What lessons S.Korea learn from MERS outbreak

A 68-year-old South Korean man visited a small clinic in his hometown Asan, south of capital Seoul, as he coughed and had fever. Doctors might have diagnosed him with a simple flu or pneumonia, but he was referred to a bigger hospital to seek better medical services, then he went to Samsung Medical Center in Seoul, one of the country's biggest hospitals in which he was confirmed to have been the index case of the Middle East Respiratory Syndrome (MERS) and dozens more were infected later.

It took nine days for the first patient to be tested positive on May 20 for the viral disease. "The biggest reason is that the patient zero was diagnosed too belatedly," Shin Sang Yop, infectious disease specialist at Korea Medical Institute (KMI), told Xinhua Wednesday.

South Korea became the most MERS-contagious country outside Saudi Arabia, where the disease first emerged in 2012 and more than 1,000 cases have since been found. The MERS corona virus had infected 186 South Koreans, among whom 36 passed away.

The total contagion number and the death toll have been unchanged for more than 40 days, but the government had yet to declare a formal end to the MERS crisis as the World Health Organization (WHO) advised the country to make the declaration four weeks, or double the incubation period, after the last infectee completely recovers. Now, only one patient, who had suffered from an immunity-weakening disease before infection, was still tested positive.

Bungling initial response

The belated diagnosis came together with the bungling of initial government response under the absence of well-established control tower. "Problems with the initial response, after confirming the first patient, resulted in failure to prevent the spread of the disease at an early stage," said Shin.

President Park Geun-hye was briefed on the matter six days after the confirmation of the first case. Former Health Minister Moon Hyung-pyo, replaced after the MERS crisis abated, stood in front of Park belatedly to report on the outbreak. Moon, a pension expert, had been reportedly named to help reform pension system for public officials.

Shin said two control towers should be set up, including one executing preventive measures against viral diseases and the other supporting the executive control tower. In South Korea, both control towers didn't work, or exist, at an early stage.

To operate the executive control tower normally, the health minister or the Korea Centers for Disease Control and Prevention head who are well trained in infectious disease prevention should take responsibility, Shin said. Under the command, public health clinics and private hospitals should actively take preventive actions.

Shin said that an advisory group comprised of experts on infectious disease and preventive medicine needs to be formed as a standing committee to help the control tower chief make a right decision in a timely way.

Epidemiological investigators, who specialize in medicine and epidemiology, should be increased in number and improved in quality. Job security should be guaranteed to the epidemiologists by providing them with stable jobs and complete training courses. If many authorities are given to well-trained epidemiological experts, fast response would be made possible, said Shin who also served as the investigator in 2003.

Here in South Korea, about 20 epidemiological experts are covering all infectious diseases outbreak, a hundredth more than 2, 000 epidemiologists in the United States. About 90 percent is composed of college graduate doctors lacking in expertise on epidemiology, who mostly serve in military service as army doctors.

In case of supporting control tower, at least a prime ministerial-level official has to be in charge to offer necessary administrative supports, including the military, police, hospitals and other facilities, at the request of the executive control tower head. It would enable the pan-nation efforts to prevent the virus spread, Shin said.

Municipal governments and education offices should separately organize control towers to provide administrative supports in cooperation with the central government, Shin said, adding that the three supporting towers from the central government, municipal governments and education offices will have to cooperate at the request of the executive control tower, not taking independent measures.

Unique hospitals culture

The MERS spread took place mostly in hospitals, especially in emergency rooms jam-packed with beds and seats. Emergency rooms were not crowded with patients in emergency, but with patients waiting to check into hospitals and their families sitting close. The emergency room of mega-hospitals is always filled with too many people.

The 14th patient, who had contracted the virus from the patient zero in Pyeongtaek, checked into the emergency room of the Samsung Medical Center in Seoul and caused the second wave of MERS contagion there by infecting dozens more.

As seen in the first patient, South Koreans flocked into big hospitals as they believed that large hospitals could provide better treatment. While MERS suspects wandered around clinics and hospitals, possibility got higher for potential carriers to infect more. It is called "doctor shopping."

"As (MERS) carriers developed symptoms, they wandered around big hospitals with better facilities and equipment without any prior notice," said Dr. Lee Jong-koo, chief of JW LEE Center for Global Medicine under Seoul National University College of Medicine. "It resulted in medical staffs and families of the patients contracting the virus in a defenseless state," said Lee.

Lee co-headed the WHO-South Korea joint mission in June to conduct an epidemiological survey on the outbreak along with Dr. Keiji Fukuda, assistant director-general for health security at the WHO.

"In our country, patients are allowed to select a hospital, into which they check, in emergency situations," said Lee, indicating that most of carriers rushed to biggest hospitals in which the vast majority of cases were discovered. "It needs to restrict the transport of patients to emergency rooms without any advance notice," said Lee.

There is also a unique culture in South Korea of frequently visiting the sick families, relatives and friends who stay in hospitals. Family members, not care workers, usually do much of the nursing work sitting next to beds, exposing themselves more to an infectious disease compared with other countries, said Shin at the KMI.

Shin said that people should refrain from visiting the sick except a few necessary cases. The doctor recommended that hospital workers, not family members, should attend on patients and that emergency rooms should be filled with only emergency patients.

The hospital culture seemed to begin to change as big hospitals encouraged the visitors of the sick to write down about personal identities while limiting the number of visitors. People began to understand why hospitals did that after the MERS crisis.

Such restrictions were needed especially in big hospitals to change the hospital culture, said Shin.