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COVID-19 Health System
Response Monitor: Republic
of Korea
December 2020
Updated February 2021
Authors: COVID-19 HSRM Japan
 Hyunjin Kang
 Soonman Kwon
 Eunkyoung Kim
Seoul National University, Republic of Korea
Editor
Anns Issac, Asia Pacific Observatory on Health Systems and Policies
Presentation outline
 Overview
 Preventing local transmission
 Ensuring sufficient physical infrastructure and workforce
capacity
 Providing health services effectively
 Paying for services
 Governance
 Measures in other sectors
Overview: COVID-19 HSRM Series
1. Preventing local transmission: Key measures to
prevent the spread of disease
2. Ensuring sufficient physical infrastructure and
workforce capacity: Physical infrastructure and
health workforce available in a country. Measures
to address any shortages, and other initiatives to
strengthen capacity
3. Providing health services effectively: Approaches
for service delivery and patient pathways for
suspected COVID‐19 cases. Also describes how
countries maintained essential health services
4. Paying for services: Health financing and coverage
during COVID-19.
5. Governance: Governance response to COVID‐19
6. Measures in other sectors: Responses to COVID-19
by non‐health sectors
 Up‐to‐date information on country responses to the COVID-19 outbreak
 HSRM presents information under six heads
 First case: 20 January 2020
 Total confirmed cases: 108,269
 Total deaths: 1,764
Korea Coronavirus Overview
Updated 09-April-2021
Source: https://coronavirus.jhu.edu/region/japan & https://coronavirus.jhu.edu/map.html
Preventing local transmission
1.1 Health communication
1.2 Physical distancing
1.3 Isolation and quarantine
1.4 Monitoring and surveillance
1.5 Testing
1
1.1 Health communication
Transparent and open communication was a KEY feature of the Republic of Korea’s
(RoK) response to COVID-19
 Extensive public communication through briefings, guidelines, campaigns and posters
on government websites and social media channels after the first case of COVID-19
 Scope of messaging within the gamut of the amended Infectious Disease Control and
Prevention Act, 2020
 Frequency and format of briefing – depending on the situation
 first briefing on the initial case of COVID-19 on 20 January
 increased number of official briefings when the (national) crisis alert level (CAL)
reached level 3 & 4
 decreased the number of live briefings or alternated them with written briefings
until a resurgence of cases occurred in mid-August 2020
 briefings increased with mass transmission at the end of September
 Central Disaster and Safety Countermeasure Headquarters (CDSC HQ) & Central
Disease Control Headquarters (CDC HQ: Regular briefings via TV and also written
documents via government websites
1.1 Health communication
Messaging on
 Basic rules of hygiene and preventive measures
 Epidemiological statistics
 National or local COVID-19 response interventions, including rules regulations and policies
 Details of confirmed cases shared via the websites and mobile notification alerts
 Emergency notification messages – at confirmed cases
 Use of sign language and English interpretations to expand reach
 Toll-free Hotlines:
 KDCA call centre (hotline 1339) and MoHW call centre (hotline 129) – 24/7
 Immigration Contact Centre (hotline 1345) and Korea travel hotline (1330)
 Rerelease of updated Rerelease official public recommendations by the government,
campaigns and guidelines across various platforms, in different formats
 Official government COVID-19 website: access to information for the public
 Tracking fake news and information: Cyber Bureau of the Korean National Police Agency
 Impact: Nationwide survey indicates trust and attention to briefings by the public
1.2 Physical distancing
 Early social distancing scheme (29 February 2020–27 June 2020) created keeping in mind:
public health concerns, feasibility, economy, public fatigue and the nature of disease outbreaks. As
a campaign rather than a scheme
 Three-level social distancing scheme (28 June 2020–6 November 2020)
 Level 1 during small-scale outbreaks
 Level 2 is operated when community spread occurs
 Level 3 – highest level: when there are multiple outbreaks in local community or large-scale
outbreaks that are spreading rapidly 28 –June-20: three-level social distancing scheme
 Five-level social distancing scheme (7 November 2020 onwards)
1.2 Physical distancing
1.2 Physical distancing
 Guidelines were published incrementally
 Well organized information with infographics on the official government COVID-19
response website to promote easy understanding and convenience of access
 Businesses were run with the basic preventive measures, including physical distancing
and hygiene – Level 1
 No domestic movement restrictions due to isolation or lockdown it was just
recommended to stay home and avoid movement
1.3 Isolation and quarantine
 Self-quarantine: keeping a person in isolation in an independent space at
his/her home
 a notice issued by the relevant public health centre (PHC) | person to comply with
self-quarantine guidelines | monitoring by government official
 dedicated teams conduct monitoring on a one-on-one basis
 Monitoring also Self-Quarantine Safety Protection App at least twice a day, along
with cooperation at the local level such as delivering rations, medicines and daily
necessities to those in quarantine
 A one-strike out system to enforce measures – example use of electronic wristbands
 Facility quarantine: keeping a person in isolation at temporary quarantine
facilities
 Hospital isolation: keeping a patient in isolation at a hospital or residential
treatment centre for treatment
1.3 Isolation and quarantine
 Treatment: by severity of illness of the patients and other factors
 Inpatient treatment during hospital isolation categorized as hospital
treatment & facility treatment
 Treatment in a residential treatment centre belongs to the latter
 Cohort isolations were used to stem further spread to nearby groups or the
community
1.4 Monitoring and surveillance
 Case definition revised as new information came in. 10-Nov-20: 3 categories
of case definition:
1.4 Monitoring and surveillance
 COVID-19 response guidelines = regularly updated
 Circulated widely to all health facilities and local governments
 Epidemiological investigation for confirmed cases to trace the source of
the infection: Key to successfully identifying and isolating COVID-19 cases
 COVID-19 Epidemiological Investigation Support System: A
centralized data collection and multi-agency coordination platform*
Centralized data collection and multi-agency coordination platform
 System built over smart city data hub – over 2 weeks followed by a 10-
day pilot, and later handed over to the Korea Centers for Disease Control
and Prevention (KCDC)
*Note: Also called “COVID-19 Smart Management System” by the Ministry of Land, Infrastructure and Transport
1.4 Monitoring and surveillance
 Use of manual logs or electronic entry log (KI-Pass) to aid contact tracing
 Travel history of patients to high-risk countries shared with health
facilities and pharmacies to support early detection for community-level
screening
 Responses cognizant of privacy and confidentiality of data
1.5 Testing
 Early development & mass production of testing kits
 public–private partnerships - the government, academia & private biotech
 Legal foundation for emergency use authorization (EUA) of test kits*
 High capacity for mass testing. Key features
 Public and private laboratory facilities and screening clinics
 February 2020: 15,000–20,000 tests per day, with a testing turnaround
time of 6–24 hours by mid-February 2020, from 600 screening centres
across the country.
 November 2020: 137 testing facilities: 25 public facilities, 96 civil hospitals
and 16 referral laboratories – that provide diagnostic tests These include
 KDCA | national quarantine stations | research institutes for public health and
environment | private clinical laboratories and hospitals
 80% of the laboratory facilities in the private sector
*Note: EUA was put into place in 2016, with the experience of MERS. The time for the legal process of approving products
that require clinical trials was reduced from 80 days to 2–3 weeks, even 7 days.
1.5 Testing
 Innovative approaches – Drive-thru and walk-thru screening
clinics
 convenient, safe and efficient. Reduces specimen collection time to
10 minutes, three times faster than a regular screening centre
 minimize the risk of cross-infections during sample collection
 Walk-thru screening centres require smaller space and shorter time
for sample collection | booth to separate medical staff from the
patients being tested
 March 2020: 79 drive-thru screening clinics
*Note: EUA was put into place in 2016, with the experience of MERS. The time for the legal process of approving products
that require clinical trials was reduced from 80 days to 2–3 weeks, even 7 days.
Ensuring sufficient infrastructure and
workforce capacity
2.1 Physical infrastructure
2.2 Workforce
2
2.1 Physical infrastructure
Covid-19 Care
 2015: outbreak response capacity strengthened during MERS outbreak
 2018:government-wide R&D fund for infectious disease research (KRW
40 billion, US$ 36 million) for five years. Informed RoK’s response to
COVID-19
 2020: Increase in budget allocation for new infectious diseases  KRW
68.8 billion (US$ 62 million) in 2015 to KRW 194.3 billion (US$ 175
million)
 Residential treatment centre- mild or asymptomatic COVID-19 cases
set up in collaboration with the private sector
 Example large suburban residential buildings by companies such as
Samsung converted to residential treatment centres
2.1 Physical infrastructure
Covid-19 Care
 43 infectious disease designated hospitals – increased to 67 (Feb-Mar
2020). 2468 hospitals by Nov 2020
 Central Co-response Situation Room at the National Medical Centre
(NMC) – patient triaging and coordination, and allocation of hospital
beds across the region
2.1 Physical infrastructure
Non-Covid health services
 Some public hospitals earmarked for mild-to-severe COVID-19 – freeing
up some hospitals for non-Covid care
 nationally designated isolation units (NDIUs) were identified (under the
central government)
 Provide immediate response to patients with an infectious disease
 Equipped with negative pressure systems
 Staffed by trained professionals
 National safe hospitals: designated for non-covid patients  with
guidelines to prevent cross-infections from respiratory ailment cases to
general patients
 October 2020: 270 national safe hospitals
 Telemedicine and prescribing without a visit to a doctor were temporarily
allowed
2.1 Physical infrastructure
Equipment
 Adequate provision of equipment and supplies for critical care
 Protective equipment provided by the RoK
 Other equipment: negative compressors, mobile x-ray units provided
 Classification of face masks into: general supply & priority supply
 Face masks were classified into two – general supply and priority
supply. measures to ban hoarding of masks and hand sanitizers
 Health Insurance Review & Assessment Service (HIRA)  support with
tracking purchase history
 Mask Supply System for Foreigners by HIRA and National Health Insurance
Service (NHIS)
2.2 Workforce
 Tracing and surveillance  Epidemic Intelligence Service
 Testing  doctors and medical laboratory scientists
 Provision of masks  pharmacists
 Health professionals mobilized to respond to outbreaks on a need
basis
 Guidelines to protect mobilized workforce
 Triage system flexible re-allocation of resources to respond to outbreaks
as needed
 No shortage of health workforce
Providing health services effectively
3.1 Planning services
3.2 Case management
3.3 Maintaining essential health services
3
3.1 Planning services
3Ts (test – trace – treat) strategy underlying RoK’s Response to COVID-19
 Flexibility in designating and mobilizing hospital beds for patients with
severe COVID-19 within the existing health system
 National Health Insurance (NHI): centralized single-fund health
financing system
 Infectious Disease Control and Prevention Act, 2020: mobilization of
resources
3.1 Planning services
Access to Health
 Improved access for vulnerable populations
 Measures on illegal stays relaxed for without a legal status
 Government support for testing and treatment without fear of deportation
or reporting
 Monitoring and provision of essential supplies such as PPE (face masks
and hand sanitizers)
 Access to face masks and sanitizers for the homeless
 Stricter preventive and management measures applied to densely
populated areas
 intensive inspection and management of vulnerable facilities (example:
cafes and restaurants), and infection-prone workplaces
3.2 Case management
Travel-elated
 Incoming international travelers details collected and categorized.
 Symptomatic passengers tested and assigned to a treatment facility if
positive. Negative results – 14 days quarantine at government-
provided facility
 COVID-19 response guideline followed for patient triage
 Patient Under Investigation: Management of PUI’s with protocols for
positive (detailed confirmation process), and negative (health
education) cases
 Confirmed COVID-19: severity checked PHC & classified by health-care
staff: mild, moderate, severe and extremely severe
 Appropriate treatment protocol followed after (see figure on next slide)
 Translated WHO guidelines: algorithm for COVID-19 triage and referral
3.2 Case management
3.2 Case management: Referral System
3.2 Case management: Treatment
 Sep 2020: No specific course of treatment recommended for COVID-19
 symptomatic treatment offered
 Use of antivirals upon the judgement of treatment team
 Whole-of-Government Support Committee for COVID-19 treatment
and vaccine development to accelerate and assist the R&D of vaccines
and therapies in collaboration with academia, industry & private
sector
3.3 Maintaining essential health services
 No lockdown and the health system capacity adequate to ensure
provision of non-Covid health services
 Remote medical services used to provide non-Covid health care also
 National safe hospitals for non-Covid health care
 Feb 2020: temporary consultation and prescription via telephone
(Under articles 39, 40 and 44 of the Framework Act on Health and Medical Services 2020, Article 59.1 of the
Medical Service Act, 2020, and Article 4 of the Infectious Disease Control and Prevention Act, 2020)
 Free influenza vaccination coverage expanded
 Safe blood collecting environment to maintain sufficient blood stores for
more than five days
Mental health services:
 Government provides mental health services for increased anxiety and
depression due to containment measures such as physical distancing
 Psychological counselling hotline (1577-0199)
3.3 Maintaining essential health services
Mental health services:
 Suicide prevention counselling line (1393)
 Support services such as Kakao Talk chat, posters and self-
examination apps provided
 National Trauma Centre: integrated psychological support group
 Tailored mental health support
 MoIS: psychological counselling for small business owners and economically
vulnerable people
 Ministry of Gender Equality and Family conducted 130 000 counselling sessions
for multicultural families
Paying for services
4.1 Health financing
4.2 Entitlement and coverage
4
4.1 Health financing
 Jun 2020 (mid): 0.5% of the NHI’s budget for 2020 spent on coping with
COVID-19, including direct medical costs, cost of maintaining essential
health services for patients with illnesses other than COVID-19 and
compensation for losses incurred by health providers
 Article 70 of the Infectious Disease Control and Prevention Act, 2020
 Medical institutions paid monthly estimated wages since April for
temporary losses
 Aug 2020: compensation for lost income of medical institutions,
pharmacies and general business sites due to COVID-19-relevant
measures
4.2 Entitlement and coverage
 NHIS, with universal coverage of the population, made it more efficient for the
government to mobilize all medical resources at once
 enabled early diagnosis and early treatment, which eventually led to well-organized
case management and governance
 Covers cost of COVID-19 tests for positive cases, suspected patients, PUI and for
those who travelled abroad with symptoms or with physician, recommendations,
etc.
 All Koreans entitled to utilize the health services when needed, with 20–30% of
the cost as copayment, depending on the level and type of care
 Free of cost health services for treatment of COVID-19: 80% by the NHIS and
the remaining cost (patient copayment component) is covered by the
government budget (See figure on next page)
 Aug 2020: fee from patients with confirmed COVID-19 entering from foreign
countries on violation of domestic countermeasures
 reciprocity arrangement in place with other governments for foreigners entering the
countries after 24 August 2020
4.2 Entitlement and coverage
Governance
5
Governance
Response marked by:
 Whole-of-government approach: swift intragovernmental communication
between ministries as well as between the central and local governments
 centralized and strong health
system
 cooperation of citizens in basic
measures of prevention and
hygiene
 Legal basis for public health
Enabled the government to strike
a balance between individual
rights and public health
Measures in other sectors
6.1 Borders
6.2 Mobility
6.3 Economy
6.4 Social and income support
6.5 Cross-border collaboration
6
6.1 Borders
 RoK borders not sealed (with exceptions and guidelines)
 Entry ban on foreign nationals from Hubei province of China
immediately after identifying the first case.
 Feb 2020: Special entry procedure introduced
 Use of Self-Quarantine Safety Protection App and Self-
Diagnosis App
 Special ambulances, buses, trains and taxi services are
operated to transport those who are subjected to treatment
or self-quarantine at a hospital, residential treatment centre
or their homes
6.2 Mobility
Domestic travel
 No aggressive restriction on domestic transport
 May 2020: Wearing of masks on public transport mandatory
 Sep 2020: operation of city buses was temporarily reduced after 21:00
hours, when level 2.5 of social distancing was implemented in Seoul in
early September
External travel:
 Updated travel advice through the official website of the Ministry of
Foreign Affairs (MoFA) on overseas safe travel
 Apr 2020: temporarily suspended visa waiver agreements with 56
countries
 Government negotiations to maintain business travel with select
countries
6.3 Economy
 Reduced household expenditure
 Closure of many micro, small and medium enterprises
3P’s (protecting, preserving and preparing) economic response
 Protecting denotes stabilizing employment, support for vulnerable groups
and protecting local economies
 Preserving focuses on economic resilience by stimulating domestic
consumption, revitalizing exports, providing support for the supply chain,
customized measures for each industry, etc.
 Preparing encompasses a new government initiative, “the Korean New
Deal”, aiming for innovation in industrial and economic structures, and an
inclusive society with a stronger safety net
6.3 Economy
Support for industries
April 2020: Economic measures for KRW 150 trillion (US$ 135 billion) in
response to the COVID-19, through four rounds of Emergency Economic
Council Meetings
 Relief funds to small and medium enterprises (SMEs) and households
and to boost consumption
 Resources to support corporate bond market and short-term money
market stabilization, and addressing stock market stabilization
 Sep 2020: eighth emergency economic council meeting
 Extra support measures taken by social security contribution and tax
payment deferrals
 customized support for various industries
6.3 Economy
Tax measures
 Direct and indirect tax measures were adopted in the RoK
 Tax credits to rental business owners who had lowered the rental fee
of a commercial building from January until December 2020
 Income and corporate tax reductions were made for SMEs in special
disaster areas as well as overseas companies' returning to the RoK
 Temporary relief from value-added tax (VAT) for SMEs
 Temporary increase in the income tax deduction rate for credit card or
other expenses from Mar-Jun 2020
 Temporary reduction of individual consumption tax on Mar-Dec 2020
 Mandatory NHI contribution discounted by 30–50% for vulnerable
populations Mar-May 2020
6.4 Social and income support
Livelihood support for the general population:
 Two emergency fund provisions for disaster relief in order to stabilize
livelihoods and stimulate domestic consumption
 First: nationwide relief in the form of cash, gift certificates, prepaid cards, credit or
debit card top-up. May 2020, for use until Aug 2020. for use in local community
 Second: targeted vulnerable groups - as small business owners, young job seekers,
the unemployed, the working poor, and households with childcare expenses. Sep
2020
 Local government support: disaster relief fund to the residents
 Sep 2020: Support to 6.7 million people with special care expenses and online
study expenses to help ease the financial and care burden caused by the
continued closure of daycare centres and schools
Unemployment benefits, job security measures
 Apr 2020: Emergency Measures for Employment Stabilization
 May 2020: Measures for the Public Sector Employment Shock
6.4 Social and income support
Support for education
 introduction of online classes and support for teacher training
 Technical assistance for online streaming and information, communication and
technology (ICT) platforms for schools were offered with the cooperation of the
Ministry of Science and ICT and MCST
 free digital device rental services and support for Internet access to students
from low-income families
 Supervisors were assigned to help children in emergency care at schools with
online classes
June 2020: all schools in the RoK had reopened, with the flexibility of online
alternative classes if necessary
6.5 Cross-border collaboration
 Active government engagement on international platforms to address
international solidarity and cooperation
 Contribution to The Group of Friends of Solidarity for Global Health Security UN
May 2020
 Support Group for Global Infectious Disease Response by WHO May 2020
 Group of Friends for Solidarity and Inclusion with Global Citizenship Education
UNESCO May 2020
 endorsed global vaccine initiatives:
 COVAX (COVID-19 Vaccine Global Access)
 International Vaccine Institute headquartered in Seoul
 RoK government supported 109 countries with essential supplies
 Sep 2020: Korea International Cooperation Agency introduced the “Agenda for
Building Resilience against COVID-19 through development cooperation (ABC
programme)”
 Knowledge-sharing activities through the COVID-19 information hub
February 2021 update
7.1 Overview: Demands for tactic changes
7.2 Physical distancing measures calibration
7.3 Continued efforts to testing, surveillance and monitoring
7.4 Resource mobilization: securing the beds for severe patients
7.5 Vaccines and vaccination
7.6 Additional social and income support
7.7 Updates on border control
7
7.1 Overview: Demands for tactic
changes
November 2020: Third COVID-19 wave in the RoK. Challenges
 Community transmission and unspecified mass transmission
coinciding nationwide
 Mass outbreaks continue in vulnerable groups
 Preemptive testing to catch the asymptomatic infection and
strengthened physical distancing nationwide
 Resource mobilization and referral to correspond to the
increasing need in securing beds for severe patients
7.2 Physical distancing measures
calibration
December 2020: Five-level social distancing scheme to implement
more stringent physical distancing measures
Undertaken based on quantitative data and qualitative consultations with experts
 Level scaled up to 2.5 for SMR (Seoul Metropolitan Region) and 2 for
the rest of the regions
 Measures adapted to meet the needs: example: mass outbreaks
occurred in a detention center, social distancing level 3 was
implemented for two weeks from 31 December 2020 to 13 January
2021 throughout all correctional facilities nationwide
 COVID-19 official website provides the public with visualization of the
social distancing level by region.
7.3 Continued efforts to testing, surveillance
and monitoring
Dec 2020:
 Lower barrier of testing: Anyone could get tested regardless of
symptoms. Testing free of charge. Treatment criterion of ‘72-hour’
without fever was reduced to ‘at least 24 hours (48 hours for
critical illness)
 Rapid antigen diagnostic tests: recent COVID-19 response
guidelines added countermeasures using rapid antigen diagnostic
tests to elaborate the response
 COVID-19 Variant: Whole Genome Sequencing (WGS) based on
Next Generation Sequencing (NGS) method is performed for the
confirmed cases among those entrants from the countries with
COVID-19 variants spread
7.4 Resource mobilization: securing the
beds for severe patients
‘Emergency Medical Response Plan in the SMR,’ ‘Emergency Medical
Response Plan for Long term care Hospitals’ took effect, and protocol for
dedicated care beds for severe patients of COVID-19 was established
Dec 2020: Emergency Medical Response Plan in the SMR
 estimate the future demands of sickbeds and secure them
 focused on increasing bed numbers, including dedicated care beds for
severe patients, and improve procedures for patient assignment and
referral
Jan 2021: Emergency Medical Response Plan for Long term care
Hospitals
 long-term care hospitals, for preliminary prevention, early response and
cohort isolation, patient referral, and follow-up measures
7.4 Resource mobilization: securing the
beds for severe patients
‘Establishment of a protocol for dedicated care beds for severe COVID-19
patients:
 Dedicated care beds for severe patients
 medical institutions manage the admission and discharge
 Medical institutions report the status of dedicated care beds for severe
patients and inpatient status daily to CDM HQ
7.5. Vaccines and vaccination
January 2021: the government of RoK secured COVID-19 vaccines to
inoculate a total of 56 million people, which are expected to be procured
through the COVAX facility and several pharmaceutical companies (123)
 COVID-19 vaccination designated as temporary vaccination has a legal
basis on Article 25 of the Infectious Disease Control and Prevention Act
(113)
 COVID-19 vaccination scheme :
 Vaccine introduction: a separate review team for safety and effectiveness
management
 enforces permission and shipment approval through three external expert
consultation procedures (Safety and Efficacy Advisory Group → Central
Pharmaceutical Affairs Council → Final InspecUon Council)
7.5. Vaccines and vaccination
 Vaccine distribution and supply:
 Cooperation with private companies to establish a distribution management
system
 Integrated control center for real-time management to control the entire
delivery and storage of vaccines
 Vaccination:
 Priority for vaccine rollout is determined after deliberation by the Korea
Expert Committee on Immunization Practices
 Feb 2020: COVID-19 vaccination information website provides vaccination-
related information. Function as a vaccination booking platform
 Post-vaccination management: Adverse reaction monitoring
 Damages recognized to be caused by vaccination are compensated by
government according to the 'National Vaccination Injury Compensation
Scheme,' which was introduced in 1995
7.6. Additional social and income support
Third Relief Fund 2021
 targets vulnerable population
 Registration dates and procedures differ depending on the fund
program for each beneficiary group
7.7 Updates on border control
Dec 2020:
 temporary suspension of visa issuance and flights from the United
Kingdom and South Africa
Jan 2021:
 Strengthened monitoring and managing of mutant viruses by reducing
the period of diagnostic tests after entering the country to ‘within one
day of entry’
 Mandatory submission of ‘the laboratory certificate PCR proven free of
infection with COVID19’ became mandatory for all entrants (air and sea)
 strengthened the management of facilities and self-isolation
Thank you
Find us at: https://apo.who.int/

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COVID-19 Health System Response Monitor: Republic of Korea

  • 1. COVID-19 Health System Response Monitor: Republic of Korea December 2020 Updated February 2021
  • 2. Authors: COVID-19 HSRM Japan  Hyunjin Kang  Soonman Kwon  Eunkyoung Kim Seoul National University, Republic of Korea Editor Anns Issac, Asia Pacific Observatory on Health Systems and Policies
  • 3. Presentation outline  Overview  Preventing local transmission  Ensuring sufficient physical infrastructure and workforce capacity  Providing health services effectively  Paying for services  Governance  Measures in other sectors
  • 4. Overview: COVID-19 HSRM Series 1. Preventing local transmission: Key measures to prevent the spread of disease 2. Ensuring sufficient physical infrastructure and workforce capacity: Physical infrastructure and health workforce available in a country. Measures to address any shortages, and other initiatives to strengthen capacity 3. Providing health services effectively: Approaches for service delivery and patient pathways for suspected COVID‐19 cases. Also describes how countries maintained essential health services 4. Paying for services: Health financing and coverage during COVID-19. 5. Governance: Governance response to COVID‐19 6. Measures in other sectors: Responses to COVID-19 by non‐health sectors  Up‐to‐date information on country responses to the COVID-19 outbreak  HSRM presents information under six heads
  • 5.  First case: 20 January 2020  Total confirmed cases: 108,269  Total deaths: 1,764 Korea Coronavirus Overview Updated 09-April-2021 Source: https://coronavirus.jhu.edu/region/japan & https://coronavirus.jhu.edu/map.html
  • 6. Preventing local transmission 1.1 Health communication 1.2 Physical distancing 1.3 Isolation and quarantine 1.4 Monitoring and surveillance 1.5 Testing 1
  • 7. 1.1 Health communication Transparent and open communication was a KEY feature of the Republic of Korea’s (RoK) response to COVID-19  Extensive public communication through briefings, guidelines, campaigns and posters on government websites and social media channels after the first case of COVID-19  Scope of messaging within the gamut of the amended Infectious Disease Control and Prevention Act, 2020  Frequency and format of briefing – depending on the situation  first briefing on the initial case of COVID-19 on 20 January  increased number of official briefings when the (national) crisis alert level (CAL) reached level 3 & 4  decreased the number of live briefings or alternated them with written briefings until a resurgence of cases occurred in mid-August 2020  briefings increased with mass transmission at the end of September  Central Disaster and Safety Countermeasure Headquarters (CDSC HQ) & Central Disease Control Headquarters (CDC HQ: Regular briefings via TV and also written documents via government websites
  • 8. 1.1 Health communication Messaging on  Basic rules of hygiene and preventive measures  Epidemiological statistics  National or local COVID-19 response interventions, including rules regulations and policies  Details of confirmed cases shared via the websites and mobile notification alerts  Emergency notification messages – at confirmed cases  Use of sign language and English interpretations to expand reach  Toll-free Hotlines:  KDCA call centre (hotline 1339) and MoHW call centre (hotline 129) – 24/7  Immigration Contact Centre (hotline 1345) and Korea travel hotline (1330)  Rerelease of updated Rerelease official public recommendations by the government, campaigns and guidelines across various platforms, in different formats  Official government COVID-19 website: access to information for the public  Tracking fake news and information: Cyber Bureau of the Korean National Police Agency  Impact: Nationwide survey indicates trust and attention to briefings by the public
  • 9. 1.2 Physical distancing  Early social distancing scheme (29 February 2020–27 June 2020) created keeping in mind: public health concerns, feasibility, economy, public fatigue and the nature of disease outbreaks. As a campaign rather than a scheme  Three-level social distancing scheme (28 June 2020–6 November 2020)  Level 1 during small-scale outbreaks  Level 2 is operated when community spread occurs  Level 3 – highest level: when there are multiple outbreaks in local community or large-scale outbreaks that are spreading rapidly 28 –June-20: three-level social distancing scheme  Five-level social distancing scheme (7 November 2020 onwards)
  • 11. 1.2 Physical distancing  Guidelines were published incrementally  Well organized information with infographics on the official government COVID-19 response website to promote easy understanding and convenience of access  Businesses were run with the basic preventive measures, including physical distancing and hygiene – Level 1  No domestic movement restrictions due to isolation or lockdown it was just recommended to stay home and avoid movement
  • 12. 1.3 Isolation and quarantine  Self-quarantine: keeping a person in isolation in an independent space at his/her home  a notice issued by the relevant public health centre (PHC) | person to comply with self-quarantine guidelines | monitoring by government official  dedicated teams conduct monitoring on a one-on-one basis  Monitoring also Self-Quarantine Safety Protection App at least twice a day, along with cooperation at the local level such as delivering rations, medicines and daily necessities to those in quarantine  A one-strike out system to enforce measures – example use of electronic wristbands  Facility quarantine: keeping a person in isolation at temporary quarantine facilities  Hospital isolation: keeping a patient in isolation at a hospital or residential treatment centre for treatment
  • 13. 1.3 Isolation and quarantine  Treatment: by severity of illness of the patients and other factors  Inpatient treatment during hospital isolation categorized as hospital treatment & facility treatment  Treatment in a residential treatment centre belongs to the latter  Cohort isolations were used to stem further spread to nearby groups or the community
  • 14. 1.4 Monitoring and surveillance  Case definition revised as new information came in. 10-Nov-20: 3 categories of case definition:
  • 15. 1.4 Monitoring and surveillance  COVID-19 response guidelines = regularly updated  Circulated widely to all health facilities and local governments  Epidemiological investigation for confirmed cases to trace the source of the infection: Key to successfully identifying and isolating COVID-19 cases  COVID-19 Epidemiological Investigation Support System: A centralized data collection and multi-agency coordination platform* Centralized data collection and multi-agency coordination platform  System built over smart city data hub – over 2 weeks followed by a 10- day pilot, and later handed over to the Korea Centers for Disease Control and Prevention (KCDC) *Note: Also called “COVID-19 Smart Management System” by the Ministry of Land, Infrastructure and Transport
  • 16. 1.4 Monitoring and surveillance  Use of manual logs or electronic entry log (KI-Pass) to aid contact tracing  Travel history of patients to high-risk countries shared with health facilities and pharmacies to support early detection for community-level screening  Responses cognizant of privacy and confidentiality of data
  • 17. 1.5 Testing  Early development & mass production of testing kits  public–private partnerships - the government, academia & private biotech  Legal foundation for emergency use authorization (EUA) of test kits*  High capacity for mass testing. Key features  Public and private laboratory facilities and screening clinics  February 2020: 15,000–20,000 tests per day, with a testing turnaround time of 6–24 hours by mid-February 2020, from 600 screening centres across the country.  November 2020: 137 testing facilities: 25 public facilities, 96 civil hospitals and 16 referral laboratories – that provide diagnostic tests These include  KDCA | national quarantine stations | research institutes for public health and environment | private clinical laboratories and hospitals  80% of the laboratory facilities in the private sector *Note: EUA was put into place in 2016, with the experience of MERS. The time for the legal process of approving products that require clinical trials was reduced from 80 days to 2–3 weeks, even 7 days.
  • 18. 1.5 Testing  Innovative approaches – Drive-thru and walk-thru screening clinics  convenient, safe and efficient. Reduces specimen collection time to 10 minutes, three times faster than a regular screening centre  minimize the risk of cross-infections during sample collection  Walk-thru screening centres require smaller space and shorter time for sample collection | booth to separate medical staff from the patients being tested  March 2020: 79 drive-thru screening clinics *Note: EUA was put into place in 2016, with the experience of MERS. The time for the legal process of approving products that require clinical trials was reduced from 80 days to 2–3 weeks, even 7 days.
  • 19. Ensuring sufficient infrastructure and workforce capacity 2.1 Physical infrastructure 2.2 Workforce 2
  • 20. 2.1 Physical infrastructure Covid-19 Care  2015: outbreak response capacity strengthened during MERS outbreak  2018:government-wide R&D fund for infectious disease research (KRW 40 billion, US$ 36 million) for five years. Informed RoK’s response to COVID-19  2020: Increase in budget allocation for new infectious diseases  KRW 68.8 billion (US$ 62 million) in 2015 to KRW 194.3 billion (US$ 175 million)  Residential treatment centre- mild or asymptomatic COVID-19 cases set up in collaboration with the private sector  Example large suburban residential buildings by companies such as Samsung converted to residential treatment centres
  • 21. 2.1 Physical infrastructure Covid-19 Care  43 infectious disease designated hospitals – increased to 67 (Feb-Mar 2020). 2468 hospitals by Nov 2020  Central Co-response Situation Room at the National Medical Centre (NMC) – patient triaging and coordination, and allocation of hospital beds across the region
  • 22. 2.1 Physical infrastructure Non-Covid health services  Some public hospitals earmarked for mild-to-severe COVID-19 – freeing up some hospitals for non-Covid care  nationally designated isolation units (NDIUs) were identified (under the central government)  Provide immediate response to patients with an infectious disease  Equipped with negative pressure systems  Staffed by trained professionals  National safe hospitals: designated for non-covid patients  with guidelines to prevent cross-infections from respiratory ailment cases to general patients  October 2020: 270 national safe hospitals  Telemedicine and prescribing without a visit to a doctor were temporarily allowed
  • 23. 2.1 Physical infrastructure Equipment  Adequate provision of equipment and supplies for critical care  Protective equipment provided by the RoK  Other equipment: negative compressors, mobile x-ray units provided  Classification of face masks into: general supply & priority supply  Face masks were classified into two – general supply and priority supply. measures to ban hoarding of masks and hand sanitizers  Health Insurance Review & Assessment Service (HIRA)  support with tracking purchase history  Mask Supply System for Foreigners by HIRA and National Health Insurance Service (NHIS)
  • 24. 2.2 Workforce  Tracing and surveillance  Epidemic Intelligence Service  Testing  doctors and medical laboratory scientists  Provision of masks  pharmacists  Health professionals mobilized to respond to outbreaks on a need basis  Guidelines to protect mobilized workforce  Triage system flexible re-allocation of resources to respond to outbreaks as needed  No shortage of health workforce
  • 25. Providing health services effectively 3.1 Planning services 3.2 Case management 3.3 Maintaining essential health services 3
  • 26. 3.1 Planning services 3Ts (test – trace – treat) strategy underlying RoK’s Response to COVID-19  Flexibility in designating and mobilizing hospital beds for patients with severe COVID-19 within the existing health system  National Health Insurance (NHI): centralized single-fund health financing system  Infectious Disease Control and Prevention Act, 2020: mobilization of resources
  • 27. 3.1 Planning services Access to Health  Improved access for vulnerable populations  Measures on illegal stays relaxed for without a legal status  Government support for testing and treatment without fear of deportation or reporting  Monitoring and provision of essential supplies such as PPE (face masks and hand sanitizers)  Access to face masks and sanitizers for the homeless  Stricter preventive and management measures applied to densely populated areas  intensive inspection and management of vulnerable facilities (example: cafes and restaurants), and infection-prone workplaces
  • 28. 3.2 Case management Travel-elated  Incoming international travelers details collected and categorized.  Symptomatic passengers tested and assigned to a treatment facility if positive. Negative results – 14 days quarantine at government- provided facility  COVID-19 response guideline followed for patient triage  Patient Under Investigation: Management of PUI’s with protocols for positive (detailed confirmation process), and negative (health education) cases  Confirmed COVID-19: severity checked PHC & classified by health-care staff: mild, moderate, severe and extremely severe  Appropriate treatment protocol followed after (see figure on next slide)  Translated WHO guidelines: algorithm for COVID-19 triage and referral
  • 30. 3.2 Case management: Referral System
  • 31. 3.2 Case management: Treatment  Sep 2020: No specific course of treatment recommended for COVID-19  symptomatic treatment offered  Use of antivirals upon the judgement of treatment team  Whole-of-Government Support Committee for COVID-19 treatment and vaccine development to accelerate and assist the R&D of vaccines and therapies in collaboration with academia, industry & private sector
  • 32. 3.3 Maintaining essential health services  No lockdown and the health system capacity adequate to ensure provision of non-Covid health services  Remote medical services used to provide non-Covid health care also  National safe hospitals for non-Covid health care  Feb 2020: temporary consultation and prescription via telephone (Under articles 39, 40 and 44 of the Framework Act on Health and Medical Services 2020, Article 59.1 of the Medical Service Act, 2020, and Article 4 of the Infectious Disease Control and Prevention Act, 2020)  Free influenza vaccination coverage expanded  Safe blood collecting environment to maintain sufficient blood stores for more than five days Mental health services:  Government provides mental health services for increased anxiety and depression due to containment measures such as physical distancing  Psychological counselling hotline (1577-0199)
  • 33. 3.3 Maintaining essential health services Mental health services:  Suicide prevention counselling line (1393)  Support services such as Kakao Talk chat, posters and self- examination apps provided  National Trauma Centre: integrated psychological support group  Tailored mental health support  MoIS: psychological counselling for small business owners and economically vulnerable people  Ministry of Gender Equality and Family conducted 130 000 counselling sessions for multicultural families
  • 34. Paying for services 4.1 Health financing 4.2 Entitlement and coverage 4
  • 35. 4.1 Health financing  Jun 2020 (mid): 0.5% of the NHI’s budget for 2020 spent on coping with COVID-19, including direct medical costs, cost of maintaining essential health services for patients with illnesses other than COVID-19 and compensation for losses incurred by health providers  Article 70 of the Infectious Disease Control and Prevention Act, 2020  Medical institutions paid monthly estimated wages since April for temporary losses  Aug 2020: compensation for lost income of medical institutions, pharmacies and general business sites due to COVID-19-relevant measures
  • 36. 4.2 Entitlement and coverage  NHIS, with universal coverage of the population, made it more efficient for the government to mobilize all medical resources at once  enabled early diagnosis and early treatment, which eventually led to well-organized case management and governance  Covers cost of COVID-19 tests for positive cases, suspected patients, PUI and for those who travelled abroad with symptoms or with physician, recommendations, etc.  All Koreans entitled to utilize the health services when needed, with 20–30% of the cost as copayment, depending on the level and type of care  Free of cost health services for treatment of COVID-19: 80% by the NHIS and the remaining cost (patient copayment component) is covered by the government budget (See figure on next page)  Aug 2020: fee from patients with confirmed COVID-19 entering from foreign countries on violation of domestic countermeasures  reciprocity arrangement in place with other governments for foreigners entering the countries after 24 August 2020
  • 39. Governance Response marked by:  Whole-of-government approach: swift intragovernmental communication between ministries as well as between the central and local governments  centralized and strong health system  cooperation of citizens in basic measures of prevention and hygiene  Legal basis for public health Enabled the government to strike a balance between individual rights and public health
  • 40. Measures in other sectors 6.1 Borders 6.2 Mobility 6.3 Economy 6.4 Social and income support 6.5 Cross-border collaboration 6
  • 41. 6.1 Borders  RoK borders not sealed (with exceptions and guidelines)  Entry ban on foreign nationals from Hubei province of China immediately after identifying the first case.  Feb 2020: Special entry procedure introduced  Use of Self-Quarantine Safety Protection App and Self- Diagnosis App  Special ambulances, buses, trains and taxi services are operated to transport those who are subjected to treatment or self-quarantine at a hospital, residential treatment centre or their homes
  • 42. 6.2 Mobility Domestic travel  No aggressive restriction on domestic transport  May 2020: Wearing of masks on public transport mandatory  Sep 2020: operation of city buses was temporarily reduced after 21:00 hours, when level 2.5 of social distancing was implemented in Seoul in early September External travel:  Updated travel advice through the official website of the Ministry of Foreign Affairs (MoFA) on overseas safe travel  Apr 2020: temporarily suspended visa waiver agreements with 56 countries  Government negotiations to maintain business travel with select countries
  • 43. 6.3 Economy  Reduced household expenditure  Closure of many micro, small and medium enterprises 3P’s (protecting, preserving and preparing) economic response  Protecting denotes stabilizing employment, support for vulnerable groups and protecting local economies  Preserving focuses on economic resilience by stimulating domestic consumption, revitalizing exports, providing support for the supply chain, customized measures for each industry, etc.  Preparing encompasses a new government initiative, “the Korean New Deal”, aiming for innovation in industrial and economic structures, and an inclusive society with a stronger safety net
  • 44. 6.3 Economy Support for industries April 2020: Economic measures for KRW 150 trillion (US$ 135 billion) in response to the COVID-19, through four rounds of Emergency Economic Council Meetings  Relief funds to small and medium enterprises (SMEs) and households and to boost consumption  Resources to support corporate bond market and short-term money market stabilization, and addressing stock market stabilization  Sep 2020: eighth emergency economic council meeting  Extra support measures taken by social security contribution and tax payment deferrals  customized support for various industries
  • 45. 6.3 Economy Tax measures  Direct and indirect tax measures were adopted in the RoK  Tax credits to rental business owners who had lowered the rental fee of a commercial building from January until December 2020  Income and corporate tax reductions were made for SMEs in special disaster areas as well as overseas companies' returning to the RoK  Temporary relief from value-added tax (VAT) for SMEs  Temporary increase in the income tax deduction rate for credit card or other expenses from Mar-Jun 2020  Temporary reduction of individual consumption tax on Mar-Dec 2020  Mandatory NHI contribution discounted by 30–50% for vulnerable populations Mar-May 2020
  • 46. 6.4 Social and income support Livelihood support for the general population:  Two emergency fund provisions for disaster relief in order to stabilize livelihoods and stimulate domestic consumption  First: nationwide relief in the form of cash, gift certificates, prepaid cards, credit or debit card top-up. May 2020, for use until Aug 2020. for use in local community  Second: targeted vulnerable groups - as small business owners, young job seekers, the unemployed, the working poor, and households with childcare expenses. Sep 2020  Local government support: disaster relief fund to the residents  Sep 2020: Support to 6.7 million people with special care expenses and online study expenses to help ease the financial and care burden caused by the continued closure of daycare centres and schools Unemployment benefits, job security measures  Apr 2020: Emergency Measures for Employment Stabilization  May 2020: Measures for the Public Sector Employment Shock
  • 47. 6.4 Social and income support Support for education  introduction of online classes and support for teacher training  Technical assistance for online streaming and information, communication and technology (ICT) platforms for schools were offered with the cooperation of the Ministry of Science and ICT and MCST  free digital device rental services and support for Internet access to students from low-income families  Supervisors were assigned to help children in emergency care at schools with online classes June 2020: all schools in the RoK had reopened, with the flexibility of online alternative classes if necessary
  • 48. 6.5 Cross-border collaboration  Active government engagement on international platforms to address international solidarity and cooperation  Contribution to The Group of Friends of Solidarity for Global Health Security UN May 2020  Support Group for Global Infectious Disease Response by WHO May 2020  Group of Friends for Solidarity and Inclusion with Global Citizenship Education UNESCO May 2020  endorsed global vaccine initiatives:  COVAX (COVID-19 Vaccine Global Access)  International Vaccine Institute headquartered in Seoul  RoK government supported 109 countries with essential supplies  Sep 2020: Korea International Cooperation Agency introduced the “Agenda for Building Resilience against COVID-19 through development cooperation (ABC programme)”  Knowledge-sharing activities through the COVID-19 information hub
  • 49. February 2021 update 7.1 Overview: Demands for tactic changes 7.2 Physical distancing measures calibration 7.3 Continued efforts to testing, surveillance and monitoring 7.4 Resource mobilization: securing the beds for severe patients 7.5 Vaccines and vaccination 7.6 Additional social and income support 7.7 Updates on border control 7
  • 50. 7.1 Overview: Demands for tactic changes November 2020: Third COVID-19 wave in the RoK. Challenges  Community transmission and unspecified mass transmission coinciding nationwide  Mass outbreaks continue in vulnerable groups  Preemptive testing to catch the asymptomatic infection and strengthened physical distancing nationwide  Resource mobilization and referral to correspond to the increasing need in securing beds for severe patients
  • 51. 7.2 Physical distancing measures calibration December 2020: Five-level social distancing scheme to implement more stringent physical distancing measures Undertaken based on quantitative data and qualitative consultations with experts  Level scaled up to 2.5 for SMR (Seoul Metropolitan Region) and 2 for the rest of the regions  Measures adapted to meet the needs: example: mass outbreaks occurred in a detention center, social distancing level 3 was implemented for two weeks from 31 December 2020 to 13 January 2021 throughout all correctional facilities nationwide  COVID-19 official website provides the public with visualization of the social distancing level by region.
  • 52. 7.3 Continued efforts to testing, surveillance and monitoring Dec 2020:  Lower barrier of testing: Anyone could get tested regardless of symptoms. Testing free of charge. Treatment criterion of ‘72-hour’ without fever was reduced to ‘at least 24 hours (48 hours for critical illness)  Rapid antigen diagnostic tests: recent COVID-19 response guidelines added countermeasures using rapid antigen diagnostic tests to elaborate the response  COVID-19 Variant: Whole Genome Sequencing (WGS) based on Next Generation Sequencing (NGS) method is performed for the confirmed cases among those entrants from the countries with COVID-19 variants spread
  • 53. 7.4 Resource mobilization: securing the beds for severe patients ‘Emergency Medical Response Plan in the SMR,’ ‘Emergency Medical Response Plan for Long term care Hospitals’ took effect, and protocol for dedicated care beds for severe patients of COVID-19 was established Dec 2020: Emergency Medical Response Plan in the SMR  estimate the future demands of sickbeds and secure them  focused on increasing bed numbers, including dedicated care beds for severe patients, and improve procedures for patient assignment and referral Jan 2021: Emergency Medical Response Plan for Long term care Hospitals  long-term care hospitals, for preliminary prevention, early response and cohort isolation, patient referral, and follow-up measures
  • 54. 7.4 Resource mobilization: securing the beds for severe patients ‘Establishment of a protocol for dedicated care beds for severe COVID-19 patients:  Dedicated care beds for severe patients  medical institutions manage the admission and discharge  Medical institutions report the status of dedicated care beds for severe patients and inpatient status daily to CDM HQ
  • 55. 7.5. Vaccines and vaccination January 2021: the government of RoK secured COVID-19 vaccines to inoculate a total of 56 million people, which are expected to be procured through the COVAX facility and several pharmaceutical companies (123)  COVID-19 vaccination designated as temporary vaccination has a legal basis on Article 25 of the Infectious Disease Control and Prevention Act (113)  COVID-19 vaccination scheme :  Vaccine introduction: a separate review team for safety and effectiveness management  enforces permission and shipment approval through three external expert consultation procedures (Safety and Efficacy Advisory Group → Central Pharmaceutical Affairs Council → Final InspecUon Council)
  • 56. 7.5. Vaccines and vaccination  Vaccine distribution and supply:  Cooperation with private companies to establish a distribution management system  Integrated control center for real-time management to control the entire delivery and storage of vaccines  Vaccination:  Priority for vaccine rollout is determined after deliberation by the Korea Expert Committee on Immunization Practices  Feb 2020: COVID-19 vaccination information website provides vaccination- related information. Function as a vaccination booking platform  Post-vaccination management: Adverse reaction monitoring  Damages recognized to be caused by vaccination are compensated by government according to the 'National Vaccination Injury Compensation Scheme,' which was introduced in 1995
  • 57. 7.6. Additional social and income support Third Relief Fund 2021  targets vulnerable population  Registration dates and procedures differ depending on the fund program for each beneficiary group
  • 58. 7.7 Updates on border control Dec 2020:  temporary suspension of visa issuance and flights from the United Kingdom and South Africa Jan 2021:  Strengthened monitoring and managing of mutant viruses by reducing the period of diagnostic tests after entering the country to ‘within one day of entry’  Mandatory submission of ‘the laboratory certificate PCR proven free of infection with COVID19’ became mandatory for all entrants (air and sea)  strengthened the management of facilities and self-isolation
  • 59. Thank you Find us at: https://apo.who.int/

Editor's Notes

  1. Communication materials and management by multiple departments Public communication: Centre for COVID‐19 Situation Administration (CCSA) The Department of Disease Control (DDC), Ministry of Public Health (MoPH), via the Emergency Operations Centre (EOC) for technical content
  2. Communication materials and management by multiple departments Public communication: Centre for COVID‐19 Situation Administration (CCSA) The Department of Disease Control (DDC), Ministry of Public Health (MoPH), via the Emergency Operations Centre (EOC) for technical content
  3. Communication materials and management by multiple departments Public communication: Centre for COVID‐19 Situation Administration (CCSA) The Department of Disease Control (DDC), Ministry of Public Health (MoPH), via the Emergency Operations Centre (EOC) for technical content
  4. Communication materials and management by multiple departments Public communication: Centre for COVID‐19 Situation Administration (CCSA) The Department of Disease Control (DDC), Ministry of Public Health (MoPH), via the Emergency Operations Centre (EOC) for technical content
  5. Communication materials and management by multiple departments Public communication: Centre for COVID‐19 Situation Administration (CCSA) The Department of Disease Control (DDC), Ministry of Public Health (MoPH), via the Emergency Operations Centre (EOC) for technical content