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A school in Seoul’s Seongbuk District posts notifications of a suspension of classes to prevent further spread of the novel coronavirus on Feb. 6. (Park Jong-shik, staff photographer)

South Korea’s public health authorities announced on Feb. 6 that they’re working on plans to reinforce their disease control systems given the possibility of a large-scale transmission of the novel coronavirus on the local level. While the authorities’ have hitherto been focused on monitoring those who’ve entered the country from China and those who’ve come into contact with infected individuals, they now intend to cast a wider net as they take precautions for local infections, in which case the route of transmission would be harder to determine. But disease control authorities haven’t figured out exactly how to accomplish that. Some argue that the priority should be placed on establishing countermeasures for the possibility of local transmission in areas with inadequate disease control infrastructure.

“Since we’ll be stepping up testing for infections and widening our caseload on Feb. 7, we expect that the number of confirmed cases could rise even further and that there may be cases of local transmission in which the source of infection is hard to deduce. I think the scale of local transmission could increase because of the tendency for this virus to be transmitted by patients with mild symptoms,” said Jung Eun-kyeong, director of the South Korean Centers for Disease Control (KCDC), in the daily briefing on Thursday.

“The tertiary and quaternary infections occurred as part of a string of transmissions. But when we broaden the scope of testing, there could also be cases of local transmission whose source we may have trouble ascertaining,” Jung added. This was the first time that a senior health official has mentioned the possibility of large-scale local transmission since people began coming down with the coronavirus.

Kim Kang-lip, head of the central disease control headquarters, had touched on the subject on Thursday morning, earlier in the day. “Now that there are 23 confirmed cases of the disease, there’s a growing likelihood that it will spread to local communities. This demands extreme caution. In the meeting, our discussion was focused on ways to further strengthen our current disease control management system and, in particular, our local governments’ regional disease response systems.”

The health authorities explained that, for now, they’re taking measures to ensure an adequate supply of medical resources, including beds and staff, for quarantine, diagnosis, and treatment in the event of an increasing number of patients. At the same time, they’re working on acquiring medication that seems to be effective, given the lack of a dedicated vaccine or designated drug for the coronavirus.

But since the number of people being treated for the disease will multiply nearly fivefold starting on Feb. 7, there might be parts of the country where those resources are inadequate. “In the capital region [Seoul and Gyeonggi Province], there should be enough resources to somehow house all the quarantined individuals and monitor those who’ve come into contact with the infection. Measures must be urgently taken for regions with inadequate resources,” said a medical professional who requested anonymity.

“Expanding the testing could lead to a drastic increase in the number of patients subject to quarantine, but we’ve only identified about 260 quarantine hospital rooms in the entire country. The best approach is to designate sections of state-run hospitals as temporary quarantine wards and keep infected patients separate from local communities and regular hospitals,” the Korean Medical Association said in an urgent advisory for the government on Thursday.

Among the four additional people who tested positive for the novel coronavirus in South Korea on Thursday, just one (the 23rd) had entered the country from China, while the other three were secondary and tertiary transmissions, which is to say they caught the disease from other infected individuals in Korea. The 20th patient (a 41-year-old Korean woman) is the sister-in-law of the 15th patient, and the 21st patient (a 59-year-old Korean woman) is an acquaintance of the sixth patient and a fellow parishioner at Myeongryun Church in Seoul’s Jongno District. Both of these were tested and diagnosed while under self-quarantine, as was the 22nd patient (a 46-year-old Korean man), who is the older brother of the 16th patient.

Amid these developments, the 20th patient tested positive, after getting negative results in an earlier test. She presumably tested negative the first time because the test was conducted after she’d come into contact with an infected individual but before her symptoms manifested. But since she remained in quarantine even after the initial results came back negative, she didn’t come into contact with anyone in her neighborhood. This is the second patient who has tested positive on a second test after initially getting negative results.

In a related story, the city of Gwangju announced that, after testing 145 of the 340 people with whom the 16th patient came into contact during visits to 21st Century Hospital and Chonnam National University Hospital, all the tests have come back negative. “The 23 people categorized as high-risk have been quarantined at 21st Century Hospital and the 31 people categorized as low-risk at the dormitory of the Gwangju Firefighting Academy,” a city official said.

As of Feb. 6, the number of confirmed cases of the coronavirus in South Korea had risen to 23, and the first through 17th patients are believed to have come into contact with 1,234 people. The epidemiological survey is continuing for more recent cases (18th through 23rd).

By Park Su-ji and Park Hyun-jung, staff reporters, and Jung Dae-ha, Gwangju correspondent

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