due to the limitation in time, I will jump in right away. That photo is not the one I would choose, I wonder where the staff got it from… We say that COVID-19 will separate the world before and after the pandemic, but for the KCDC, MERS, the Middle East Respiratory Syndrome, was just such a thing that brought many changes.

01:47 - I say this because although the ability of those who are there is the same, but the people looked to the government to be invested in the situation, and initiatives were taken. After MERS died out in Korea in 2015, I was appointed to the KCDC on February 3rd, 2016. The position of the Director of the Center for Disease Control and Prevention left vacant for a while. Various preparations were undertaken, and for the year and a half of my service until July 2017, we did quite a few things. In terms of improvements, we created the Emergency Operations Center (EOC).

02:25 - EOC is currently orchestrates all operations related to COVID-19, and the current director, Dr. Jung Eun-kyeong, was the head of this center at the time of my appointment. She is the number one person in the practical affairs of the KCDC. Next, we strengthened our system for epidemiological investigation. Epidemic Intelligence Service is a very important job in the US, but in Korea, medical staff with experience only as public health doctors that just came and went as epidemiological investigators.

02:57 - We gained approval for hiring 37 specialists and started recruiting medical specialists, experienced nurses, and public health experts. We also desperately felt the importance of crisis communication, and Professor Park Kisoo, who is also present today, worked with me at the time to create an office for crisis communication. At the time of the MERS outbreak, as a respiratory physician, I needed to treat MERS patients in person, but I wasn’t given any information. But the government had all the information. After I was appointed, I learned that the government had already been prepared for the MERS outbreak and had created a national public health crisis response team.

03:46 - They had all this in place, but when it actually happened, they weren’t able to do anything. The professors are also somewhat responsible for the fallout. All professors who participated in this crisis response team should take responsibility, but this is all in the past. We signed an MOU with the Korea Medical Association signed an MOU to send information to all doctors in the country via mobile phone. The KCDC sends out any information of interest to their mobile phones.

04:09 - At first, we tried faxing, etc, to the doctors but learned that they don’t look at it. Since they look at their mobile phones every day, this is what we decided to do. As you know, infection control within hospitals has also been strengthened a lot. We added more negative pressure rooms, and restrictions have been put in place for hospital visits. I’ll mention the DUR, which is a new system, later, as well as about the new smart quarantine system we implemented to automatize the quarantine procedures.

04:40 - First, to look at the organization chart, the new offices we created are a team for preparing for emerging infectious diseases, and next to it is the EOC, then there is the center that played a big role for its diagnostic kits, which became well-known worldwide, the Center for Laboratory Control of Infectious Diseases, which includes the Division of Laboratory Diagnosis Management. This center was in charge of the kits. The National Institute of Health provided us with the basic science behind the infectious diseases, and Dr. Jee served the head of the center. I will just briefly mention the organization structure of the EOC due to time constraints. The Division of Public Health Preparedness and Response manages the EOC, and the Division of Quarantine Support oversees the 13 quarantine stations set up nationwide, and the Division of Resource Management manages stockpiles of PPE, etc. which is said to be scarce these days. There also are separate divisions for risk analysis and international cooperation, and a division in charge of preparations for new infectious diseases. We built the EOC pretty well.

05:59 - It opened in May last year, and it looks great. Before the EOC was built, we worked in a tiny, shabby office, and after I left the KCDC, they built this beautiful center. This is the situation room where the control tower is. Meetings are held here, and the press room is at the back. It’s well equipped and looks great from above as well. The people who work here have been working non-stop for over 100 days. Now, this is the smart quarantine system we completed in 2017. But, as you know, COVID-19 cannot be screened through quarantine procedures. When we identified the first patient, we thought, ‘Okay, we did it.’ But from then on, patients started to roll in non-stop.

06:48 - They say that about 10% of the active cases are asymptomatic until they are cured, and even if someone shows no symptoms, s/he may be infected. Anyway, as you can see, when a passenger flies in, the information is sent to the quarantine center. The information held by the Ministry of Foreign Affairs is also sent to the KCDC, as well as the information on foreigners held by the Ministry of Justice. What is more important are the mobile service companies. These companies send in all the roaming data from the phones to the KCDC.

07:27 - So, we created a system where, if the phone is roaming, we can track where the owner of the phone has been, and all these systems were mounted on the DUR system that the Review & Assessment Service has, which I mentioned earlier. DUR refers to drug utilization review, a great system for preventing doctors at different hospitals from prescribing drugs that should not be taken together. Since the DUR is input with patient information, we made it so that, for instance, if a patient had been to the Middle East within two weeks, a flag would show. It would pop up in red letters. So, the patient becomes surprised when asked, “Have you been to the Middle East?” Using this system, we made it so that any visits to risk areas, for instance, Wuhan and such, will show up. So, we created this system that connects the hospitals and the KCDC with their collaboration.

08:27 - This is what we call the smart quarantine system. I will summarize what I have observed so far and assess the KCDC’s operations. The starting point is critical. That is, what the KCDC did before the patient number 1 appeared. Interestingly, in mid-December, the KCDC did a practice exercise. It was titled, “An unknown pneumonia has occurred in China. What do we do?” This was before Wuhan’s situation became known. Really, what a coincidence. So, the KDCD was prepared. Such practice exercises are held every now and then, and it was just held at the perfect time. Then, we came to know about the unknown pneumonia found in Wuhan, and we started to do a risk evaluation based on the information we found. We have a risk assessment department that prepared the response guidelines for local governments and medical facilities and agencies, and then we thought to make a guideline for the quarantine centers to check people who have visited China, but at this time, China insisted that there was no person-to-person transmission in China. This is one point that China really did wrong.

09:46 - Next, we put in a request for strengthening surveillance of Wuhan visitors to local government. You think this will make them move, but not one bit. They don’t know what to do, so it just ends up in a pile of paperwork, but anyways, we did this. Then we implemented the DUR I mentioned and visited Wuhan. The most important thing was to establish a Pan-Corona test. We developed a test method that detects all the corona viruses called Pan-Corona. We had no idea what the coronavirus was, because China didn’t reveal this information. So, the KCDC’s Division of Laboratory Diagnosis Management decided, let’s detect all coronaviruses. There are six coronaviruses we know about. MERS Corona, SARS Corona, and four others that cause the flu. This is a routine test in hospitals.

10:36 - So, if the Pan-corona test comes out positive, then we test for all six viruses. And if the test detects one of the six, then we can say, “Okay, it’s this direction.” And if all six come out negative, then, “This is a new coronavirus, it must be the seventh corona.” This later became SARS Corona II, but that’s how we diagnosed patients 1 and 2. Then, at the end of January, as virus sequencing was revealed, and we quickly made a kit called RT-PCR, that is, Real-Time PCR.

11:08 - Next, in the four-tier alert system, consisting of Blue, Yellow, Orange, and Red, the KCDC proactively raised the level from Blue to Yellow as a start. We saw our first active case in January 20th. I will briefly summarize what happened up to patient 29. The first patient was identified and gracefully sent to a negative pressure room. The KCDC has been well trained to find patients, investigate close contacts, and hospitalizing and isolating them. Although you may not know, the KCDC actually still manages 200 suspected cases of MERS each year. About 1,000 people are reported, and 200 people are managed, that is, they are hospitalized in negative pressure rooms, examined, and managed until their tests come back negative and they are discharged, so finding patients, hospitalizing them, managing close contacts, contacting and calling for 14 days, etc. are things the KCDC do all the time. This was the same thing, whether it’s COVID-19 or MERS. On January 27th, the alert level was raised to Orange. This was also quite preemptive, and a significant one at that.

12:27 - Alert systems need to be preemptive as a response, and if it is raised after things have escalated, it is already too late. At this alert level, the Central Disaster Management Headquarters headspears the operations, and while the director of the KCDC is the head of the Central Disease Control Headquarters, the head of this HQ is the Minister of Public Health and Welfare. This makes two control towers. The Minister of Public Health needs a role, as well as the Vice- minister and the department heads… So little by little, the KCDC director is bypassed in certain situations. This is a big weakness of ours. Patient 29 was confirmed on February 16th. The emergency room at Korea University Hospital identified the patient really well, suspecting the unknown pneumonia as COVID-19.

13:20 - We did know how this patient became affected. It was a community-acquired infection. We identify patients who just get pneumonia in their daily lives as community acquired pneumonia, or CAP. Much later, we learned that the patient came in close contact with an infected person in Jongno, but it was a sign that COVID-19 finally spread to the local community level in Korea, that it is no longer the stage where disease control authorities can control the spread. But we just let it pass. Then, patient 31 happened in Daegu on February 18th, as you all know. Things became frantic, and medical institutions were paralyzed.

13:55 - Daegu has four medical schools and 5 university hospitals. The city calls itself “Medicity Daegu” – that’s how well it is equipped with medical facilities. Still, patients died due to the lack of access to an intensive care unit. They couldn’t even go to the hospital. As Dr. Lee said earlier, we were paralyzed by just 2,000 patients. What people like me thought at the time when the number of patients exploded in Daegu, after patient 31, was that we should empty the public hospitals in Daegu.

14:28 - There are quite a few public hospitals in Daegu. Veterans hospitals, hospitals for industrial accidents, medical centers, etc. We could empty all the patients there. It is possible to do this, one by one. One-third of the patients at public hospitals are usually people who don’t need to be hospitalized. I assure you, we can send them all out. If we prepared this way, then things wouldn’t have gone so bad. But we left it to happen. We left it, then made a move too late when things became urgent.

14:54 - If a patient goes into arrest and we need to do CPR, it’s no use. We need to be ready before patients go into arrest. So now, the KCDC started assisting the Daegu local government. The Daegu local government was supposed to have two epidemiological investigators and operate an infectious disease control center, but when I was at the KCDC, it didn’t follow the requirements. ‘Cause there’s usually no work for them. The KCDC went to Daegu, things were awful.

15:20 - A senior staff that the KCDC said, “I don’t know where to begin.” And after controlling the nationwide situation, it was only on February 23rd that the alert level was raised to Red. Way too late. The level should have been raised to Red at least around February 20th after the active case was identified on the 19th. The criterion for Red alert is community-acquired infection. This was already happening, but we didn’t raise the level.

15:47 - I strongly suspect that there are other factors besides epidemiology and quarantine measures. As the situation in Daegu was being dealt with, and we moved on to distancing in daily life. Under Red alert, the Central Disaster and Safety Countermeasure Headquarters is formed, which is headed by the prime minister. Without Red alert, even when the Countermeasure Headquarters is formed, the Minister of Public Health and Welfare takes the lead. All efforts are put into stabilizing Daegu and Gyeongbuk regions, and small group outbreaks were managed, etc.

16:24 - After that, we thought it was almost over, but then the Itaewon club outbreak happened, which made us realize, ‘the social distancing wasn’t sufficient.’ ‘Cause this happened when social distancing was enforced. It was to be lifted on May 6th, and the Itaewon outbreak happened the day before. So, this is how things went. Now, my assessment. The positive points. Everyone believes what the KCDC Director Jung Eun-kyeong says. She is an icon of stability and trustworthiness. She’s been standing in front of the camera for three months now, unfaltering. Next is transparency of information. All information is publicly released, and we’re told “this is what’s going on, so follow our directions.” Nothing is hidden. Also, as you may have expected, the staff at the Ministry of Public Health and Welfare and the KCDC are truly dedicated. These people used to always go back and forth between Sejong and Seoul, but now they stay put in Sejong and Ohsung. A lot of people were sensitive about privacy issues, but a consensus has been built that “public interest may come first.

” 17:48 - Although it’s business as usual, our thorough tracking, identification, and contact management. No other country in the world does it this way. The KCDC deputy announcing, “Whoever went to this PC room on which floor in what building or used the elevator in the building, “please report to authorities and get tested or be cautious.” They don’t do it like this. This is a culture and method particular to Korea, and it’s working. Although people may not be interested, but we established diagnostic tests early on, from pan-corona, RT-PCR, then Fast-track, but making kits like these don’t get approved right away.

18:28 - We already put in place a system so that kits can be approved in just 1 or 2 weeks rather than three to four months. And the kit we made was proved to be superior. I just have a couple more slides. What can be improved? I mentioned briefly, but is the KCDC the main actor in the prevention and quarantine measures for COVID-19? Are all the policy measures at least being checked, if not approved, by the KCDC director? I don’t think they are. There are many issues. But the delayed management of incoming population from China and the delayed Red alert, and enforcing social distancing in daily life without taking any additional measures. Why are we only now enforcing wearing face masks on the subway? This should have been done sooner.

19:18 - And people should’ve been told to keep wearing face masks when social distancing measures were enforced. Instead, we let people slide and then suddenly tell them, “you can’t ride the subway without a face mask.” This is such a backward move. This is not something that would have come from Dr. Jung Eun-kyeong. The same goes for reopening schools. We closed the schools and had them run classes online, then after just a few weeks, we have them open up school again, especially in Incheon or Seoul in this situation. Schools are now closed again this morning, so soon after reopening them.

19:54 - Is this well thought-out management by the Ministry of Education? Concerning critical patients, as I mentioned earlier, there are some who died without ever getting the chance to go to the hospital. This should not have happened in our country, the Republic of Korea. That’s why the live-in treatment center should have been prepared in advance. When patient numbers exploded on February 18th, we should’ve emptied condominiums and dormitories in two, three days. Who uses condominiums and dormitories in this situation? But this was put off again and again, and only done at the last minute when things wouldn’t get better.

20:31 - I suspect that these measures were also implemented by an actor other than the KCDC. The same is true with the face masks. Face masks are what protected us so far. Koreans’ high sense of civic duty and face masks. Try riding the subway, in New York or London, without wearing a face mask. That’s how the spread happened is how I see it. Another thing is that there are insufficient exchanges among front- line medical staff. Clinical data should be shared. Dr.

Jee mentioned earlier that more than 10,000 people have seen the data, but why isn’t it shared amongst themselves? 21:00 - There is a platform called ICRIT that Dr. Jee and the KCDC has. You just have to enter the data. Doctors don’t have to do it. We can hire people. Job are scarce these days, why don’t we do this? Even I don’t know the data well. We don’t know about the data on 10,000 patients. At least not in detail. We just hear stories. This is why we need to share information on what we’re doing. Lastly, the KCDC is not the center for managing infectious diseases.

21:30 - All diseases, especially chronic infectious diseases need to be managed. There’s talk about making the KCDC an independent agency, but even this is not sufficient. Do you think making it an independent agency will give it autonomy in appointments and budgeting? Do you think it can make policies? Enact laws? I discussed with Dr. Park Dojoon about cultivating specialists in infectious disease control, but we couldn’t make it happen in the end. We couldn’t even make a graduate school that even cancer centers have.

21:54 - Why can’t we, when so many people are terrified? Ultimately, I think it’s important to make this happen in collaboration with a research institute. Thank you. .