Earlier this week, South Korea became the first country to officially announce a second wave of the novel coronavirus after a recent resurgence of cases.
Jeong Eun-kyeong, director of the Korea Centers for Disease Control and Prevention, said during a briefing Monday the new wave stemmed from multiple nightclub visits during a holiday weekend in early May, and is concentrated in the greater Seoul region, an area which had previously seen few cases despite its dense population.
“In the metropolitan area, we believe that the first wave was from March to April, as well as February to March,” Jeong said. “Then we see that the second wave, which was triggered by the May holiday, has been going on.”
So what can Canada learn from South Korea’s waves so far? Experts say it should serve as an example of how to test and what to look out for after reopening.
Canada is currently at the tail end of its first wave, with the rate of infection dropping across provinces and territories. Some provinces, like Prince Edward Island and Newfoundland and Labrador, haven’t recorded new COVID-19 cases in weeks.
If cases were to start rising, Canadian public health officials would need to decide whether the country is actually in its second wave, or just a continuation of the first.
In order for there to be a second wave, there needs to be a severe case increase in an area where the virus appeared to have been naturally wiped out, and return as a new variation of itself, Winnipeg epidemiologist Cynthia Carr told Global News.
Saturday’s numbers from the KCDC showed between 18 and 67 new cases of COVID-19 per day since June 9. New cases of the virus in South Korea dropped down to single digits in April, but the country has been recording new cases ever since.
The country’s quick response and robust testing were widely credited in March for keeping the current death toll at a low 280 in a country more populated than Canada, and South Korea appears to be continuing its methods into its second wave. The latest data from Johns Hopkins University showed South Korea had 12,653 confirmed cases — in comparison with Canada, which has just over 104,000.
Colin Furness, an infection control epidemiologist and assistant professor at the University of Toronto, said there are lessons to be learned from both of South Korea’s COVID-19 waves.
“To stop a pandemic, when it’s less contagious, it turns out you can do it two ways,” he said. “You can lock everyone down or you can test everyone. And you’ve got to commit fully to at least one of those.”
Canada, on the other hand, placed the country in lockdown, closing its borders to non-essential travellers, banning small gatherings, closing down bars and nightclubs and implementing heavy physical distancing guidelines and campaigns.
To date, Canada has tested more than 2.7 million people, in comparison with South Korea’s 1.2 million. But during the height of the first wave in March, South Korea had ramped up testing to 20,000 people per day (amounting to 600,000 per month), while by the end of March, Canada had tested just over 250,000.
Furness said the two present contrasting approaches of how to handle a pandemic. While South Korea may have been able to quash their case numbers early, he said whether that will help with the severity of their second wave remains unclear.
The concept of physical distancing may not have been firmly “embedded into their thinking,” particularly with young people — a key demographic in nightclubs, Furness said.
This is also not the first time nightclubs were linked to an increase in cases. Following a 10-day streak of reporting zero new infections in May, South Korea recorded 34 that were traced to different nightclubs visited by one confirmed patient.
Even in certain parts of Canada, COVID-19 cases in young people is on the rise.
A study from the University of Guelph showed that while the number of infections for other age groups went into a steady decline around mid-May, they were increasing in young people within certain parts of Ontario hit hardest by the virus.
“What we could learn is public health messaging needs to be developed and targeted to that age group. Twenty-somethings know that they’re not likely to die from this,” Furness said, adding that opening a nightclub without completely reducing the rate of infection down to zero is “a really bad cue to a group that is already engaging in risky behaviour.”
“When you’re in your 20s, you’re invincible. So I think they under-recognized the risk of 20-somethings and they made it worse. They put gasoline on the fire.”
However, there are some areas where South Korea excelled that can be considered real teaching moments for Canada.
Zahid Butt, an infectious disease expert and assistant professor at the University of Waterloo, said South Korea was a champion of contact tracing, which involves tracing an infection person-by-person and keeping them away from other people to prevent further spread.
“If there is a surge of new cases, then you need to prepare,” he said.
“It seems that was much better (in South Korea) than it was in Canada,” Butt said of contact tracing, adding it played an important role in the way South Korea reopened its economy.
How the country has primed itself for a potential second wave, and how this tool is re-used could pose as research for Canada, he said.
Carr added that with Seoul’s high population density, “there absolutely is a risk now” for an “exponential increase” in cases — and Canada should take note.
In Canada, many provinces are in the process of reopening and easing COVID-19 restrictions.
Moving into a second wave, Carr said Canada will have to be vigilant and invest resources into ongoing asymptomatic testing in order to get a better grasp of where the virus circulates throughout the population, track down clusters and enforce isolation as needed.
“Different pockets of the population infected or different outcomes, more hospitalizations or more deaths — those are the key for us to watch for,” she said.
“The outcome, the severity of the illness, if that changes or the clusters or impact more severely, starts a second wave.”
Wearing masks in areas where social distancing is not possible will also be pivotal in reducing the severity of the second wave, Carr said, adding how serious Canada’s second wave will be determined by how well people adhere to public health guidelines.
By April, South Korea was relaxing its social distancing measures. By May, it revealed its plans to end its social distancing campaigns, reopening crowded spaces like shopping centres and “entertainment facilities” with minimal mention of the importance of masks.
“Humans are the wildcard in all of this. We know what the risk factors are. We know what the safety measures are. Public health officers tell us every day about distancing,” she said. “We all know what we should be doing.”
As Caroline Colijn, the Canada 150 research chair in mathematics for evolution, infection and public health at Simon Fraser University, noted: “The only thing that has consistently worked is really staying away from each other physically.”
“This bug has not receded in any natural way. It’s only gone away because we did things and in particular, we stayed away from each other,” she said.
“As we come together and stop staying away from each other and go to bars and go to restaurants and go to nightclubs… (the virus) will just take those opportunities to move from person to person and cause more cases.”
— With files from Reuters
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