March 28, 2020

Covid-19: Korean Quarantine Model

There has been criticism on the web about shutting down the entire State of California since community spread of the disease is only apparent in the San Francisco Bay area, Los Angeles county, San Diego county, Sacramento county, the Seattle environs, and New York city.

Community spread means the people who’ve gotten Covid-19 don’t have any idea who infected them. Tracing contacts of infected people and isolating those contacts is the first line of defense in stopping an epidemic, but does not work when the people to contact and isolate cannot be identified.  When contagion happens by community spread, a disease can take off throughout the population as happened in the infamous “Spanish Flu” of 1917 though 1918.

Some critics suggest we adopt the South Korean model of Covid-19 containment, which seems to be working well there. They are isolating seniors and the chronically ill while letting the rest of the population go about their business. Infection rates seem lower and their health care system is not being overrun.

The foregoing said, there are some important facts that make suggestions of following the South Korean model of isolating only seniors and the chronically ill from the rest of us now pre-mature in areas of the country where community spread has already taken hold, such as New York City, Seattle environs, Los Angeles, San Diego, and the San Francisco Bay area.

There is an important difference between the US and Korea. South Korea has a well-developed and well stocked traditional Asian medicine component to its health care system. Traditional Asian medicine works well at combating Covid-19 infections.  It is not 100% effective, no medical approach is, but it is far more effective than western medicine. There are multiple studies that support this. The Chinese government has utilized it in this latest pandemic with good results. Entire hospital teams are on government recommended herbal regimens as they fight the disease. Doctors dying on the front lines has dropped off since those regimes were implemented. More on how it works and why in another post. Koreans can use it at will throughout their country, many do. I suspect this has more to do with the low mortality and severity rate in Korea than is currently reported.

Medical masks, until our government put out the call for domestic manufacture in February, were not made in the US.  They were imported from China.  When the Chinese government realized what was happening in Wuhan, they bought up almost the entire stock of medical masks in the world’s commercial pipeline and all Chinese manufactured masks were diverted to domestic Chinese consumption.  New medical masks stopped being available for purchase by health care workers in the US in late February. I, a primary care health care provider, was told there would be no shipments of medical masks into the US from China till sometime in the fall or next winter when I tried to buy some masks for my clinic and family.

Whether one gets sick from a virus depends on the number of viral particles to which one is exposed and the state of one’s immune system.  Once the virus is in one’s lungs and tissues the term is “viral load”. The higher the viral load, the more stress on the immune system and normal functions of the host.  If one already has diabetes, any cardiovascular disease, asthma, other breathing disorder, or is exhausted, the immune system is compromised.  Covid-19 kills its host by infecting and damaging the lungs thus reducing oxygen supply to the body. Once the lung tissues have been damaged, viruses enter the blood stream and are seeded throughout the organs, resulting in multiple organ failure.  Like the general population, a very significant percentage of health care workers have these pre-existing conditions.

Medical staff in Wuhan were killed by Covid-19 because they were exposed to high viral load before the nature of the illness was apparent and were exhausted.  Medical staff treating a stream of patients all day, a small percentage of which actually have Covid-19 and a larger percentage have common flus, are exposed to tremendous viral loads.  If we were to follow the Korean model in areas where community spread already exists, the general population would quickly become majority infected and, even if told to stay home unless very ill, many would show up at their medical providers.  Even 10% of them showing up for treatment or diagnosis would quickly overwhelm the capacity of our medical services to treat them.  More importantly, there are not enough masks yet for all staff who come in contact with the patients (meaning everyone from the doctor to the janitor). Viral load would be so great for these workers that many who would otherwise shrug off a minor infection would come down with serious illness and need hospitalization.  But our hospital capacity is only able to bed 2% of our population at a time.  Thanks to the leadership of Mr. Trump and Mr. Pence and the rapid response of American manufacturers, we’ll have sufficient supply of masks to front line clinics and hospitals within several more weeks.  It looks like the same can be said of gowns, gloves, hand sanitizer, face shields and other personal protective equipment (PPE).

Lack of PPE is not the only problem. We cannot successfully identify, track infections and quarantine if we cannot test to determine who has Covid-19.  The automated testing that the South Koreans have been doing existed only in South Korea until our leaders cut through the regulatory morass and arranged with our medical manufacturers to get them manufactured here. We’ll have enough tests within the next several weeks.

So, yes, for USA areas where community spread is now occurring, mandatory school and business closure, social distancing, and self-isolation are the best defenses.  Where community spread has yet to occur, such actions are pre-mature and far too damaging to the economy.  Once we have sufficient PPE and medical capacity to identify and treat only those who actually need treatment for Covid-19, following the South Korean model of keeping Grandma, Grandpa and those vulnerable away from those who are not, will probably work; and will create far less damage to the economy and our children’s education.  In the meantime, we are staying put and not getting within 6 feet of anyone other than my patients.  I’m happy to hear from my patients that the roads are deserted.

Many people have expressed their desire to communicate their opinions to their representatives regarding handling of this pandemic. You can find your Congresspeople and State Legislators for free at USgeocoder.com. Enter your address and zip code, then the + at the top left corner of the column of data that appears. Scroll down and click on the name of your representatives, their contact information and role in their legislative bodies will pop up for you.  The email addresses and webform links you’ll find are the best means of communicating with your elected representatives.  I would appreciate it if you could mention getting PPE to traditional Asian medical practitioners (Licensed acupuncturists in the US are the ones practicing Asian medicine.) Without PPE we risk getting infected and then infecting our families and our patients as well as anyone who comes in with symptoms but just has an ordinary flu or brings a relative for care.  Although I have PPE sufficient to treat some patients, most of my colleagues and I do not have enough to treat more than a handful of patients.  Since we cannot obtain PPE at the moment, we are having to sit on the sidelines when we could be helping.

Full disclosure, my wife and I co-founded and own USgeocoder LLC.  We hope you find it useful in communicating with your elected representatives regardless of your opinions and ideologies.