NightMERS

By any measure, South Korea’s response to the Middle East respiratory syndrome (MERS) outbreak has been a failure. Since its patient zero slipped past the airport quarantine on May 4, at least 181 people have been infected, and 31 have died. Although South Korea is a world away from the Middle East — the region that gives the disease its name — the country has the world’s second-highest incidence of MERS after Saudi Arabia. Authorities say the outbreak seems to be “easing,” with the tone sounding more like a prayer than a promise.

South Korea has not always been this hapless in responding to deadly epidemics. Indeed, during the severe acute respiratory syndrome (SARS) outbreak in 2003, South Korea was the model of disease containment: only four confirmed cases and no deaths. SARS was most prevalent in Hong Kong and China, where the disease caused 648 deaths out of more than 7,000 cases. South Korea’s human traffic with China and Hong Kong is magnitudes greater than that with the Middle East, yet its record against SARS was so flawless that the BBC reported on the silly theory that the country’s national dish, kimchi, prevented SARS.

Between the two outbreaks, what changed in South Korea? Two factors stand out. First, South Korea’s rapidly aging population has been demanding increased coverage, which exerts strong upward cost pressure on the country’s public health care system. To minimize costs, South Korea has few publicly run hospitals — instead, it relies on the private sector to an unusual degree. The country nearly tops OECD states in per capita number of hospital beds, with 10.29 beds per 1,000 people (second only to Japan) — however, only 1.2 beds per 1,000 people belong to public hospitals.

South Korea’s relatively low number of public hospitals meant that in the early stages of the MERS epidemic, few hospitals were ready to take aggressive measures in the interest of public health. Nearly all of South Korea’s MERS infections occurred as a result of cross-contamination among patients at hospitals. Just two for-profit hospitals, Samsung Medical Center and Pyeongtaek St. Mary’s Hospital, reportedly accounted for nearly 70 percent of the MERS cases. Unlike public hospitals, for-profit hospitals were slow to quarantine MERS patients and slower still to announce the incidences of MERS inside their buildings — a public announcement would surely have driven away customers.

Other cost-cutting measures also contributed. For hospital stays, South Korea’s national health insurance only covers shared rooms with up to six patients in a room, requiring patients to pay extra for private rooms. This cost structure incentivized patients to stay in shared rooms, which exacerbated cross-contamination. The third MERS patient, and the first to die, contracted the disease while sharing a hospital room with patient zero. The national health insurance has a low coverage rate for bedside care, which often leads the patient’s family members — rather than a trained professional — to attend to the patient. Family members tending the patients are free to enter and leave the hospital without taking proper steps to disinfect themselves, further spreading germs and disease. (The fourth MERS patient was the third MERS patient’s daughter, tending to her father at the hospital.)

But the health care system alone does not fully account for South Korea’s wildly divergent reactions against SARS and MERS. The more significant factor has been the people who operate the system. To put it bluntly, South Korea’s current administration, headed by President Park Geun-hye, was not up to the challenge.

In 2003, President Roh Moo-hyun’s administration — whose executive efficiency has always been deeply underrated — sprang into action when SARS broke out in Hong Kong, even before there were any reported cases in South Korea. Then prime minister, Goh Kun personally visited South Korea’s major airports to oversee the installation of thermal detectors that scanned every traveler entering from affected countries. Seoul set aside roughly $20 million in an emergency budget for disease control, designated more than 40 quarantine hospitals, and paid them in advance to make up for any potential loss they might come to suffer as a result of the designation. The Roh administration also formed a centralized SARS-response task force with broad plenary authority, including the authority to shut down any hospital that showed any sign of cross-contamination among its patients and professionals.

In contrast, the Park administration did not even have a prime minister when MERS broke out in South Korea. The country’s second-highest office was vacant as the Park administration struggled to find a scandal-free candidate after its second prime minister in two years resigned following a bribery scandal. (The current prime minister was not sworn in until June 18.) And Park herself seemed unwilling to get involved: She did not meet the minister of health and welfare until six days after the first confirmed case of MERS.

With no head of government and little involvement from Park, Seoul’s initial response lacked leadership. Instead of establishing a centralized control tower that would take decisive actions, no less than five different task forces emerged in different parts of the government, with little coordination. The Ministry of Health and Welfare, for example, initially decided not to release the names of the hospitals in which MERS occurred, to prevent unnecessary panic. But Korail, South Korea’s publicly owned rail company, released the names in a June 4 travel advisory. As public distrust of the government grew in reaction to this bungled response, local leaders such as Seoul’s mayor clamored to take over the MERS response in their jurisdictions, which added to the chaos. Amid the confusion, MERS in South Korea — which began with just one person who traveled from the Middle East — grew into a full-blown outbreak.

When Park assumed office in February 2013, there were concerns that she might follow the footsteps of her father, Park Chung-hee, an iron-fisted strongman who ruled South Korea for 17 years until his assassination in 1979. As it turns out, the opposite concern might have been more appropriate — that the younger Park may not be decisive enough to take initiative during a nationwide crisis.

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