3.1 Presentation
General Description in South Korea, Japan, India, and China
Located across the sea from the Chinese city of Qingdao, South Korea is an East Asian country of 51.6 million inhabitants, with half of the population concentrated in the capital city of Seoul and its metropolitan area. The country has 15.5% of people over the age of 65. According to the Organization for Economic Cooperation and Development (OECD), South Korea is a wealthy and developed country with a per capita GDP of 42 700 US$.[7] South Korea’s healthcare system is considered one of the best in the world, with a Computed Tomography (CT) Scanners count of 39 per 1 million inhabitants and 12.4 hospital beds per 1,000 inhabitants in 2018. [8]
Japan, China’s neighbor, is a developed country with 127 million inhabitants residing in 364555 km2, most of the residents live in urban areas (91.8%).[9] According to the OECD, Japan’s GDP in 2019 was per capita 42239 US$.[10] Japan is an aging country, with 28% of the total population over 65 years old. [11] Japan’s healthcare system undoubtedly ranks among the best in the world. Japan’s total health expenditure in 2019 was 4823 US$, which was 11.1% of GDP. General government expenditure on health is 20.28 % of total government expenditure in 2014. [12,13]
China and India are both developing countries and the most populous countries in the world. However, India’s population density is almost three times that of China, and urban slums may have a population density of more than 250 000/km2. [14] India’s GDP in 2016 was per capita 5901 US$, and China’s GDP in 2017 was per capita 14306 US$. According to the OECD, India’s health system is relatively weak, with only 0.5 hospital beds per 1,000 inhabitants in 2017. General government expenditure on health accounted for only 5.05 % of total government expenditure in 2014. [15] After the lessons learned from SARS in 2003, China has been enhancing its healthcare system. Given the size of the population, China’s per capita health resources are also inadequate. Health expenditure per capita in China in 2017 was only 440.83 US$. [16] General government expenditure on health accounted for 10.43 % of total government expenditure in 2014. [13]
Epidemiological Situation of the four Country Regarding COVID-19
Figure 1 shows the comparison of the daily new confirmed COVID-19 cases per million people in India, Japan, South Korea, and China as of May 18, 2021. The figure was produced and published by Our World in Data. From January 2020 to May 18, 2021, South Korea and Japan experienced three waves of COVID-19 epidemic, but the number of daily new confirmed cases per million people was relatively small in both countries, and South Korea had fewer daily new confirmed cases per million than Japan. Following the COVID-19 outbreak in Wuhan in late 2019, China successfully contained the first wave of the outbreak and is not currently experiencing a large-scale resurgence of the epidemic. India is experiencing a grim second wave of the epidemic and has far more daily new confirmed cases per million than South Korea and Japan.
Figure 2 shows the timeline comparing the cumulative confirmed deaths per million people of COVID-19 in India, Japan, China, and South Korea. Throughout 2020, the number of COVID-19 deaths per million population remains low in South Korea, Japan, and China, while India has seen an upward trend in deaths per million population since July. Japan’s number of deaths per million population increases gradually into 2021, and is higher than that of Korea and Japan, while India’s number of deaths per million population continues to increase, far exceeding that of Japan, Korea, and China.
Testing is our window into the pandemic and how it spreads, and the positive rate shows the level of detection relative to the size of the outbreak. Figure 3 shows the comparison of the total tests per thousand people and the positive rate for COVID-19 in India, Japan, and South Korea. (Relevant data for China are not fully disclosed) As of May 18, 2021, the number of total tests per thousand people in South Korea, India, and Japan was 230.65, 181.23, and 99.59, respectively. South Korea and India both have more than twice as total tests per thousand people as Japan.
According to the standards published by the WHO in May 2020, a positive rate of COVID-19 less than 5% indicates that the epidemic situation in a country is under control. We can see that the positive rate of COVID-19 in South Korea is 2.2%, which is lower than the standard announced by the WHO, indicating that the epidemic in South Korea is well controlled. The positive rate in Japan is 6.9%, which is slightly higher than the standard positive rate, while the positive rate in India is 17%, which is much higher than the standard positive rate. The task of epidemic prevention and control is still arduous in India.
3.2 Management and Outcome
“Non-pharmaceutical interventions (NPIs)” are social interventions, including isolation, management of sources of infection, social distancing, and so on, aimed at
reducing contact rates in the population and thus reducing the spread of the virus.[17]
The major measures taken by South Korea and Japan in response to COVID-19 were summarized in Table 1 from the government infectious disease risk alert approach, immigration, screening, surveillance, healthcare, and society. Table 2 shows the major measures taken by India and China in response to COVID-19.
Government policies and non-pharmaceutical interventions in response to COVID-19 in South Korea and Japan
The first wave of COVID-19 in South Korea was a cluster of outbreaks linked to a religious group in the city of Daegu and northern Gyeongsang province. The first wave peaked at 813 new cases on February 29, 2020, after which the number of new cases began to gradually decrease.[18] This was followed by a sustained outbreak in small clusters and an increasing number of imported cases from outside Korea. A retrospective look at the fight against the COVID-19 from 2020 to late May 2021 shows that South Korea did not resort to blockades and suspension of public transport to restrict people’s movement, even at the height of the outbreak. The core of Korea’s response to COVID-19 is massive and rapid testing to identify positive cases, along with meticulous tracing and quarantine of all contacts. To provide safe and effective screening for COVID-19, the Drive-Through and Walk-Through Screening Centre have been implemented in Korea. In addition, effective mitigation strategies such as mask-wearing campaigns, social distancing, avoiding crowds, and frequent hand and face washing were implemented.
To avoid the overwhelming of medical resources, Korea prepared for other types of care centers beyond hospital beds. KCDC converted public facilities and residential facilities provided by the volunteer into isolation-and-care facilities and named Life Treatment Centers (LTCs).[19] LTCs can prevent asymptomatic or mildly ill patients from infecting family members. The latest digital technology is also key to the control of COVID-19 in Korea. The Korean government developed Self-Diagnosis Mobile Application to monitor the health of inbound passengers and patients in LTCs. The Korean government has temporarily allowed doctors to engage in telemedicine activities, which can avoid hospital infections and cross-contamination during patient visits. [20]
Japan was the third country to have the first COVID-19 case in January 2020 after Thailand. From January 2020 to May 2021, three waves of COVID-19 outbreaks surfaced in Japan. COVID-19 is a disease that mainly threatens the elderly, and Japan has more elderly people per capita than any other country. The first wave of outbreak control focused on avoiding medical resource shortages and reducing deaths due to COVID-19. The Japanese government adopted a strategy of hospitalizing serious patients and isolating the mildly at home.[21] The main measures of the Japanese government were to close schools at the end of February 2020 and to urge the public to wear masks, telecommute, work shifts, not hold events, and avoid contact with others to reduce transmission.[22] Instead of massive testing, the Japanese Government declared a state of emergency on April 17, 2020.[23] Many restaurants and companies reduced the time people spent outside their homes by reducing business hours and shifting to teleworking.
Japan initially adopted a strategy that focused primarily on symptomatic patients, controlling clusters, and seeking ways to coexist with the virus rather than eradicating it. However, after the first wave of the outbreak, socio-economic activities quickly resumed and the epidemic resurfaced. Although the peak period of the second wave of infections was larger than that of the first wave, the number of infections declined in the absence of measures such as a state of emergency. However, during the second wave of the outbreak, Tokyo increased the number of testing. Since early November 2020, the number of infections has started to increase again, and Japan has entered the third wave of the outbreak. The government did not declare a state of emergency, and local governments only called for reduced business hours and limited activities in December 2020. [24] The third wave of the outbreak in Japan is ongoing.
Government policies and non-pharmaceutical interventions in response to COVID-19 in India and China
India reported the first case of COVID-19 on 30 January 2020. The international community is concerned about India's control strategy and capacity due to high population density, socioeconomic inequalities, and low health care resources. India's robust response began at the outset of the pandemic. Border controls such as fever screening, travel history, identification of disease symptoms, and airport screening began in late January 2020. A national lockdown that began on March 24 impacted 1.3 billion individuals. Public health measures such as social distance, hand hygiene, mask use, and telecommuting were also widely practiced. India made every effort to increase health resources, converted train cars into isolation beds. The Government also introduced a mobile phone application named Aarogya Setu for contact tracing and aiding in quarantine. Testing numbers have also increased rapidly, with 553 government labs and 231 private labs nationwide having expanded. [25]
Despite a robust response at the outset of the pandemic, India has the world's fastest-growing in absolute numbers as of May 2021. WHO has stated that the “future of the pandemic will depend on how India handles it.” [26] From June 2020, India has already gradually relaxed the lockdown measures. With the gradual socio-economic recovery and continued relaxation of restrictions, a second wave of the outbreak emerged in India in February 2021 and gained momentum.
As the country that first identified the COVID-19 outbreak, China took the lead in initiating an unprecedented lockdown. From January 23 to April 8, 2020, Wuhan, the source of the outbreak, suspended all traffic in and out of the city. The central thrust of China’s efforts to control the first wave of the outbreak was to actively identify and manage cases, track, and isolate close contacts, and severely restrict or control population movements when feasible and appropriate. [27] The main response policies of the Chinese government include the following levels. Mobility restrictions: Except for the lockdown of Wuhan, schools were closed nationwide, online offices, and non-essential business premises were shut down to minimize the movement of people. Medical resources: The chain of command of the CPC Central Committee and State Council coordinating the joint multi-departmental response allowed the necessary resources to be mobilized. After the outbreak, the Chinese government mobilized medical resources from across the country to support relief efforts in Wuhan and other parts of Hubei, setting up two critical care hospitals and 16 Fangcang hospitals. Case treatment: The policy of ensuring that all those in need are tested, isolated, hospitalized, or treated was implemented. Putting four categories of people – confirmed cases, suspected cases, febrile patients who might be carriers, and close contacts – under classified management in designated facilities from Fed 2,2020. Contact tracing: Testing and tracing are a vital part. China adopted the principle of due diligence. Almost the entire city of Wuhan, where the epidemic occurred, has completed nucleic acid testing and screening. It is also the decisive actions and strict measures that have allowed China to control the first wave of epidemics so far, except for sporadic epidemics and imported cases.