What Should the U.S. Learn from South Korea’s Covid-19 Success?

In February, as South Korea watched the numbers of a novel coronavirus surge, Seo Hyun-ho grew worried about the health of his wife and two young children. But Seo, like other residents of Seoul, felt secure in knowing that most Covid-19 cases were concentrated in the southeastern part of the country, approximately 150 miles away, in Daegu.

For Seo, that assurance ended on Feb. 28 with an unexpected text message: A coworker at his Gangnam office had tested positive, it said. The ensuing string of calls and texts informed him that, since he’d been in the same elevator at the same time as the confirmed patient, he should get tested immediately and quarantine for two weeks. Seeing it as his civic duty, he didn’t think twice about cooperating.

The Korea Disease Control and Prevention Agency (KDCA) knew Seo and the patient had shared an elevator, and that both had been wearing face masks at the time, because of the nation’s elaborate contact tracing infrastructure. The system pulls data from credit card transactions, cell phone locations, and, in Seo’s case, CCTV footage to reconstruct infection pathways and identify individuals whose routes overlap. This has since been automated, through a platform called the Epidemic Investigation Support System that completes the process in just a few minutes. In essence, the apparatus, which launched in March, does much of the legwork of contact tracing for health officials.

Related

Opinion: The Overlooked Covid-19 Testing Success

This swift response, according to COVID Translate Project co-director Ohk Seung-cheol, is an example of what makes South Korea’s approach to containing Covid-19 so effective — without having to resort to nationwide lockdowns. Despite a recent outbreak that has alarmed officials, people retain their freedom of movement, and authorities can mostly pinpoint sites of potential transmission, says Ohk, who leads an international team of volunteers translating the KDCA’s Covid-19 protocol so that other governments may learn from it.

“Because of this invasive contact tracing system, Korea has done such a good job of controlling coronavirus, compared to other countries,” echoes Seo. “I think officials could actually be even more invasive.”

The World Health Organization and American health officials have praised South Korea for its Covid-19 response. But when it comes to learning from it, many Americans seem less willing to adopt their ally’s practices.

Even as U.S. public health officials scramble to track infections, they have sometimes struggled to win basic cooperation from a public that prizes privacy, let alone implement the kind of widespread tracking seen in South Korea. The barriers to doing so are steep, highlighting stark differences not only between the two countries’ contact tracing infrastructures and public health systems, but also people’s civic trust and sense of public surveillance and social responsibility. Americans’ perceptions in giving up privacy for the public good have shifted before, particularly after the 9/11 attacks. But if the U.S. could overcome such hurdles and adopt South Korea’s containment strategy, would it even be desirable?

While many Americans would balk at South Korea’s big data surveillance system, a large majority of South Koreans support it. One poll from early March found that around 78 percent of respondents believe efforts to contain Covid-19 warrant the relaxation of human rights protections.

“Asian societies shifted in the direction of treating these technologies as contributing to a public good that is well worth the temporary and necessary incursions of privacy,” Victor Cha, senior adviser and Korea chair of the Center for Strategic and International Studies (CSIS), recently wrote in The Washington Quarterly, a policy journal.

In South Korea, this attitude has been informed by memories of another coronavirus — the Middle East Respiratory Syndrome — that propelled the country into panic in 2015. Caught off guard, South Korea recorded the highest number of cases outside of Saudi Arabia, with 38 deaths. (Meanwhile, the U.S. had only two reported cases.) Many South Koreans were outraged, not only by their government’s response but also by its initial refusal to release information, like the names of the hospitals treating patients.

The National Assembly quickly amended the Infectious Disease Control and Prevention Act (IDCPA) in 2015, to expressly permit health officials to collect personal information for contact tracing purposes, and then disseminate anonymized versions of it publicly — with or without consent.

As such, many people now expect the government to spring to action when there is a public health hazard. When Yi Soo Jeong, who works as a music festival manager, found out in May that she’d been within a few blocks of a major Covid-19 cluster in Itaewon, a popular entertainment district of Seoul, she was amazed the authorities had the ability to track her down. The same weekend that there was a superspreader event at a nightclub, Yi and her husband had gone to a nearby restaurant.

“I was waiting for the text message,” she says. “Actually, I felt relieved when I received it, because it meant that the government was really doing their job by checking everyone.”

For all of Undark’s coverage of the global Covid-19 pandemic, please visit our extensive coronavirus archive.

In South Korea, when an infection is confirmed, the patient’s details are posted on the relevant district government office website, including their movement logs, any public transit they used, and any businesses they visited that involved close contact. This information is texted out to the public in an emergency alert so that individuals can cross-check their routes and essentially contact trace themselves. To streamline the process, many turn to third-party mobile apps that aggregate and plot infections on a map, and even send push notifications when users come within 330 feet of a location recently visited by an infected person.

These technologies serve as tools in carrying out “a social contract between the state and society,” wrote Cha, which obligates the people to cooperate with digital tagging, and obligates the authorities “to provide the best information possible as quickly as possible.” Such transparent exchange of data helps the public feel that they are in control of their own surroundings and security, and builds confidence that their government is also keeping them safe, according to Cha.

South Koreans felt so confident that in April, less than two months after the height of the outbreak, 29 million of them went to the polls to vote in the nation’s parliamentary election — the highest turnout in nearly 30 years. Not a single infection was traced back to voting.

In the eyes of many South Koreans, then, to sacrifice some privacy isn’t much of a sacrifice at all, when it means safeguarding other liberties. “The situation in other countries that had lockdown, where the government and police mandated you to stay at home,” Yi says, “also could be seen as a violation of an individual’s freedom.”

Internet advertisers, Yi points out, already use her personal information for targeted marketing. That concerns her more than data gathering by public health officials. “We are cooperating,” she says, “not letting the government steal our private information.” 

Across the globe, the story in the U.S. paints a different picture of people’s perceptions of surveillance and privacy.

In the wake of the Sept. 11 terrorist attacks, more surveillance started entering the lives of Americans. In the fall of 2001, President George W. Bush signed the USA Patriot Act into law, enabling the government to listen in on citizens’ phone calls, track and review emails at any time, and investigate the internet behavior of individuals suspected of terrorist activity. Although the law was controversial — and ended up disproportionately targeting Muslim communities — many Americans accepted it at a time of heightened national emergency as a sacrifice of privacy for the greater good.

Over time, this perception of giving up individual liberties and privacy for the public good waned, says James Lewis, senior vice president and director of the Technology Policy Program at the CSIS in Washington D.C. But, he says, “if you can make a convincing case to the public that the increased surveillance increases their safety and security, the majority of them will accept it.”

The type of surveillance depends on the situation. “If you say to people, ‘would you be like to be tracked everywhere you go?’ The majority will say no. If you say to them, ‘would you like to be screened when you enter a sporting event so you don’t need to show your ticket and we weed out any violent criminals,’ most people say yes,” he says.

Over the last two decades, digital technologies have expanded the ability of corporations and government agencies to collect data on individuals. During this time, Americans have grown more aware of how they’re being surveilled as well, says Lee Rainie, director of internet and technology research at the Pew Research Center. “There’s this rising sense that data are being collected both because they’ve agreed to it, and sometimes because they just have a sense that others are watching,” he says.

In 2019, Rainie’s group at Pew surveyed 4,272 American adults on their perceptions of privacy, concluding that Americans are “concerned, confused, and feeling [a] lack of control over their personal information.”

That set the stage for the Covid-19 pandemic. Suddenly, people were asked to surrender their private information for useful public health interventions like contact tracing. The result of the 2019 Pew survey “is the basic story we would be telling even in the midst of the pandemic,” Rainie says.

And, during the demonstrations that emerged across the U.S. in the wake of the deaths of George Floyd and other Black people at the hands of law enforcement, protestors became increasingly concerned about privacy, with police in some instances using aerial surveillance and facial recognition technology to track protestors. This increased policing made many activists, protestors, and civilians more sensitive about being surveilled by the government, Lewis says.

This lack of trust ultimately poses challenges for contact tracers. While South Korea’s big data approach to tracking taps into a centralized apparatus that streamlines the process for epidemiologists, contact tracing in the U.S. is mostly done manually, with a separate system run by each state’s health department.

In the U.S., health officials enter positive Covid-19 cases in a database. Case investigators and contact tracers then call up these individuals and ask who they have been in contact with. Most states define a “contact” as someone who was within an infected person’s 6-foot radius for at least 15 minutes. It’s up to the tracers to ask questions that jog a person’s memory of past contacts. Are they still going to work? Where is work? How do they get to work? Who have they hung out with recently? Then, the tracers call these contacts to check on their health and provide necessary recommendations.

Tracers often receive pushback, and even cooperative people may not remember their every move. In Maine, for example, contact tracers aim to reach 95 percent of a positive cases’ contacts. In reality, however, they’ve only been getting to around 80 percent. “Some contacts do not answer the phone,” says Robert Long, the communications director of the Maine Center for Disease Control and Prevention. Language barriers pose a challenge for contact tracers, he says, and people of some ethnicities who hail from countries with oppressive governance tend to be more skeptical of government surveillance. And tracers across the country also see the distrust of government and reluctance to share close contact information, stifling contact tracing efforts.

Recently, technology giants Apple and Google launched contact tracing apps to try to streamline contact tracing and several states, including Colorado and Virginia, have integrated the technology into official state Covid-19 tracing apps. The apps can tap into a phone’s Bluetooth signal to track and monitor whether the user is near someone who later tests positive. In such a case, they would receive an alert on their phone to get tested and self-quarantine. Although the apps would make contact tracers’ work easier and more effective, the public is split on whether or not they would download such apps onto their phones, according to a Kaiser Family Foundation poll this past April. Most states have relied on old fashioned phone calls rather than using the available apps. 

With regards to privacy, most Americans tend to be transactional, according to Pew’s research. In other words, if they give up their personal information, they’d want something for it in exchange — such as club cards at wholesale stores that allow shoppers to save money in return for allowing the store to track their purchases.

The stakes of the transaction and the trade-off are a bit higher in a health context, says Rainie. What further complicates the transaction is that most Americans don’t think their private information is safe in the hands of private companies or government agencies, and they feel like they can’t opt out of a system where their information is being used, explains Rainie.

Some restaurants and other businesses have found creative transactional ways to coax people into sharing information. In June, Drew Dellinger, a writer and poet from the San Francisco Bay area, visited the Highland Stillhouse, a Scottish pub near Portland, Oregon. When the check came, the server came over and explained to Dellinger and his family that the restaurant was holding a raffle. They could enter if they wrote down their phone number, the server explained, which would also be used for contact tracing if needed. The raffle “seemed like a smart and smooth way to get the contact tracing done,” Dellinger wrote in a Twitter message, adding that he would have shared his phone number even without the transaction. “If contact tracing is a good idea and a necessary thing,” he reasons, “then why not help the restaurant and public health officials make that possible?”

Both the U.S. and South Korea reported their first Covid-19 cases on Jan. 20. But South Korea acted almost immediately, activating its existing infectious disease control law, which had pre-enlisted the help of credit card companies, cell phone carriers, police, and the National Health Insurance Service. By early February, officials had also approved a Covid-19 testing kit, and they prioritized widespread testing and tracing.

Overall, South Korea, a country of roughly 52 million — about six times smaller than the U.S. population — has had more than 300 times fewer cases than the U.S. and, as of October 5, only 422 deaths. Despite several small flare-ups in recent months, and even a spike that, since Aug. 12, has linked more than 1,170 infections to a single church, most establishments remain open, and life is largely back to business as usual.

It is this very success — and the international media’s overwhelmingly positive coverage — that has helped validate South Korea’s strategy to its people, according to Kelly Kim, general counsel at the internet freedom group Open Net. She cautions, though, that such emergency measures should be eyed with greater scrutiny, especially when they lack clearly defined boundaries.

On July 30, Open Net and four other South Korean civil society organizations filed a lawsuit challenging the constitutionality of the IDCPA, the legal basis of the country’s contact tracing system, which they say infringes on citizens’ privacy. “The law allows the government to collect and disclose personal information without warrant and without courts’ review,” Kim says. “It’s not just a bad precedent for Korea or Korean people, but it’s also a bad precedent for the world.”

In the constitutional complaint, petitioners contend that location data collection after the Itaewon outbreak was excessively broad. While the first Covid-19 transmissions of that outbreak took place on May 2, health authorities used cell phone location data to trace more than 10,000 people who had been in the vicinity between April 24 and May 6. By treating all 10,000 of those visitors as infectious disease risks, the complaint says, it violated their human rights.

More recently, authorities accessed the cell phone data of more than 15,000 people who had been in the area of an anti-government protest, after it was determined that the leader of the controversial church at the center of the August outbreak was among them and ended up testing positive. Open Net denounced that data collection as “unconstitutional,” too.

The Itaewon outbreak was particularly sensitive because it was linked to gay clubs, sparking fears that publicizing personal details would result in a mass outing of a population that, in a largely homophobic country, is especially vulnerable. Similar concerns had been echoed by the National Human Rights Commission of Korea (NHRCK) in early March, when it advised against disseminating unnecessary data that could lead to the public identification of patients.

While the NHRCK’s recommendation did prompt the KDCA to revise its guidelines to limit disclosure, much of the mainstream public appears to be unconcerned about collection.

Earlier this summer, when the government rolled out a QR-code based system to track entries into venues deemed to be high risk, like nightclubs and churches, it was generally accepted. According to one poll, that system — which collects patrons’ names and phone numbers, and records the time of their visit — was supported by 70 percent of those surveyed.

Critics like OpenNet believe health authorities need to address privacy questions beyond simple data collection and disclosure. They say the government must also ensure the Epidemic Investigation Support System is secure from hacking, that civil servants are not leaking information to the press or public, and that personal details are deleted within a reasonable period of time.

Lewis, of CSIS, says that Americans are reluctant to trade privacy for public health benefits because the U.S. lacks the collective action mindset of countries like South Korea, in which people prioritize meeting their own personal obligations to maintain the well-being of a larger group. “If you have a culture where people have a stronger sense of community, good policy and leadership will resonate better there,” he says.

The U.S. has experienced both bad policy and a weak sense of community, Lewis argues. “When you have a very individualistic culture with weak leadership — and that’s true for Trump, it’s true for [New York Gov. Andrew] Cuomo — individualist culture with weak leadership is not the best way to go into a crisis.” A clear directive from the White House in the early days of the pandemic would not only have reduced the number of fatalities, he says, but also built the credibility to impose greater surveillance. Now, he thinks it’s too late to adopt any semblance of a tracing method like South Korea’s. “Privacy doesn’t exist in a vacuum,” he says, “but in a great political and social context.” When people distrust the government, he says, they “are going to be more reluctant to share.”

That individualist mindset could turn towards collectivism, argues Mikey Biddlestone, a social psychologist at the University of Kent in the U.K. For instance, financial incentives in more individualistic countries may prompt people to act in the greater interest. “If you give someone a selfish reason to do something,” he says, “that might be the best route for at least the U.S. and U.K. at the moment.”

But experts like Cha add that it would be misguided to attribute South Korea’s success to cultural differences alone, noting that orientalist stereotypes often underlie assumptions that South Koreans are inherently Confucian in spirit or submissive to authority. In South Korea, legal penalties are involved — up to 3 million won (around $2,500) for refusing testing, and 10 million won or up to one year in prison for breaking quarantine, which is monitored by an app. On Aug. 1, the leader of the secretive Christian sect Shincheonji, the nexus of the nation’s earliest and largest Covid-19 cluster, was arrested for not cooperating with authorities. South Koreans are also motivated by the fear of public backlash: One survey found that many people were more scared of the stigma of Covid-19 than of Covid-19 itself.

While South Koreans may tend to put the public interest above individual rights, and some Americans might feel compelled to do the opposite, Kim says societies must be thoughtful about balancing the two. And, as she points out, the unique dynamics of a pandemic — in which public health affects personal health, and vice versa — can scramble neat distinctions between collectivist goals and individualistic priorities.

“This is an unprecedented situation,” she said. “You might die. So if you die, your privacy doesn’t matter anymore. In that way, it’s really hard to balance and weigh against each other — your life and your privacy.”

UPDATE: An earlier version of this story provided a dated figure for the number of Covid-related deaths in South Korea. As of Monday, October 5, 2020, the country had seen 422 deaths, not 416.

Wudan Yan is an independent journalist based in Seattle. Ann Babe is a Korean-American journalist based in Seoul.