So many Misinformation everywhere — Listen to this Leading COVID-19 Expert from South Korea
Most likely Future Scenarios and Possible Cure
Interview with Professor Kim Woo-Joo from Korea University Guro Hospital, COVID-19 Expert, Department of Infectious Diseases
There is a lot of panic and misinformation that is going around about the coronavirus. South Korea is widely acknowledged for having had one of the best responses to contain the pandemic.
If you are wondering what Korea has done to be so effective and if you also want to get the most accurate information on the coronavirus, keep on reading. Today we have come to Korea University Guro Hospital to talk with the most prominent coronavirus expert in the country.
Interview executed by the Asian Boss Community. Summarized interview transcript and article written by Ozzin Jun.
This article covers up COVID-19 related to following sub topics: Source of COVID-19, risk group, death rate, possible reinfection, transmission of COVID-19, tests, preventions, symptoms of COVID-19, safety advices, global impact, current situation in Korea, possible cure, future scenarios and timeframe of this epidemic.
Disclaimer: Since it is a long article, you can skip certain topics and read up the parts that interest you personally the most.
Interview 24 March 2020
Could you briefly introduce yourself?
I’m currently working at Korean University Guro Hospital in Seoul as a professor in the Department of Infectious Diseases. I have been working in this field since 1990. I have dealt with many infectious diseases, including tuberculosis, AIDS, measles, SARS in 2013, Pandemic Flu in 2009, Ebola in 2014, as well as the MERS outbreak in 2015. From all my experiences I had so far over 30 years, COVID-19 pandemic is the most challenging one.
What kind of work are you doing in relation to COVID-19?
In the hospital I look after people with COVID-19 symptoms. I also take care of inpatients. Because I am the most senior member of our staff, it is my job to go on national TV to talk about COVID-19 and provide the most accurate information to the public.
Could you tell us where COVID-19 comes from?
December 2019, Wuhan in Hubei province, China: We started seeing pneumonia cases of an unknown cause which lead to deaths. When the Chinese government became aware of the issue, they notified the World Health Organization (WHO) on 31 December 2019.
Based on our 3 months research, we came to the conclusion that the coronavirus originally came from bats. Everything started in a wholesale seafood market in Wuhan, where the virus has been transmitted to a human. There had to have been intermediate hosts, whether it be pangolins or snakes. But we are not entirely sure yet.
«The virus knows as SARS-CoV-2 that caused COVID-19 jumped from a bat to an intermediate host, a pangolin or a snake, and then to a human, resulting in severe pneumonia.»
Many people still do not know much about COVID-19. Do you have the data on the death rate?
The death rate varies depending on the country. Even though it is the same virus, every country has different quarantine protocols, different levels of sophistication for healthcare, and different demographics. For countries with a large elderly population like Italy, the death rate is 8 to 9 %.
Is there any data on the death rate by age group?
The death rate is 2-3 % on average. Because this is a new virus that we have never encountered before, we do not have any treatments or vaccines. In every country the number of patients is exploding. Europe and big cities like New York are especially in a bad situation.
Today (24 March 2020), there are 8’961 confirmed cases in Korea and 111 patients have died. 3’166 patients have fully recovered. We do a lot of tests in Korea. Out of about 9’000 confirmed cases, we found that around 20 % show no symptoms. Therefore overall, we have a better grasp of the extent of infection compared to other countries.
Death rate of infected people categorized in Korea by their age group:
- 80s = 11.6%.
- 70s = 6.3%.
- 60s = 1.5%
- 50s = 0.4%
- 40s/30s = is 0.1%
There has been no deaths in the teens and 20s so far. In Korea, 90% of those who died are over the age of 60.
Can the virus be asymptomatic?
Yes, it can be asymptomatic. If we look at the data of Korea, 20% of about 9’000 patients have no symptoms. An asymptomatic patient can still spread the virus and that is the tricky thing.
Why is this virus so deadly to the elderly?
However, if you are over 60 years old, your immune system deteriorates. It is called immunosenescence. Especially if you’re over 80, just like a cancer patient for comparison’s sake, your immune system starts deteriorating rapidly. Thus, if those in their 70s or 80s get infected, they are overmatched and cannot fight the virus.
COVID-19 is a new virus that does not have a vaccine yet. The only thing that can fight the virus is your own immune system. For those between their teens and 40s, they might only experience mild cold-like symptoms for 1 to 2 weeks and recover afterwards.
«Because the virus can lead to pneumonia or inflammation all over the body. Those with chronic medical conditions and elderly people are part of the high-risk group.»
Even people under 60 can be at risk, if they have any cardiovascular problems, a chronic lung condition, diabetes, or are smokers. Because nicotine can accumulate in their respiratory system and they can get very sick. Those, who are using immunosuppressive like steroids or anticancer drugs are at risk as well.
Let’s say you already got the virus. Can you get reinfected after you recover?
Yes. That is the scary part. Many misinformation has already been spread around that you cannot get infected again, which is not true.
There is still so much we do not know. Usually, when we get sick, it takes about 2 weeks for our body to develop antibodies. Then we do not get sick from the same virus. But with COVID-19 we have seen cases where a patient got COVID-19, recovered, and was discharged.
«But after 5 to 7 days, they started to show the COVIID-19 symptoms again. We are seeing these re-activation cases.»
How do we catch COVID-19? For example, some might think they will catch it just by breathing, whereas others might think that they need to be sneezed on to catch it.
Once the virus infects our respiratory system, the main symptoms are: fever coughing, and breathing difficulties. When you cough or sneeze, you produce droplets. Basically, you’re spitting. It has to be bigger than 5 microns to be considered as a droplet, and one droplet of an infected patient contains many viruses.
Could COVID-19 infect our eyes?
Yes, it can infect our eyes. This happens through the mucous membrane.
Because droplets are bigger than 5 microns in size, when you cough or sneeze, droplets you shoot out like a rainbow, will typically land within about 1 to 2 meters (3 to 7 feet). At that point, the virus can infect our eyes, nose or mouth.
Can I get infected by just walking through the same place where an infected person passed? (transmission through air)
Air is a slightly different issue. The most common route is transmission through droplets.
The second route is when we sneeze and have a runny nose, we tend to wipe our nose with our hands. In this case the virus is on our hands. Then, we shake hands with someone and the virus is rapidly transmitted.
When a patient coughs or sneezes, their droplets land on nearby surfaces like tables, door handles, or keyboards.
«Then the virus can survive anywhere from a few hours to beyond 3 or 4 days. If the virus is on clothes it can last longer.»
It also depends on the temperature and humidity. For example, in Korean winter where you have 5 to 10°C (411 to 50°F) with 30% humidity, the virus can survive for a long time.
Basically, you can’t get infected just by breathing then. Right?
That is correct, but there can be some exceptions. Usually, in our everyday lives, you get infected from the droplet transfer, direct contact, and indirect contact.
«You can get infected through the air under certain circumstances. This is called aerosol transmission or airbone transmission.»
For example, recently thousands from areligious group called Shincheonji got infected in Korea. The church was on the 10th floor of a building, inside a closed space. These hundreds of people gathered within 1 to 2 meters of each other praying singing for hours. If one infected person is present, think about the number of droplets produced.
We all spit even when we talk normally. But if you are singing and shouting you are going to get a lot of droplets. When people are shouting and screaming gravity doesn’t pull all the spit down, which means the droplets don’t land within 1 to 2 meters. Because the air can also flow sideways as well.
Consequently, when you shout, the droplet can travel much further than 1 or 2 meters. The size of the droplet shrinks to less than 5 microns, and it turns into aerosol. That is how a person, standing quite a few feet away can still get infected. That is airbone transmission. This is why isolated gathering places like churches, call centers or any densely-packed areas where people are shouting or eating are at risk.
In regular outdoor environments, such as parks, forest and hiking trails a transmission is unlikely because they are not in a closed space.
In your opinion, who should get tested for COVID-19?
First of all, if you have a fever, sore throat, coughing or having any difficulty in breathing, you should get tested. This is especially important for the elderly and those in the high-risk group. Even if they are experiencing fatigue, loss in appetite or mild aches all over.
«Our team of researchers confirmed that about 30% of those infected by COVID-19 can’t smell or taste anything.»
You basically lose your senses of smell and taste, and that can last for 5 to 10 days. I would say that this a pretty unique symptom.
I don’t feel sick, but can I still get tested?
You can always pay for yourself and get tested. It’s 170’000 Won (USD 140). If you test positive, you get your money back. If a doctor thinks that your data is valuable, then the test is also free. In South Korea, if you test positive, the government will pay for your tests. Not many countries do that.
Korea is being praised for its quick response and doing a lot of tests. How much testing is actually being done in Korea?
We are doing 15’000 tests daily. Until 23 March 2020, 338’000 tests have been done.
But in some countries, they are not able to carry out that much testing. How is Korea able to test over 300’000 people so quickly?
This, because Korea already went through the 2009 flu pandemic (swine flu), and the 2015 MERS outbreak 5 years back. Many Koreans are already educated on such pandemic and therefore, know how to react. They know for example that washing our hands and wearing masks helps prevent infection.
During the MERS outbreak, we already figured out that we need to quickly develop test kits and use them. At the time, I was the chief of Korean’s rapid response team for MERS. We realized that we couldn’t develop medicine or a vaccine right away. But we could make test kits that use PCR (polymerase chain reaction), which is a very effective method to diagnosis.
«So we emphasized making these test kits quickly and making them easily accessible.»
A patient could be coughing and have a fever, but we need to find out whether they have COVID-19 or flu. Then, we can quarantine them, treat them and find out where they have been in the last few days and who they have been in contact with.
«In this case, we can test all other people who got in contact with the infected person and quarantine them if needed. That is the core of prevention.»
If the virus can go into your eyes, where is the point of having masks?
People who are wearing glasses are better protected. I mentioned eyes, nose, and mouth because there are mucous membranes inside them. It is inside your eyelids and nose. These mucous membranes have a receptor called ACE2. The virus has to stick to those receptors. But we don’t have receptors on our skin. Our skin actually acts as a sort of a barrier. The virus can’t get through our skin and ears.
How effective is wearing a mask in general?
It is definitely effective. Why would doctors in hospitals wear masks? They wear them because they prevent infection.
During the SARS outbreak, in Hong Kong Singapore, Canada, Taiwan, and China a lot of medical professionals were infected. Even now, medical professionals in Wuhan and Italy are getting infected.
«According to the research, medical professionals wearing masks have a significantly lower chance of getting infected than those who don’t.»
In the West like Europe and the US, you don’t really see people wearing masks. I find that quite odd. The US Surgeon General said people didn’t need to wear masks and WHO recommended people not to wear masks, but I’d have to disagree. I did read this tweet and you have to understand the context.
«I think the point was to prevent the public from hoarding masks because medical professionals need them more.»
If medical professional run out of masks, they can’t even treat patients, right? In other words, because masks are in short supply in the US medical professionals should be prioritized.
In Korea most people wear masks. Do you think this is another reason why COVID-19 did not spread more around ?
Yes, it is definitely a reason. I you look at WHO’s recommendations, they don’t encourage normal people to wear masks. However, in Asian countries, because of the cultural differences, they do recommend people to wear masks. That’s what they say, which I personally think is problematic. Because masks have been proven to prevent infection. In Asian countries we all wear masks. In the meantime, if you look at many European countries and the US, the virus is spreading rapidly.
«One of the reasons Korea has relatively low rate of infection is because everyone is wearing a mask and washing their hands regulary.»
What is the current situation in Korea?
Currently, Korea is controlling the situation better than any other country. But it is not over yet. There’s still risk of infection. The problem right now is that there is an increasing amount of people who are coming in from Europe or North America and bringing back the virus with them. At Incheon Airport in Korea right now, people getting diagnosed with COVID-19 and it is increasing again.
«Since 22 March 2020 Korean citizens and foreigners coming from Europe have to be tested. In fact, 20% of the cases being confirmed daily is of people coming from abroad.»
Since 2012, MERS was mostly concentrated in Saudi Arabia, and it is endemic to the Middle East. Outside of the Middle East, the only country MERS had a big impact on was Korea: 186 people got infected, and 38 of them passed away. Korea already went through hell back then, but it was a valuable lesson.
How long does it take for the results to come out after you get tested?
It usually takes 6 hours. But the problem is that too many people are getting tested at once. That is why people are being stationed at a temporary facility for a day and get their results the next day.
What happens when you get tested positive or negative?
If they test positive: critical or serious patients go to a hospital and less serious cases go to health treatment centers.
If they test negative: they go home, and self-quarantine themselves for 2 weeks. We help them install a self-quarantine app on their smart phones. If they have that app while they are at home, we can track their location.
«If they step out, of their house, an alarm will sound and alert that they left the boundaries.»
Additionally, you have to input your symptoms on the app 2 times a day. Like whether if you have fever. Because people who self-quarantine could start getting symptoms after the virus’s incubation period. So that’s why they record their symptoms on the app. If a staff monitoring you sees that you didn’t input anything on one day, they will think you’re not self-quarantining properly and they will contact you.
I didn’t know that Korean government was going to that extent. Of course, this could trigger some privacy issues, since we are using location tracking to intrude on people’s privacy. I’m sure they are getting people’s consent.
In Korea, the start of the school year is being postponed. People are practicing social distancing, and the government even sends regular updates via texts. How well do you think this is all being handled?
On 20 March 2020, the prime minister made a special announcement that he strongly recommends social distancing. From that date for 2 weeks, these 3 types of places (Religious faculties, bars, and indoor gyms), were strongly recommended to shut down.
People who are over 50 or 60 are following these protocols well. But teens and those in their 20s are not. Because for teens in Korea their education is very important. Even if they’re sick and have fever, they have to go to school and academy. The school year was postponed for elementary, middle, and high school because of COIVD-19. But in the evening kids go to academies.
«So even if the government pushed back school, kids will still go to academy to study at night.»
Many 20s people still go to clubs in Gangnam on Fridays or Saturdays. They won’t care at all and won’t wear a mask. They still keep on dancing, drinking, and chatting in a confined space.
«30% of our confirmed cases here in Korea are of people in their 20s.»
Some people are saying when summer comes and it gets warmer, it will calm down. When will the COVID-19 situation definitely have an end?
This is the questions I’ve been asked the most. It’s hard to predict but I can tell you it won’t be over quickly.
There are several future scenarios
1.The best scenario would be, if countries all over the world can work together like they did during SARS pandemic to end this by July or August of this year, that would be the best-case scenario. And that it won’t infect the human population again. It’s possible.
The 2003 SARS outbreak started in 2002 in the Guangdong Province of China. And it spread to Hong Kong, and then through tourists, it spread all over the world, infecting about 8’000 people. The fatality rate was about 9.6%. The whole SARS situation ended in the beginning of July 2003.
2. The second scenario would be that it stays around until the summer and be gone form the Northern Hemisphere, but in turn, it will spread in the Southern Hemisphere like Australia, South Africa and South America. Then, it will come back to the Northern Hemisphere in November or December like the seasonal flu. It could have a regular cycle.
3. The last scenario would be that we develop a vaccine. We would vaccinate the whole human race. In 1980, we got rid of smallpox from the face of the planet with vaccines. If we find a very effective vaccine just like back then, we can vaccinate ourselves. We can put an end to it. This scenario is possible, but the most ambitious and difficult to achieve.
How likely do you think the best-case scenario will be possible?
It is not as likely as SARS, so maybe the success rate of the best scenario is around 10%. Because 2003 is already 17 years ago. Back then, international travel was not as frequent like today.
How far is the development for a COVID-19 vaccine? And how long will it take until the vaccine can be available to the public?
Inventing a vaccine for a new virus typically takes 10 to 15 years. And it will cost over 800 US dollars. It has been only 3 months since we got familiar with the DNA of COVID-19.
As the director of the US’s National Institute of Allergy and Infectious Diseases Anthony Fauci said:
«At the fastest, if everything goes smoothly; which means if the clinical trial of the vaccine successfully goes through the trial Phase 1 to 3 perfectly, it will take 18 months.»
USA has lot of citizens and it would be impossible for the US to vaccinate all their citizens in a short amount of time. It becomes the question: Who is the priority. Healthy people in their teens and 20s probably won’t be able to get one.
Are you currently participant in the development of a vaccine? Is there an alternative instead of developing a vaccine?
I’m not directly involved in the development of a vaccine, but there are vaccines and medication. Since a vaccine will take a long time to develop.
«The quickest thing we can do is drug repurposing.»
People know Viagra as a drug for erectile dysfunction, but it was originally developed for pulmonary arterial hypertension. As a byproduct, if was found to be effective for treating erectile dysfunction. Likewise, we are trying to see if a drug that has already being used for another infectious disease can be effective for COVID-19. That’s the fastest option we have.
Possible ways to heal people from COVID-19
1.Kaletra, a medication for AIDS and Chloroquine, a medication for malaria, were tested and found to be somewhat effective on COVID-19, so they’re being used on critical patients.
We’re also doing clinical trials for remdesivir, a medication for Ebola developed by Gilead Sciences, to see if it’s effective for COVID-19. But that needs funding and manpower. We’re planning to test a couple of drugs actually.
2.Another quick method is to take the convalescent plasma from the blood of the patients who already recovered form COVID-19. This method has been in use since 100 years back. Within the blood of patients who recovered form COIVD-19, there are antibodies that can fight and subdue the virus. We are asking people who recovered from COVID-19 and ask them to donate their blood, so we can give their convalescent plasma to critical patients. But it’s difficult to look after patients and research at the same time. We need more funding and manpower. Realistically, it’s not easy.
What is that you and other medical professional need the most at this point?
Doctors have the responsibility of treating and saving sick patients, and that is what drives us. But there is a dilemma.Doctors have been working on-site for 2 months now, so they are very worn out. They are even more worn out than regular people. They could also catch the virus from their patients. What doctors need right now is rest. But they can’t take the break now.
«Doctors and nurses are like soldiers on a battlefield fighting against the virus. So, they can’t take break while at war.»
What advice would you give to people?
You may think that you are safe because even if you get it, you will be fine. You might not be worried about it at all. But if you spread it to an older family member, it can be dangerous and fatal to them.
Wash your hands well, wear a mask, and socially distance yourself form others. You need to protect your own health as well as your family’s.
That is how you can help out this pandemic our country and the society is facing. Then, every individual will be contributing to end this outbreak.
Last words
South Korea has spent years investing in technology and, more recently, biotechnology. To be sure, disease surveillance isn’t new. Typically, healthcare professionals need to inform public health officials for selected diseases. Since the swine flu in 2015, the Korean government invested a lot in the research and development of these PCR test kits. More importantly, the companies making these tests kits knew they could make a lot of money on this, so they started investing in R & D. Voluntary sharing risks misreporting, with no validation from lab tests.
There are other pitfalls, especially data collection based on human behavior and media coverage. For instance, Google and the U.S. Centers for Disease Control and Prevention teamed up for web data on searches around the flu. Putting data to work effectively isn’t an easy task. In China, a highly connected and watched society, fears of misuse and mass-scale surveillance abound. Beijing has resorted to data to track citizens in the ongoing quarantines across the country. The U.S. doesn’t seem to have the data, or at least isn’t marshaling it effectively. Much of what it collects is in the hands of Big Tech.
South Korea is conscious of risks to privacy. There are laws to protect data about children and personal information. But having a watchful eye in the name of public health has helped in this time of crisis. Without using data as ammunition, it isn’t clear how to effectively contain the spread of this disease without locking down large parts of a country.
Every country is dealing differently with the situation, but we all need to stick together and support each other to overcome this difficult time. Solidarity leads us most likely to the best future scenario.
Acknowledgement of Thanks
We want to thank Professor Kim Woo-joo from Korea University Guro Hospital for taking his valuable time to inform us more about COVID-19. He just started his official YouTube channel and even though it’s all in Korean, you should subscribe to his channel just in case he makes important announcements in the future: https://www.youtube.com/user/KUMCbroa.
