South Korea’s disease control capacity will be put to test once again on Wednesday as its tens of millions of eligible voters head out for the 21st legislative elections.

Korea, which once had the largest outbreak outside China, has managed to bend its curve, with the daily virus tally down to double-digits for the 14th consecutive day on Wednesday.

But the country’s months of hard work may go to waste following the inevitability of collective breach in social distancing that comes with voting, say some experts, who worry that the consequences of its choice to go ahead with the election as planned, undaunted by the perils posed by the pandemic, will manifest in due time.

Korea Centers for Disease Control and Prevention has laid out an elaborate set of safeguards for the election, which reassured voters into producing the highest turnout since 2004.

Still, the election was not without potential transmission hazards, according to infectious disease specialist Dr. Lee Jae-gap of Hallym University Hospital, given the multiple variables at play.

One of them is the feasibility of sifting out hidden infections through symptom checks.

While authorities said they would thermally screen all voters and redirect anyone with temperature above 38 Celsius degrees to a separate polling booth, pulmonologist Dr. Chun Eun-mi said fever was a poor marker of coronavirus infection.

“Fever is often not a symptom that is present in milder cases. Having a fever means the disease has already progressed past the early stages,” she said.

Another safety compromise, in prioritization of voting rights, is the 13,642 quarantined individuals who were allowed outside for 100 minutes to cast their ballots.

“It’s impossible to address all the scenarios that could unfold as quarantined people travel to and from polling stations,” Lee said. But he said it was a necessary risk on account of the inviolable right to vote.

This wasn’t the first time Korea has stopped short of the most stringent measures to stop the virus. Restrictions on movement in the form of a lockdown or international travel ban has not been introduced since day one, for instance.

“How well or poorly we have fared through the election week will be exposed in about 10 to 14 days’ time (the coronavirus’ incubation period),” Lee said.


Post-election ventures

Korea has been contemplating a rosy timeline for an economic reopening starting April 19, when its second phase of “intense” social distancing comes to end.

President Moon Jae-in has said the third week of April could mark a crucial turning point for the country’s virus action plan.

On Friday, a day after Daegu saw zero new cases for the first time in 52 days, Moon applauded the feat in a Facebook statement, saying, “If we succeed in making through Easter and the general election, we may be able to shift away from social distancing.”

At its peak on Feb. 29, as many as 791 of Daegu’s residents tested positive in one day. The city still accounts for 64 percent of the national total.

But it may be too early to make the call for scaling down containment efforts, experts say.

Preventive medicine specialist Dr. Ki Moran of the National Cancer Center said Korea was still on the second to last stage of coronavirus transmission according to World Health Organization standards.

“This means there are clusters of cases continuously emerging here and there, and we need to keep up what we have been doing -- contact tracing, testing and isolating.”

Former director of KCDC Jun Byung-yool, who helmed the agency between 2011-2013, said the “flattened” curve was not an endpoint, but a trend that needed to be maintained until there are cures and vaccines.

“A classic rule of disease control is minimizing the exposure to infections, which is why physical distancing has to go on,” he said.


Unforeseen plot twists

The new disease is subverting earlier projections and posing uncharted challenges for containment.

One of which was recovered patients testing positive again, according to Ki. The disease control center said Korea had 124 such cases as of Wednesday.

“A ‘reactivation’ or a second positive was not seen with other coronaviruses, SARS and MERS,” she said. A patient has to test negative twice in a 24-hour interval in order to be deemed cleared of virus.

In addition, Ki said that the novel coronavirus may in fact be more contagious than initially thought.

“In Daegu, the R0 (the virus transmission rate) was estimated to be 3.5, which is more infectious than the flu,” she said, meaning, one infected person can pass on the disease to 3.5 other people on average.

A high proportion of asymptomatic patients presented an added dilemma.

Infectious disease expert Kim Woo-joo of Korea University Hospital in Guro, southern Seoul, called for random testing to gain a more comprehensive picture of how many of the population was infected.

“The SARS-CoV-2, the virus that causes COVID-19, is a stealth virus with atypical spectrum of symptoms,” Kim said. “Testing at-risk groups at random -- even if they are without ties to infected patients -- will enable early diagnosis and early treatment, and help lower the fatality rate.”


Too early for self-congratulations

In a press briefing held Tuesday, the Korean Medical Association’s chief Choi Dae-zip said as the outbreak was still in progress, any positive assessment at this point was “precocious.”

“A self-congratulating government can lull the public into a false sense of security,” he said.

As for the apparent decline in number of tests in the past month, Choi said while it did not seem “politically motivated,” the government was to be held responsible for failing to expand the scope of testing further.

The medical group had said on March 31 it was investigating complaints from doctors in the field who claimed testing was being discouraged.

“Once community transmission has set in, large-scale testing is the only way to track down symptomless patients and preemptively isolate them,” he said.

He also lamented a lack of official mourning from the administration for the over 200 virus victims who have died. Korea’s death toll reached 229 as of Wednesday afternoon, with the case fatality rate standing at above 2 percent.

“Staying humble and vigilant is how we will get through the crisis,” Choi said.

By Kim Arin (arin@heraldcorp.com)