East vs. West: Coronavirus Fight Tests Divergent Strategies
South Korea and Italy offer two bookends of how a country can tackle the coronavirus. Their divergent experiences hold urgent lessons for the U.S. and other democracies where the pandemic is at an earlier stage.
Seoul, accepting the illness had arrived, kept its borders open and aggressively tracked down the infected using data and extensive tests. Rome, after escalating attempts to reduce travel and social interactions, quarantined the whole country, while only screening people once they had shown symptoms.
The countries have two of the biggest coronavirus outbreaks outside China. But South Korea's known infections are now stabilizing at around 8,000, whereas Italy's are rising relentlessly past 15,000. South Korea has 67 deaths as of March 13. Italy's death toll was a far higher 1,016 by late Thursday, because the virus has hit its large and vulnerable elderly population and overwhelmed hospitals in some areas.
The different trajectories reflect how policy efforts have interacted with the response of the population, shaped by culture and recent experience. In South Korea, as in Japan and Taiwan, the lingering cultural imprint of Confucianism gives a paternalistic state a freer hand to intrude in people's lives during an emergency, says Lee Sung-yoon, an international-relations professor at Tufts University's Fletcher School.
"Most people willingly submit themselves to authority and few complain," Mr. Lee said. "The Confucian emphasis on respect for authority, social stability and the good of the nation above individualism is an ameliorating factor in a time of national crisis."
Kim Seung-hwan, a 28-year-old office worker in South Korea's virus-hit city of Daegu, is trying to avoid co-workers and says the collective fight against the virus has uprooted his personal life. "I haven't even met my girlfriend for the past two weeks because she stays at home," Mr. Kim said. He sat alone in a cafe, armed with hand sanitizer, and tugged his face mask down only to sip his coffee.
"I wouldn't ever greet someone by kissing them on the cheek," Mr. Kim said, a reference to the common Italian greeting. Nobody had to tell him to abstain.
"I'm not surprised they did it. We had to reach this point, because you need to force Italians to do things by law," said Sara Nicodemo, a 24-year-old concierge at an apartment block. "Everybody was ignoring recommendations. This is how we function."
In Italy, as in many Western countries, reactions to the coronavirus reflect a different social contract that limits the claims of the collective, as well as a widespread skepticism toward authority that has its own deep historical roots.
The irony is that, to influence behavior, easygoing Italy has now suspended personal freedoms to a far sharper degree than Asian democracies.
The government in Rome is trying hard to persuade the population that, despite the decree, success rests in citizens' hands if they put public spirit ahead of personal preferences. It's a hard sell.
An Italian tradition has long venerated being furbo, or cunning, by evading the rules—a legacy of centuries of viewing public authorities as incompetent, capricious and self-serving. So when Prime Minister Giuseppe Conte called on Italians to cooperate with the national quarantine, he said: "We must not think about being furbo."
In the U.S. and Europe, warning sirens from health officials have similarly won a less-than-urgent response from citizens, health experts say. "There's a premium on the individualistic Western mind to be defiant," said Gary Slutkin, an epidemiologist and former World Health Organization official.
Many observers have noted that China's stringent lockdown of 500 million people, which put a brake on coronavirus infections, was far easier in a dictatorship than a democracy. But the more important question in developed countries might be: Are some democracies better than others at fighting global epidemics? Are Western nations at a disadvantage compared with Asian democracies?
Globalization has increased the risk of infectious diseases spreading rapidly across borders, but Asia has had more practice handling that threat than the West has. The outbreaks of SARS, MERS, H1N1 and avian flu all gave Asian countries a foretaste of what the new coronavirus requires. Governments developed new policy tools in response. Citizens learned the drill, including donning masks and keeping a distance.
"There's a precedent and an understanding of how serious this type of infectious disease can be in many Asian countries," said Melissa Graboyes, a University of Oregon professor who teaches the history of medicine and global health.
When South Korea faced MERS in 2015, a stumbling response led to political support for dramatically broadening the country's infectious-disease law. The state won powers to target at-risk individuals or groups for testing, treatment and isolation. Now, as a result, detailed case information gets posted on government websites or text-messaged to individuals from the affected neighborhoods, sometimes within hours.
The new coronavirus has led governments to restrict travel and impose quarantines on a scale never seen before, enlisting wide swaths of their population, most of them healthy, to become participants in the public-health struggle, said Keiji Fukuda, a former WHO official who worked extensively on the H1N1, avian flu and other recent major outbreaks.
"What is new is the scope of these social-distancing measures," said Mr. Fukuda, now a University of Hong Kong public-health professor. "It's unprecedented."
South Korea accepted in mid-February that the coronavirus had seeped into the country from China. Opposition lawmakers and the country's largest physicians' group argued for restrictions on Chinese visitors, but President Moon Jae-in's administration rejected the idea, pointing to Koreans who had traveled to China as the conduit.
The virus spread mostly in the city of Daegu, among members of a secretive religious movement with a nationwide network of followers. The Moon administration's first moves were aimed at identifying, corralling and testing all of the roughly 10,000 members of the Shincheonji Church of Jesus in Daegu—whether or not they showed symptoms.
Police tracked down Shincheonji members who didn't answer government phone calls. Health officials sifted through credit-card transactions, peeked at GPS tracking data on people's phones, and used footage from security cameras. The country expanded its number of virus-test sites by opening drive-through clinics. The government instituted new fines of up to about $8,300 for those refusing to be hospitalized and treated.
The aggressive push to test Shincheonji members put all of South Korea on alert about the virus at a time when it could easily have spread across the country, said Ryu Sukhyun, a preventive-medicine professor at South Korea's Konyang University. "The government did a good job of stopping the situation from getting even worse," Dr. Ryu said.
South Korea can carry out more than 15,000 tests daily, with a team of 1,200 medical experts able to diagnose patients within six hours, health officials say.
But Seoul's playbook has relied equally on social norms. Like many other Asian democracies, South Korea could largely count on its citizens to follow government advice and wear face masks, stay indoors and avoid large groups—a leap of faith now being tested across the U.S. and Europe. South Koreans are frequent users of face masks even in normal times, when they are worn to counter bad air quality.
The country's collective buy-in has reshaped daily life. Movie-ticket sales this month plummeted around 85% from a year earlier. Office buildings thinned out and added thermal cameras. The number of Seoul's bus and subway passengers nosedived by one-third in early March right after local officials started a "Hold Off" campaign to reduce contagions. Food delivery, even of shaved-ice desserts, soared.
Deputy Health Minister Kim Kang-lip recently suggested other countries should follow the government's test-and-tech approach. He also heaped praise on the many citizens "voluntarily taking part in the Covid-19 response effort."
The combination of vigorous detection and social compliance helped bring down the rate of new infections after it peaked on Feb. 29. "I can see some hope that we may approach an inflection point in the near future," South Korean Prime Minister Chung Sye-kyun said on Monday.
South Korea isn't in the clear. The focus on testing Shincheonji members meant some screening of some nonmembers was delayed. Daegu city officials have warned of a rise in infections beyond the church.
Around the country, cases have popped up at other churches, hospitals, and even a Zumba class. The country's capital city of Seoul is dealing with a new cluster of cases. More than 100 people working at a call center have fallen ill, reigniting fears that the coronavirus could spread across the Seoul metropolitan area, where half the country's population lives.
From early on, Italy focused on restricting movement rather than testing.
On Jan. 31, Italy banned all direct flights to and from China, to Beijing's chagrin. The government declared a state of medical emergency, allowing it to cut through bureaucracy and impose measures on local authorities in a crisis.
But the coronavirus had already begun to spread, undetected, in small towns southeast of Milan. How the virus got there still hasn't been established. On Feb. 23, the government sealed off 10 towns in the area, plus another town near Venice. Army checkpoints blocked the roads in and out of the "red zones," whose 53,000 inhabitants were told to stay home. Northern Italian regions closed schools, universities and museums and banned most public gatherings, including at soccer games and cultural events. In Milan, Parma and Venice, the Catholic Church stopped celebrating Mass.
Testing for the virus was initially unfocused and locally variable, leading to 95% negative results. The government issued more restrictive guidelines for testing, telling local health authorities to test only people who showed symptoms and had also been in contact with virus hot spots, such as the Lombard towns or China.
Most people who were potentially infected weren't tested if they showed no or only light symptoms. Only around 3,000 tests a day were carried out, in a population 20% larger than South Korea's. The virus continued to spread.
Italians soon began pushing back against unpopular restrictions. Under public pressure, Milan relaxed a short-lived 6 p.m. curfew on bars, letting them stay open late provided people maintained a distance of a meter between one another. Many didn't.
Politicians drank aperitivo with Milanese citizens to show that normal life was continuing, and the hashtag "Milan isn't stopping" spread on social media. One leading politician who was photographed out in Milan on a Saturday night, giving high-fives to passersby, later tested positive for the virus.
Italy's infection count was rapidly approaching South Korea's. Worse, Italy's daily death toll surpassed China's declining fatalities on March 2. In the worst-hit parts of Italy's rich north, hospitals were running out of beds in intensive-care units.
The government's scientific advisers were urging more radical steps to cut down contact between Italians. If the epidemic took off in Italy's poor south, they warned, the health-care system would collapse.
On March 4, Italy's government shut down all schools in the country. Italians were banned from watching live soccer or going to the theater or movies. The elderly, who accounted for nearly all deaths, were urged to stay home.
Unease spread in the peninsula, but many Italians tried to maintain their way of life, going out for evening drinks, and traveling about the country on the weekend to visit family or go skiing.
In recent days, Mr. Conte's government brought down the curtain on the dolce vita. First the north, then the whole of Italy was ordered not to move from place to place unless necessary. Everyone was to stay home if they could. On Wednesday night, Mr. Conte shut down all bars, restaurants and shops apart from groceries and pharmacies.
The first-ever nationwide lockdown in a modern democracy will take time to work, Mr. Conte warned. "We can't think that tomorrow or the next day we'll see the impact of these measures."