J Korean Med Sci.  2022 Dec;37(50):e356. 10.3346/jkms.2022.37.e356.

COVID-19 Outbreak in Daegu City, Korea and Response to COVID-19: How Have We Dealt and What Are the Lessons?

• Kim SW

• KMID: 2537054
• DOI: http://doi.org/10.3346/jkms.2022.37.e356

Abstract

The first coronavirus disease 2019 (COVID-19) outbreak in Daegu city was overcome by efforts, including; 1) prompt isolation and quarantine action by local government with cooperative help from expert groups and the central government, 2) high-intensity social distancing and active cooperation of citizens, 3) admission of asymptomatic and mild patients in ‘residential treatment centers’, and 4) use of a telephone scoring system for the allocation of patients, with a mortality rate of 2.5%. A continuous suppression policy with test, tracing, and treatment (3 Ts) was implemented as an active response to the initial outbreaks in Korea. With the introduction of vaccines and therapeutic agents, the COVID-19 crisis had improved. Recently, the omicron variant was responsible for most domestic outbreaks, albeit with a low mortality rate (0.1%). Since the omicron outbreak, a damage mitigation policy has been implemented, focusing on protecting vulnerable groups. In the future, preparation including below are needed; 1) improving the national public health emergency response system, 2) strengthening the crisis response capacity of local governments, 3) cooperation between public healthcare and private healthcare, and 4) establishing a resilient medical response system.

Keyword

COVID-19; Outbreak; Response to COVID-19; Lessons; Daegu City; Korea; Preparedness

Figure

• 

  Fig. 1 The first reported case of COVID-19 in Daegu (the first epidemic in Korea).COVID-19 = coronavirus disease 2019.

• 

  Fig. 2 Changes in cases and SARS-CoV-2 variants in Korea and changes in response policies.SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2, COVID-19 = coronavirus disease 2019.

Reference

1. Korea Disease Control and Prevention Agency. COVID-19 outbreak report from January 20, 2020 to January 19, 2022 in the Republic of Korea. Public Health Wkly Rep. 2022; 15(13):796–805.

2. Korea Disease Control and Prevention Agency. Outbreak report of COVID-19 during designation of class 1 infectious disease in the Republic of Korea (January 20, 2020–April 24, 2022). Public Health Wkly Rep. 2022; 15(30):2126–2136.

3. Kim SW, Kim SM, Kim YK, Kim JY, Lee YM, Kim BO, et al. Clinical characteristics and outcomes of COVID-19 cohort patients in Daegu metropolitan city outbreak in 2020. J Korean Med Sci. 2021; 36(1):e12. PMID: 33398946.

4. Kim JY, Lee YM, Lee H, Kim JW, Kim SW. Epidemiological characteristics of a COVID-19 outbreak caused by religious activities in Daegu, Korea. Epidemiol Health. 2021; 43:e2021024. PMID: 33872485.

5. Korean Society of Infectious Diseases. Korean Society of Pediatric Infectious Diseases. Korean Society of Epidemiology. Korean Society for Antimicrobial Therapy. Korean Society for Healthcare-associated Infection Control and Prevention. Korea Centers for Disease Control and Prevention. Report on the epidemiological features of coronavirus disease 2019 (COVID-19) outbreak in the Republic of Korea from January 19 to March 2, 2020. J Korean Med Sci. 2020; 35(10):e112. PMID: 32174069.

6. Huh K, Shin HS, Peck KR. Emergent strategies for the next phase of COVID-19. Infect Chemother. 2020; 52(1):105–109. PMID: 32100487.

7. Noh JY, Seong H, Yoon JG, Song JY, Cheong HJ, Kim WJ. Social distancing against COVID-19: implication for the control of influenza. J Korean Med Sci. 2020; 35(19):e182. PMID: 32419400.

8. Min KD, Kang H, Lee JY, Jeon S, Cho SI. Estimating the effectiveness of non-pharmaceutical interventions on COVID-19 control in Korea. J Korean Med Sci. 2020; 35(35):e321. PMID: 32893522.

9. Park PG, Kim CH, Heo Y, Kim TS, Park CW, Kim CH. Out-of-hospital cohort treatment of coronavirus disease 2019 patients with mild symptoms in Korea: an experience from a single community treatment center. J Korean Med Sci. 2020; 35(13):e140. PMID: 32242347.

10. Kim SW, Lee KS, Kim K, Lee JJ, Kim JY. Daegu Medical Association. A brief telephone severity scoring system and therapeutic living centers solved acute hospital-bed shortage during the covid-19 outbreak in Daegu, Korea. J Korean Med Sci. 2020; 35(15):e152. PMID: 32301298.

11. Kwon HH, Kim HI, Kwon KT, Hwang S, Kim SW, Kim Y, et al. Healthcare workforce response to the coronavirus disease outbreak in Daegu, Korea: a multi-center, cross-sectional survey. Infect Chemother. 2022; 54(2):298–307. PMID: 35706078.

12. Kim JH, An JAR, Min PK, Bitton A, Gawande AA. How South Korea responded to the Covid-19 outbreak in Daegu. NEJM Catal Innov Care Deliv. 2020; 1(4):04.

13. Choi JY. COVID-19 in South Korea. Postgrad Med J. 2020; 96(1137):399–402. PMID: 32366457.

14. Kwon KT, Ko JH, Shin H, Sung M, Kim JY. Drive-through screening center for COVID-19: A safe and efficient screening system against massive community outbreak. J Korean Med Sci. 2020; 35(11):e123. PMID: 32193904.

15. Lee J. COVID-19 screening center: how to balance between the speed and safety? J Korean Med Sci. 2020; 35(15):e157. PMID: 32301302.

16. Kim SI, Lee JY. Walk-through screening center for COVID-19: an accessible and efficient screening system in a pandemic situation. J Korean Med Sci. 2020; 35(15):e154. PMID: 32301300.

17. Lee Y, Min P, Lee S, Kim SW. Prevalence and duration of acute loss of smell or taste in COVID-19 patients. J Korean Med Sci. 2020; 35(18):e174. PMID: 32383370.

18. Shin HS. Empirical treatment and prevention of COVID-19. Infect Chemother. 2020; 52(2):142–153. PMID: 32476308.

19. Kim SB, Huh K, Heo JY, Joo EJ, Kim YJ, Choi WS, et al. Interim guidelines on antiviral therapy for COVID-19. Infect Chemother. 2020; 52(2):281–304. PMID: 32342676.

20. Hong KS, Jang JG, Hur J, Lee JH, Kim HN, Lee W, et al. Early hydroxychloroquine administration for rapid severe acute respiratory syndrome coronavirus 2 eradication. Infect Chemother. 2020; 52(3):396–402. PMID: 32757497.

21. RECOVERY Collaborative Group. Horby P, Mafham M, Linsell L, Bell JL, Staplin N, et al. Effect of hydroxychloroquine in hospitalized patients with COVID-19. N Engl J Med. 2020; 383(21):2030–2040. PMID: 33031652.

22. Kim SB, Ryoo S, Huh K, Joo EJ, Kim YJ, Choi WS, et al. Revised Korean Society of Infectious Diseases/National Evidence-based Healthcarea Collaborating Agency guidelines on the treatment of patients with COVID-19. Infect Chemother. 2021; 53(1):166–219. PMID: 34409790.

23. RECOVERY Collaborative Group. Lopinavir-ritonavir in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2020; 396(10259):1345–1352. PMID: 33031764.

24. Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe COVID-19. N Engl J Med. 2020; 382(19):1787–1799. PMID: 32187464.

25. Park C, Hwang JM, Jo S, Bae SJ, Sakong J. COVID-19 outbreak and its association with healthcare workers’ emotional stress: a cross-sectional study. J Korean Med Sci. 2020; 35(41):e372. PMID: 33107230.

26. Kim B, Kwon KT, Hwang S, Ryoo HW, Chung US, Lee SH, et al. Psychological effects of COVID-19 patient management experience among paramedics and emergency medical technicians: a nationwide survey in Korea. Infect Chemother. 2022; 54(2):316–327. PMID: 35706083.

27. Hyun J, You S, Sohn S, Kim SJ, Bae J, Baik M, et al. Psychosocial support during the COVID-19 outbreak in Korea: activities of multidisciplinary mental health professionals. J Korean Med Sci. 2020; 35(22):e211. PMID: 32508070.

28. RECOVERY Collaborative Group. Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med. 2021; 384(8):693–704. PMID: 32678530.

29. Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the treatment of Covid-19 - final report. N Engl J Med. 2020; 383(19):1813–1826. PMID: 32445440.

30. Pawankar R, Thong BY, Tiongco-Recto M, Wang JY, Latiff AH, Leung TF, et al. Asia Pacific perspectives on the second year of the COVID-19 pandemic: a follow-up survey. Clin Exp Allergy. 2022; 52(8):965–973. PMID: 35906963.

31. Joo EJ, Ko JH, Kim SE, Kang SJ, Baek JH, Heo EY, et al. Clinical and virologic effectiveness of remdesivir treatment for severe coronavirus disease 2019 (COVID-19) in Korea: a nationwide multicenter retrospective cohort study. J Korean Med Sci. 2021; 36(11):e83. PMID: 33754512.

32. Kwak YG, Song JE, Kang J, Kang J, Kang HK, Koo HK, et al. Use of the monoclonal antibody regdanvimab to treat patients hospitalized with COVID-19: real-world data during the delta variant predominance. Infect Chemother. 2022; 54:e66.

33. Amano N, Iwata K, Iwata S. Clinical effectiveness of REGN-COV2 in patients with COVID-19 in Japan: a retrospective cohort study with a Bayesian inference. Infect Chemother. 2021; 53(4):767–775. PMID: 34979607.

34. Hong SI, Ryu BH, Hong KW, Bae IG, Cho OH. Real world experience with regdanvimab treatment of mild-to-moderate coronavirus disease-19 in a COVID-19 designated hospital of Korea. Infect Chemother. 2022; 54(1):114–124. PMID: 35384423.

35. Lee CM, Park SW, Lee E. Early oxygen requirement in patients with mild-to-moderate COVID-19 who received regdanvimab after delta-variant outbreak. Infect Chemother. 2022; 54(2):258–265. PMID: 35706081.

36. Planas D, Saunders N, Maes P, Guivel-Benhassine F, Planchais C, Buchrieser J, et al. Considerable escape of SARS-CoV-2 Omicron to antibody neutralization. Nature. 2022; 602(7898):671–675. PMID: 35016199.

37. Kim HM, Kwon KT, Cha HH, Seong WJ, Kim MJ. Prediction of adverse outcomes among women in the third trimester of pregnancy with coronavirus disease 2019. Infect Chemother. 2022; 54(3):493–503. PMID: 36196608.

38. Park HC, Lee YK, Ko E, Yu S, Cho A, Kim DH, et al. COVID-19-related clinical outcomes among Korean hemodialysis patients. Kidney Res Clin Pract. 2022; 41(5):591–600. PMID: 35791744.

39. Lim JH, Park SH, Jeon Y, Cho JH, Jung HY, Choi JY, et al. Fatal outcomes of COVID-19 in patients with severe acute kidney injury. J Clin Med. 2020; 9(6):1718. PMID: 32503180.

40. Choi JH, Choi SH, Yun KW. Risk factors for severe COVID-19 in children: A systematic review and meta-analysis. J Korean Med Sci. 2022; 37(5):e35. PMID: 35132841.

41. Hong SH, Shi HJ, Kim SY, Park Y, Eom JS. Clinical characteristics and pregnancy-related outcomes of pregnant women hospitalized with COVID-19 during the delta wave: a single-center observational study. Infect Chemother. 2022; 54(3):433–445. PMID: 35920268.

42. Park JJ, Seo YB, Lee J, Na SH, Choi YK. Protocol and clinical characteristics of patients under ‘at-home care’ for COVID-19 in South Korea: a retrospective cohort study. BMJ Open. 2022; 12(6):e061765.

43. Gu H, Krishnan P, Ng DY, Chang LD, Liu GY, Cheng SS, et al. Probable transmission of SARS-CoV-2 omicron variant in quarantine hotel, Hong Kong, China, November 2021. Emerg Infect Dis. 2022; 28(2):460–462. PMID: 34860154.

44. Ji S, Xiao S, Wang H, Lei H. Increasing contributions of airborne route in SARS-CoV-2 omicron variant transmission compared with the ancestral strain. Build Environ. 2022; 221:109328. PMID: 35784591.

45. Song JY, Peck KR. Korean Society of Infectious Diseases. A debate on public health responses to COVID-19: focused protection versus sustained suppression. J Korean Med Sci. 2020; 35(49):e433. PMID: 33350189.

46. Jung J. Preparing for the coronavirus disease (COVID-19) vaccination: evidence, plans, and implications. J Korean Med Sci. 2021; 36(7):e59. PMID: 33619920.

47. Kwon SL, Oh J. COVID-19 vaccination program in South Korea: a long journey toward a new normal. Health Policy Technol. 2022; 11(2):100601. PMID: 35127400.

48. Kang SJ, Jung SI. Age-related morbidity and mortality among patients with COVID-19. Infect Chemother. 2020; 52(2):154–164. PMID: 32537961.

49. Kim M, Yoo JR, Heo ST, Lee HR, Oh H. Clinical characteristics and risk factors for severe disease of coronavirus disease 2019 in a low case fatality rate region in Korea. Infect Chemother. 2021; 53(4):718–729. PMID: 34951535.

50. Kang E, Lee SY, Kim MS, Jung H, Kim KH, Kim KN, et al. The psychological burden of COVID-19 stigma: evaluation of the mental health of isolated mild condition covid-19 patients. J Korean Med Sci. 2021; 36(3):e33. PMID: 33463098.

51. Hoang T, Tran Thi Anh T. Comparison of comorbidities in relation to critical conditions among coronavirus disease 2019 patients: a network meta-analysis. Infect Chemother. 2021; 53(1):13–28. PMID: 34409779.

52. Ji W, Huh K, Kang M, Hong J, Bae GH, Lee R, et al. Effect of underlying comorbidities on the infection and severity of COVID-19 in Korea: a nationwide case-control study. J Korean Med Sci. 2020; 35(25):e237. PMID: 32597048.

53. Suh HJ, Kim DH, Heo EY, Lee HW, Lee JK, Lee CS, et al. Clinical characteristics of COVID-19: clinical dynamics of mild severe acute respiratory syndrome coronavirus 2 infection detected by early active surveillance. J Korean Med Sci. 2020; 35(32):e297. PMID: 32808513.

54. Hastie CE, Lowe DJ, McAuley A, Winter AJ, Mills NL, Black C, et al. Outcomes among confirmed cases and a matched comparison group in the Long-COVID in Scotland study. Nat Commun. 2022; 13(1):5663. PMID: 36224173.

55. Song JE, Oh GB, Park HK, Lee SS, Kwak YG. Survey of adverse events after the first dose of the ChAdOx1 nCoV-19 vaccine: a single-center experience in Korea. Infect Chemother. 2021; 53(3):557–561. PMID: 34405593.

56. Shang W, Wang Y, Yuan J, Guo Z, Liu J, Liu M. Global excess mortality during COVID-19 pandemic: a systematic review and meta-analysis. Vaccines (Basel). 2022; 10(10):1702. PMID: 36298567.

57. Yoo SH, Sim JA, Shin J, Keam B, Park JB, Shin A. The impact of COVID-19 on cancer care in a tertiary hospital in Korea: possible collateral damage to emergency care. Epidemiol Health. 2022; 44:e2022044. PMID: 35538696.

58. Yang HJ, Yoon H, Kang SY, Lee G, Park JE, Kim T, et al. Respiratory protection effect of ear-loop-type KF94 masks according to the wearing method in COVID-19 pandemic: a randomized, open-label study. J Korean Med Sci. 2021; 36(28):e209. PMID: 34282608.

59. Li T, Liu Y, Li M, Qian X, Dai SY. Mask or no mask for COVID-19: a public health and market study. PLoS One. 2020; 15(8):e0237691. PMID: 32797067.

60. Lee SH, Noh JW, Kim Y, Ryoo HW, Park KH, Park SY, et al. Expert consensus on measures to promote physical and psychological health among COVID-19-related healthcare workers in Korea using Delphi technique. Infect Chemother. 2022; 54(2):247–257. PMID: 35706073.

61. Gupta L, Gasparyan AY, Misra DP, Agarwal V, Zimba O, Yessirkepov M. Information and misinformation on COVID-19: a cross-sectional survey study. J Korean Med Sci. 2020; 35(27):e256. PMID: 32657090.

62. Jung J. A long way to the recovery: COVID-19 will not disappear. J Korean Med Sci. 2021; 36(32):e231. PMID: 34402229.

63. Kim J, Ashihara K. National disaster management system: COVID-19 case in Korea. Int J Environ Res Public Health. 2020; 17(18):6691. PMID: 32937946.

64. Wernli D, Clausin M, Antulov-Fantulin N, Berezowski J, Biller-Andorno N, Blanchet K, et al. Building a multisystemic understanding of societal resilience to the COVID-19 pandemic. BMJ Glob Health. 2021; 6(7):e006794.

65. Haldane V, De Foo C, Abdalla SM, Jung AS, Tan M, Wu S, et al. Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nat Med. 2021; 27(6):964–980. PMID: 34002090.

66. Lim S. The COVID-19 pandemic battlefield: protection of long term care hospitals. Infect Chemother. 2020; 52(2):231–233. PMID: 32618148.

67. Yoon YK, Lee J, Kim SI, Peck KR. A systematic narrative review of comprehensive preparedness strategies of healthcare resources for a large resurgence of COVID-19 nationally, with local or regional epidemics: present era and beyond. J Korean Med Sci. 2020; 35(44):e387. PMID: 33200593.

68. Kim Y, Bitna-Ha , Kim SW, Chang HH, Kwon KT, Bae S, et al. Post-acute COVID-19 syndrome in patients after 12 months from COVID-19 infection in Korea. BMC Infect Dis. 2022; 22(1):93. PMID: 35086489.

69. Kim Y, Kim SE, Kim T, Yun KW, Lee SH, Lee E, et al. Preliminary guidelines for the clinical evaluation and management of long COVID. Infect Chemother. 2022; 54(3):566–597. PMID: 36196612.

70. Giri S, Chenn LM, Romero-Ortuno R. Nursing homes during the COVID-19 pandemic: a scoping review of challenges and responses. Eur Geriatr Med. 2021; 12(6):1127–1136. PMID: 34136990.

71. Kim CO, Jang SN. Who are the people willing to pay for physician home visits? J Korean Med Sci. 2020; 35(20):e158. PMID: 32449323.

72. You J. Lessons from South Korea’s Covid-19 policy response. Am Rev Public Adm. 2020; 50(6-7):801–808.

73. Kim Y, Kim SW, Chang HH, Kwon KT, Bae S, Hwang S. Significance and associated factors of long-term sequelae in patients after acute COVID-19 infection in Korea. Infect Chemother. 2021; 53(3):463–476. PMID: 34405592.

74. Kim Y, Kim SW, Chang HH, Kwon KT, Hwang S, Bae S. One year follow-up of COVID-19 related symptoms and patient quality of life: a prospective cohort study. Yonsei Med J. 2022; 63(6):499–510. PMID: 35619573.

75. Morens DM, Breman JG, Calisher CH, Doherty PC, Hahn BH, Keusch GT, et al. The origin of COVID-19 and why it matters. Am J Trop Med Hyg. 2020; 103(3):955–959. PMID: 32700664.

76. Simpson S, Kaufmann MC, Glozman V, Chakrabarti A. Disease X: accelerating the development of medical countermeasures for the next pandemic. Lancet Infect Dis. 2020; 20(5):e108–e115. PMID: 32197097.