South Korea and America's incredibly stupid Covid debate

South Korea and America's incredibly stupid Covid debate

Places like New York and Italy that had big early COVID-19 outbreaks generally ended up with higher death tolls than places that were better-prepared for the virus by the time it arrived.

But then there’s South Korea, which in the early phases of the pandemic was one of the countries that suffered the most. But then, unlike the United States — and also unlike Asian success stories that closed their borders rapidly and simply never had a big outbreak — Korea actually triumphed over the virus and beat it. Dylan Scott has an article out in Vox that tells the tale and I strongly recommend it, mostly because it serves as a searing expose of how phenomenally stupid the COVID-19 debate in the United States has been.

South Korean officials made a plan. They needed to test as many people as possible, as quickly as possible, to figure out how bad the outbreak was. Then they had to find out who might have come into contact with the infected people. And they needed all of those people — both the infected and the potentially exposed — to isolate themselves to prevent the virus from spreading any further.

It was a three-step protocol: test, trace, and isolate. And it worked. Within a week of Patient 31’s diagnosis, the country was performing the most Covid-19 tests in the world; it implemented perhaps the most elaborate contact tracing program anywhere; and it set up isolation centers so thousands of patients could quarantine.

And it worked (for the sake of reference, South Korea has about 50 million people).

But the country’s response saved lives. Thousands of health care workers and millions of everyday South Koreans made the sacrifices necessary to prevent the kind of mass death seen in much of the Western world. To date, fewer than 2,000 South Koreans have died from Covid-19. The country has never issued an official stay-at-home order; subway trains and buses have been mostly packed with commuters, and people have been working in their offices as usual since last spring. Masks are commonplace, but otherwise, Covid-19 has not altered the fabric of everyday life in South Korea the way it has in much of the Western world.

For details on exactly how the contact tracing and isolation system worked, read the article. The key thing, though, is that their approach to tackling the pandemic was to use surveillance and isolation to suppress outbreaks, not to limit restaurant capacity and issue unenforced bans on house parties. Donald Trump completely flubbed the pandemic. But then once he flubbed it, American Covid politics degenerated into a lot of posturing about things that didn’t really make a difference versus a lot of denialism and quack cures — outdoor masking versus take two hydroxychloroquines and call me in the morning.

I think this is mostly Trump’s fault with a side helping of American public health officials being weird about what they would and wouldn’t even put on the table. But regardless of whose fault it is, we’ve now gotten ourselves locked into a dynamic where I’m terrified about the next pandemic.

America’s stupid Covid debate

The main way you can tell that America’s Covid debate is extremely stupid is that now that Andrew Cuomo has slunk off somewhere, the main person who wants to talk about his record in fighting the pandemic is Ron DeSantis.

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What’s weird about this is it’s not like Florida’s pandemic response has been amazingly effective. As Derek Thompson explains, it’s been totally average — which is to say tons of people have died and many more have been hospitalized with grave illness and perhaps serious long-term consequences.

So why is DeSantis bragging? Well, not because he did amazing stuff that beat the pandemic, but because he did less stuff than a lot of Democrats thought he should do. And while DeSantis’ approach didn’t work, his claim to fame is that California’s approach also didn’t work. The argument is essentially that while Gavin Newsom failed, DeSantis had the good sense to not even bother trying. In Asia, the idea was to do things that work!

But within the confines of the American debate, there’s a lot to what DeSantis is saying. The main idea in Blue America is that you fight a respiratory pandemic that doesn’t seem to affect children very much with dining restrictions on restaurants, school closures, and mask rules. But you don’t actually enforce the mask order on public transit or the limits on private gatherings in homes. Then in Red America, you say that masks are tyranny, the virus is fake, and indulge all kinds of wild anti-vaxxer nonsense. In that context, DeSantis has I guess landed on the wise middle ground of not doing that much, trying to distribute vaccines, and picking fights with the media to own the libs.

It’s worth recalling that it wasn’t supposed to be this way! If you go back to the nationwide social distancing orders of March and April 2020, the plan from the Covid Conscious segment of America wasn’t “let’s just do this forever.” There were these grand schemes of organizing an army of contact tracers, and Vox was running Yglesias takes about how we should create centralized quarantine systems. The idea was to be like South Korea, not to be like California.

What South Korea did

You should read Scott’s piece to really understand Korea.

But the way I think about it is that you basically have to purge from your mind everything that’s happened over the past 14 months. Think back to before the pandemic and what, in your mind, it would mean to take the control of an epidemic disease seriously. What that means in Korea is a lot of testing of people, and a lot of forceful contact tracing, surveillance, and isolation.

The testing part I think people got wind of last spring. We saw Korea was doing well and it had something to do with testing and we were behind on testing. America did eventually ramp testing up, though arguably never enough. But critically, we didn’t really do anything with testing. In Korea, testing was part of an overall surveillance system. Cooperating with contact tracing was non-optional. One guy lied to a tracer because he didn’t want to admit he’d been at a gay bar and he went to jail for his trouble. The government used CCTV cameras to track people down.

In the U.S., back in March of 2020, some researchers in Seattle took a bunch of samples that they had for a flu study and decided to test them for Covid. Instead of being congratulated for taking proactive steps to protect public health, they got in trouble because the participants in the flu study hadn’t given informed consent to be tested for Covid.

To flatter ourselves, we could say that the United States is too civil libertarian and too privacy-loving to take the tough measures Korea used to get the pandemic under control. But if you take the area under the curve, the fact is that freedom has been more curtailed in the United States because we keep limping along with lots of restrictions in place. But beyond that, tons of American families ended up voluntarily foregoing domestic travel and get-togethers with families because the pandemic was raging out of control. Had we taken tougher, more authoritarian steps to control the pandemic, we could have had much freer lives in a practical sense.

We chose to rely on measures that don’t work very well and ever since we have been trapped in a cycle of arguing about whether we should do not-so-effective things or nothing at all.

Who cares about outdoor masks?

To me, the summit of American stupidity has been the debate playing out in the media over the past week — but in society for months — over the idea of wearing a mask while outdoors.

What’s so ridiculous about this is its sheer irrelevance.

Ask anyone about the hardships of the past year and absolutely nobody would say that the need to wear a mask while outside has been one of the top 10 most burdensome things they’ve been asked to do by public health officials.

Ask any public health official why SARS-Cov-2 infections keep spreading and absolutely nobody would say that public failure to wear masks while outside has been one of the top 10 biggest drivers of the virus’ spread.

It’s a whole debate in which one group of people say “the benefits are so low!” and another group says “the costs of compliance are so low!”

But who cares? At this point, it’s only something that gets argued about for the sake of positioning yourself emotionally and intellectually vis-a-vis others.

Sometime in summer 2020, the country gave up on trying to take efficacious steps to contain Covid and has just been arguing about nonsense every since. Even the most Covid conscious jurisdictions were not doing anything to restrict travel, weren’t really tracing contacts, and none of the big names on public health Twitter were calling for the cops to bust up private gatherings.

Then on the right, you had this endless procession of unproven cures from Donald Trump (plasma, etc.) and politicians actively making things worse by spreading misinformation about the virus, vice-signaling about their Thanksgiving dinners, and calling the death toll into question.

There’s going to be more pandemics

In some ways, the truly craziest thing about the Korea story is that everyone seems to agree that the strong mobilization against Covid is a consequence of the country getting a bad scare from MERS that left them determined to do better next time.

In the United States the lesson we learned from Covid is… what?

My lessons, personally, are this:

Masks work and should be encouraged, probably even as just a routine anti-flu measure.

Travel restrictions work, but only if you’re very strict about them.

If you want to suppress a pandemic, you need to isolate cases and contacts in a somewhat coercive way.

If you want to address a pandemic without suppression, you need very fast vaccine testing via human challenge trials.

But I don’t think any of this is even vaguely approaching a consensus position in the United States.

In terms of playbooks for the next pandemic, the right’s takeaway seems to be that we shouldn’t even bother trying to fight it and the left’s playbook is… I don’t really know. There is a correct sense among liberals that Trump handled this in an irresponsible and flippant way, and that you could do better with a more serious leader. But optimistically, that gets you to a Canadian or a German outcome, not to a Korean or an Australian one. That’s an awfully low bar to set for ourselves. After all, what if the next virus is 60% deadlier? Or what if it kills kids? And I don’t think that just redoubling our efforts to scold people for socializing (but of course without any enforceable rules) is a viable solution. And I definitely don’t think the Republican approach of deciding that true victory is to have barely made an effort so at least you didn’t inconvenience people too much is the answer.

I think a lot of people have the sense that since Covid was so unprecedented in terms of the experiences of our lifetimes, this is probably just a one-off. But if you put Covid in the context of SARS and MERS it looks less like a one-off to me. Whether this was a wet market mishap or some kind of lab accident, I don’t see any reason to think that the underlying problem has been solved. This could happen again in the near future. And we ought to be working to do better next time. Yet it increasingly looks to me like we won’t really try.