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Editor's Note: Dr. Kent Sepkowitz is a CNN medical analyst and infection control expert and physician at Memorial Sloan Kettering Cancer Center in New York. The opinions expressed in this comment are the author's own. See more opinion at CNNe.com/opinion
(CNN) - The most complicated issue in the United States right now is how, when and where to reopen the cities and towns that have been protected on the spot. Everyone wants to resume the mobile life of social proximity that we enjoyed a few months ago, but balancing this with the competitive need to ensure individual security, and because this is a contagious disease, social security remains a substantial challenge.
Fortunately, a new "early release" study from South Korea (just final and peer-reviewed, just before) has just been published in the CDC medical journal, Emerging Infectious Diseases.
Entitled "Coronavirus Disease Outbreak in Call Center, South Korea," it describes how South Korea dealt with an outbreak in a high-rise building in the busiest part of Seoul with early and decisive intervention that included the closure of the entire building, exhaustive tests and quarantine of infected people and their contacts. The study was conducted by experts from the Korea Centers for Disease Control and Prevention, the Seoul Metropolitan Government and other local institutions.
Although it is a single-building solution, the authors' approach to identifying and monitoring covid-19 can serve as a model for local and national policy makers struggling on how best to proceed.
The outbreak was first recognized on March 8, 2020, about two weeks after South Korea was in the midst of a major national epidemic that stemmed from exposures at Shincheonji Church in Daegu City, about 240 kilometers south of Seoul. About half of South Korea's current figure of 10,738 confirmed cases is related to the Shincheonji Church outbreak.
Informed by previous SARS and MERS outbreaks, South Korean health officials already had a mature process for containment when the first call center case was identified. A response team conducted an immediate review of the infection site: a 19-story mixed-residential-commercial building.
On March 9, a day after the first cases were reported, the entire building was closed. The tests were carried out almost immediately on 1,143 people (workers, residents and some visitors) with quick results available to those affected and the team that works to control the situation.
Tests showed that 97 people (8.5% of the people occupying the building) were infected. Most of the cases were women in their 30s and almost all (94 of the 97) worked on the 11th floor of the building, in the call center.
Interestingly, unlike many outbreaks reported before and since then, virtually all infected, 92% of cases, had active symptoms of covid-19 at the time of diagnosis.
Investigators then constructed a detailed map of who was and who was not infected, showing that the overwhelming majority of cases had worked on one side of the 11th floor in close proximity. Overall, 43% of all workers on the 11th floor developed an infection with an even higher proportion among those in the severely affected wing.
The South Korean team then evaluated the families and housemates of the 97 people with the infection. Of these, about 16% were positive for covid-19. Surprisingly, no cases were diagnosed in the 15 home contacts of cases with “pre-symptoms” (nothing at the time of the test but development soon after) or no symptoms at any time. This also runs counter to current thinking about transmission, which is that it occurs even before people show symptoms.
In their discussion, South Korean researchers reflected on the effect that their work could have on regular business in Seoul. They note that the cases were in a "high-density work environment" and that the spread was largely limited to one section of a floor.
But they don't give themselves credit for what they accomplished. Yes, the distance between the chairs and the duration of exposure are critical determinants of transmission at a single point in time, but allowing undiagnosed people to do their business inadvertently increases the chance that more and more uninfected people have close and sustained contact with them, possibly leading to a secondary case.
If the researchers had waited a week, the infection would likely have spread widely to the family, then to friends, and then to friends' workplaces, as we are seeing in outbreaks at meat processing plants in USA With a comparable high-density work environment. The virus knows no walls: once a company is infected, the entire community can quickly become infected, unless dramatic steps are taken, such as those that occurred in Seoul.
The current notion by some American public officials of simply reopening our cities and towns, such as a grand opening of a department store moving from nowhere to a full-service store overnight, is surely an impossible dream. But this report from South Korea shows us how we can handle the uncertain business of resuming a normal life.
To do so will require decisive decisions, such as quickly shutting down an entire building if necessary, widely available evidence with quick results, and citizens willing to be quarantined as needed for the public good.
Only by adopting this plan in its entirety can the vision of returning to a vibrant and free nation be achieved. Trying to sneak away ignoring the problem, a pandemic that has killed more than 60,000 Americans in two months, or hoping that it might go away if we eat this or drink that or we don't spend as much time worrying. -It will not only fail miserably, it will immediately take us to the terrifying first weeks of March, when the sky really looked like it was falling.
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