The MERS Impact: A Differing Tale of 2 Countries
By Matthew Fennell
In May 2014, the United States reported two confirmed cases of the Middle East Respiratory Syndrome coronavirus (MERS); one year later in May 2015, South Korea reported its first MERS case. The cases in the United States affected healthcare providers who had lived and worked in Saudi Arabia. Both traveled to the U.S. from Saudi Arabia, where they are believed to have been infected. In Korea, a 68-year-old man was diagnosed after a 9-day business trip to the Middle East. Although we see similarities in the transmission of MERS to the two counties, the impact on the U.S. and Korea is vastly different.
Since the two reported cases in America, there have been no further outbreaks in the country whereas Korea has reported almost 200 additional cases with over 30 deaths. So why do we see such a difference in outcomes between the two nations? One could point to the fact that in Korea, the first patient went undiagnosed for 9 days in which he visited 4 different hospitals infecting dozens whom he came in contact with. The two people who became sick with MERS in the U.S. after traveling from the Middle East, were immediately isolated after undergoing a comprehensive travel history report upon hospital admission.
The healthcare coverage of the United States and Korea has undoubtedly played a role in the spread of MERS. Korean Healthcare is universal, highly accessible and above all cheap. Walk down any major street and you can see hospitals, clinics, and drug stores on virtually every corner. Nearly all will accept national insurance and a visit to the doctor will typically cost less than $10. This healthcare system promotes people to visit medical facilities even if it is for treatment of a common cold. Almost all MERS infections were spread in not on the streets of Seoul but in the nation’s hospitals, exaggerated by the large amounts of people visiting these hospitals.
Another reason for the varying impact of MERS is the different hospital culture between the two countries. Many Koreans flock to the best hospitals in the country to visit the top doctors that are on offer; this regularly leads to overcrowding in the waiting areas which in turn exposes ill patients to each other. In addition, family members often carry out much of the nursing duties on the wards, such as changing sheets or washing the patient, thus also exposing themselves to infections. This culture is not so prevalent in the United States with more patients being kept separated and there being more regulation in visiting conditions.
Finally, the two countries are very different geographically, in particular in relation to the population and where people live. Korea is 23rd in the world when we talk about population density with more than 500 people per square kilometer. The United States on the other end of the scale is 182nd in the world with only 32 people per square kilometer. Naturally this effects the likelihood of the disease spreading quickly with less people in close proximity to each other reducing the risk of infection. Korea on the other hand has overcrowded transport systems, health facilities and people naturally live and coexist in close contact with each other, therefore increasing the risk of infection.
These are just some of the reasons why the United States was able to control the spread on MERS while Korea is in the middle of a battle to contain and eradicate it. From school closures and the cancellation of events, to the impact on tourism and the economy, Korea needs to the end of MERS to come quickly. Lessons must be learned and comparing how other countries dealt with the outbreak is a good start.
*Matthew Fennell is Asia Society Korea Center's Contributing Writer and Assistant Professor at Hanyang University in Seoul.