hankyoreh

Seoul City Hall reopens on Aug. 20 after being shut down for disinfection after a civil servant tested positive the previous day. (Kim Bong-gyu, senior staff photographer)

This weekend is shaping up to be a crossroads in terms of whether social distancing measures across South Korea are to be upgraded to Level 3. Experts have warned that if the recent spread of COVID-19 cannot be checked by this weekend, the result could be a major epidemic mirroring those of the US and Europe.

“If we fail to trace patients through this weekend, we could find ourselves at any moment in the direst of situations as experienced by the US or Europe,” said Korea Centers for Disease Control and Prevention (KCDC) Vice Director Kwon Jun-wook on Aug. 20. A total of 288 cases (276 community transmission) were recorded for Aug. 20 as of 12 am. With triple-digit increases observed throughout the past week and numbers far exceeding 200 for the past three days, the fearsome spread shows no signs of slowing.

Four main variables are seen as likely to determine what happens at the current crossroads. The question of what happens with these variables through the coming weekend will determine whether a full-scale pandemic situation erupts or whether the outbreak can be contained in its early stages.

Numerous infections have already begun to emerge among participants in a rally by conservative groups near Seoul’s Gwanghwamun Square on Aug. 15. The rally is now serving as the “detonator” behind an explosion of cases that originated in services at Sarang Jeil Church in Seoul’s Seongbuk District. On Aug. 20, the KCDC announced 60 cases among participants in the Gwanghwamun rallies. Thirty-three of them were members of Sarang Jeil Church, while 18 others participated in the rally without any church connections. An additional nine cases were confirmed by tracking their smartphone data.

The demonstration on Aug. 15 was attended by over 20,000 people from all over South Korea. While it took place outdoors, the number of infections is still expected to be substantial owing to the inherent characteristics of such events, which involve shouting, which spreads saliva droplets. As of the morning of Aug. 20, around 8,500 of the demonstration’s attendees had been tested for the virus.

In addition to the demonstrators themselves, confirmed cases have also been found among police officers who patrolled the rally. Four officers who were deployed to the Gwanghwamun rally tested positive on Aug. 20. A total of 7,613 police officers were deployed to the scene that day.

If participants in the Gwanghwamun demonstration were infected with the virus, their symptoms are likely to begin appearing in earnest around Aug. 21 to 22. Kwon Jun-wook said, “While symptoms may appear as quickly as two days [after exposure], it typically takes six or seven days, so we could end up with confirmed cases and people with symptoms continuing to emerge through Friday.”

“We’re looking at the Liberation Day demonstrations as a potential detonator for a nationwide spread,” he added.

Large numbers of people converged in the Gwanghwamun demonstration, arriving from all over South Korea by charter bus. If those people become transmission links upon returning to their home regions, the effects will be increasingly apparent starting this weekend. On Aug. 20, the Central Disaster and Safety Countermeasure Headquarters (CDSCHQ) announced, “The fact that confirmed cases connected with the Gwanghwamun rally are distributed nationwide in nine cities and provinces is very concerning.” Gwanghwamun-related cases have been appearing all over the country, including five in North Gyeongsang Province, two in Busan, one in North Chungcheong Province, and one in South Chungcheong Province. Of the 676 cumulative cases associated with Sarang Jeil Church as of noon on Aug. 20, 39 came from outside the Seoul Capital Area (SCA).

Even without the factors of the Gwanghwamun demonstration and the Sarang Jeil Church cluster at the heart of the recent spread, infection clusters have been occurring in different regions at scales that cannot be ignored. The number of confirmed cases associated with Gwangju nightlife establishments rose by two on Aug. 20 to reach a total of 21; Busan has seen infection clusters associated with the bolt and screw company Youngjin Bolt in the Sasang District (10 cases), a gathering of friends (nine), and a family in the Yeonje District (12). It’s a situation that is raising fears of a growing outbreak not only in the SCA -- which has accounted for over 80% of confirmed cases recently -- but also outside of it.

“This is a hair-trigger situation where the cluster infections in Seoul and Gyeonggi Province could erupt into a nationwide pandemic,” warned CDSCHQ General Coordinator Kim Kang-lip on Aug. 20.

What disease control authorities find most concerning is a situation where a rise in so-called “mystery patients” leads to cases of silent transmission. As of 12 am on Aug. 20, the proportion of mystery cases for which contact tracing failed stood at 14.7% for the two-week period dating back to Aug.7. The rate had more than doubled from just 6.6% as recently as Aug. 1. Since breaking the 10% barrier on Aug. 10 at 10.4%, the proportion of mystery cases has hovered in the 11-15% range.

Even more troubling than the percentage is the sheer number: among the 1,847 confirmed cases in the past two weekends, 272 patients have no idea where they might have been infected. The category of mystery patients includes the initial confirmed case in a particular infection cluster combined with individual patients whose transmission routes remain unknown. But an increase in patients like the current one stands to slow the rate at which transmission links can be established, which leads to a further increase in cases. The result is a situation where anyone could be infected anywhere and at any time.

“When you have a patient whose transmission route is unknown, it’s not actually just one patient,” said Choi Won-seok, a professor of infectious diseases at Korea University Ansan Hospital. “They were infected by someone else and are infecting others, which means [the actual number] could be many times -- even dozens of times -- larger than what you see on the surface.”

The number of confirmed cases has been rising sharply for days on end, and the only means available for now for keeping the situation from slipping outside the disease prevention network’s control is through social distancing. As of 12 am on Aug. 19, enhanced Level 2 social distancing measures have been in effect, including the suspension of operations of high-risk establishments such as internet cafes. Kwon Jun-wook said, “The effects of our efforts in contact tracing, diagnostic testing, and quarantining will start to become apparent this weekend, and our paramount goal for now is managing the overall outbreak as that combined with the effects of Level 2 distancing.”

But questions remain over how effective Level 2 distancing will be at a time when the reins of disease control have been loosened, with distancing practices not being properly observed in cafes, restaurants, and bars that remain packed with customers.

“The extent of the outbreak is going to depend on how much we can overcome these laxer attitudes and how we respond this week” predicted Kim Dong-hyun, a professor of medicine at Hallym University and chairperson of the Korean Society of Epidemiology.

By Hwang Ye-rang and Choi Ha-yan, staff reporters

Please direct comments or questions to [english@hani.co.kr]