943708

research-article2020
ARPXXX10.1177/0275074020943708The American Review of Public AdministrationYou

Article

American Review of Public Administration

Lessons From South Korea’s Covid-19

1­–8
© The Author(s) 2020
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DOI: 10.1177/0275074020943708
https://doi.org/10.1177/0275074020943708
journals.sagepub.com/home/arp

Jongeun You1

Abstract
In responding to the Covid-19 (SARS-CoV-2) pandemic, some government policies have been more effective in containing,
suppressing, and mitigating the disease than others. Government leaders and public administrators can learn from other
countries and adapt these lessons to their crisis management and public health systems. South Korea has emerged as a
model to emulate in fighting the pandemic. While South Korea endured devastating early outbreaks, the country flattened
the coronavirus curve without paralyzing the national health and economic systems. The author reviews South Korea’s public
health policy approaches and the embedded context, by using documents and materials written in Korean and English, to
learn how the country managed coronavirus from January through April 2020. The critical factors in South Korea’s public
health administration and management that led to success include national infectious disease plans, collaboration with the
private sector, stringent contact tracing, an adaptive health care system, and government-driven communication. This article
also proposes some key aspects to be considered to transfer lessons from country-level responses in South Korea to other
contexts.

Keywords
pandemic crisis management, infectious disease, emergency management, public administration response

Introduction March 2020. As shown in Table 1, however, South Korea

The emergence and amplification of infectious diseases have
influenced societal changes, which are not limited to public
health outcomes (Bloom & Cadarette, 2019). Accordingly,
infectious disease policy and emergency management have
encompassed social science perspectives beyond the biologi-
cal and medical perspective (Porter et al., 1999). As the
Covid-19 pandemic is massively impacting society, leading
to significant investment and new regulations by govern-
ments, the role of public administration is critical. Public
administration scholars can help understand the processes,
rules, and approaches that governments can use to help con-
trol the spread of the disease as well as mitigate its effects on
society (Weible et al., 2020). Furthermore, the current situa-
tion is highly uncertain, and Covid-19 is a transboundary
crisis. Thus, the public administration community needs to
embrace international and comparative perspectives on
Covid-19 to inform how governments respond to the crisis—
and potential future crises, including new waves of corona­
virus infection—and advance pandemic crisis management
(Boin & Lodge, 2016; Fitzpatrick et al., 2011).
South Korea recorded its first coronavirus disease 2019
(Covid-19) case on January 20, 2020, and its first coronavi-
rus death on February 20, 2020. As coronavirus infections in
South Korea surged to more than 3,000, the country had the
highest number of virus cases outside China until early
slowed the spread of Covid-19 in a relatively short period
(Center for Systems Science and Engineering at the Johns
Hopkins University, 2020). As of April 15, 2020, among
10,591 confirmed cases in South Korea, 7,616 patients (72%)
recovered and were released from quarantine, 2,750 patients
(26%) were under quarantine, and 225 patients (2%) passed
away. Along with other seemingly successful efforts found in
Taiwan and Germany, South Korea has motivated govern-
ment leaders and public administrators around the world to
assess and update their policies for coping with the coronavi-
rus pandemic (World Health Organization [WHO], 2020).
The South Korean government described and shared its
coronavirus response with the world in their report titled
“Tackling Covid-19: Health, Quarantine and Economic
Measures of South Korea.” The report was published on
March 31, 2020, and explains their comprehensive approach
to the coronavirus outbreak, including the world’s first drive-
through screening centers, walk-through screening stations,
self-diagnosis application, and community treatment centers
1
University of Colorado Denver, USA
Corresponding Author:
Jongeun You, School of Public Affairs, University of Colorado Denver,
Denver, CO 80204, USA.
Email: jongeun.you@ucdenver.edu
2 American Review of Public Administration 00(0)
Table 1.  Covid-19 Confirmed Cases (Deaths) in Four Countries.
Country February 15, 2020 February 29, 2020
USA 13 (0) 68 (1)
Italy 3 (0) 1,128 (29)
China 68,413 (1,663) 79,356 (2,837)
South Korea 28 (0) 3,150 (16)
Source. Center for Systems Science and Engineering at the Johns Hopkins University (2020).
(The Government of the Republic of Korea [ROK], 2020a).
The report summarizes South Korea’s responses in three
policy strategies: (a) Speedy and swift action, (b) “3T” mea-
sures (widespread Testing, contact Tracing, and rigorous
Treating), and (c) public–private cooperation and civic
awareness. South Korean officials also call it the “TRUST”
strategy, which stands for Transparency, Robust screening
and quarantine, Unique but universally applicable testing,
Strict control, and Treatment.
This article analyzes South Korea’s Covid-19 policies
from January through April 2020, by using documents and
materials written in Korean and English. This article explores
not only the policy actions the South Korean government
took, but also why their intervention worked. In doing so, the
author takes an integrative look at the country-level responses
in South Korea and offers deep insight of interest to public
administration practitioners and scholars. The analysis high-
lights certain factors in the South Korean context that were
pivotal to the country’s policy response. These factors are
well-prepared national infectious disease plans, collabora-
tion with the private sector, stringent contact tracing, an
adaptive health care system, and government-driven com-
munication. The following sections are structured around the
U.S. Centers for Disease Control and Prevention’s (U.S.
CDC) five domains of pandemic planning and preparedness:
(a) national management plans, (b) medical countermea-
sures, (c) surveillance and contact tracing, (d) health care
system response, and (e) communication and public outreach
(U.S. CDC, 2017). The article concludes by proposing ideas
for how other countries could use South Korea’s experience
to inform their pandemic responses.
National Infectious Disease
Management Plans Enabled the Policy
Response
When considering how other countries may learn from South
Korea, it is essential to understand the context within which
South Korea’s policy actions emerged. South Korea has a
democratic unitary political system, meaning that local gov-
ernments have limited autonomy, and its public health gover-
nance is centralized. Unlike federal or decentralized
governance structures, South Korea’s agencies can act
quickly to implement policy decisions at the local level.
Provincial and municipal health units are guided by the
March 15, 2020 March 31, 2020 April 15, 2020
3,499 (63) 188,172 (3,873) 644,089 (28,529)
24,747 (1,809) 105,792 (12,428) 165,155 (21,645)
81,003 (3,203) 82,279 (3,309) 82,295 (3,342)
8,162 (75) 9,786 (162) 10,591 (225)
national government, including the Korean Ministry of
Health and Welfare (KMHW) and the Korea Centers for
Disease Control and Prevention (KCDC), while regional and
local elected officials have authority over their health units.
South Korea’s infectious disease emergency manage-
ment goal is to establish prevention and preparedness plans
against an infectious disease crisis and respond promptly to
minimize emergencies (KCDC, 2019). The KMHW updates
and adopts South Korea’s infectious disease plan every five
years. Capacity-building and performance measures are
essential in this planning (Shin & Yeo, 2019). Based on this
national plan, local governments have their own execution
plans for managing infectious diseases and coordinating
with the national government. The Second Master Plan for
Prevention and Control of Infectious Diseases (2018–2022)
emphasizes the One Health approach, emergency response
system, and intergovernmental cooperation (KMHW, 2018).
In addition, the KMHW and KCDC applied the lessons
learned from the Middle East Respiratory Syndrome
(MERS) outbreaks in 2015 and 2018 by upgrading the stan-
dard operating procedures for emerging infectious disease
and clarifying the roles and responsibilities of governmental
units (Oh et al., 2020).
Although the primary goal of South Korea’s infectious
disease emergency management plan is prevention and pre-
paredness, in executing its plans during the coronavirus pan-
demic, South Korea prioritized three principles: openness,
transparency, and democracy (ROK, 2020b). Therefore, the
government was able to avoid excessive restrictions and
remained relatively open to international travelers. For
instance, though the coronavirus cases and deaths had been
centered in Daegu city and Gyeongbuk province, accounting
for more than 80% of outbreaks in South Korea (see Table 2),
a lockdown of Daegu was not considered at all by the Moon
administration.1 The author defines a “city lockdown” as the
situation of a city being imposed with a regional blockade
and citizens not having the usual physical access to outside
the city.2 Mobility restrictions in and out of the Daegu and
Gyeongbuk areas were not implemented. Instead, the gov-
ernment strengthened preventive measures in the areas hard-
est hit by the pandemic, including additional investigation on
residential facilities for the elderly and care hospitals (KCDC,
2020a). On March 15, 2020, the Moon administration
declared Daegu and three cities and counties of Gyeongbuk
as special disaster zones, making them eligible for tax and
You 3
Table 2.  Covid-19 Confirmed Cases (Deaths) in South Korea.
Region February 15, 2020 February 29, 2020
Daegu city N/A 2,236 (8)
Gyeongbuk province N/A 488 (6)
Sum 86% (88%)
South Korea 28 (0) 3,150 (16)
Source. Korea Centers for Disease Control and Prevention (2020c).
fee discounts and financial assistance (KCDC, 2020b). In
addition, South Korea held the 21st legislative election on
April 15, 2020, which was the first national-level election in
the world since the coronavirus pandemic began (Larsen,
2020). These measures could not have been taken had South
Korea not implemented its infectious disease master plan,
which included the stockpiling of resources necessary to
fight a viral pandemic.
Public–Private Partnerships Facilitated
Diagnostics and Other Medical
Countermeasures
From the pandemic’s early stages, South Korea had the test-
ing capacity to identify coronavirus patients. To achieve this
capacity, the Moon administration utilized the public–private
partnership (PPP) model. The KCDC developed and evalu-
ated the real-time reverse transcription polymerase chain
reaction (rRT-PCR) diagnostic method for coronavirus in
January 2020, partnering with the Korean Society for
Laboratory Medicine (KSLM) and the Korean Association
of External Quality Assessment Service (KAEQAS).3 Real-
time RT-PCR is a robust technology that is widely used in
diagnostic virology (Corman et al., 2020). KCDC shared the
data with the Korean biotech industry and implemented the
diagnostic method nationwide beginning January 31, 2020
(KMHW, 2020a). Through the Korean Ministry of Food and
Drug Safety’s (KMFDS) fast review that reduced govern-
ment red tape, four diagnostic companies (Kogene Biotech,
Seegene, SolGent, and SD Biosensor) received emergency
use authorization for their coronavirus detection kits in
February 2020. As of March 9, 2020, these four companies
produced 15,971 kits (capable of testing 522,700 people) and
supplied 11,478 kits (capable of testing 381,500 people) to
national and local governments (KMFDS, 2020). In March
2020, another detection kit by BioSewoom was approved by
the KMFDS. As of April 15, 2020, South Korea has tested
534,552 people for coronavirus, which is 10.4 people per one
thousand population (KCDC, 2020c). In addition, as of April
15, 2020, South Korea operated more than 600 screening
centers (including 71 drive-through centers) and walk-
through screening stations at international airports that col-
lect specimens, as well as more than 90 medical institutions
(including 18 public health and environment institutes) that
March 15, 2020 March 31, 2020 April 15, 2020
6,031 (53) 6,684 (114) 6,823 (155)
1,157 (17) 1,300 (38) 1,348 (50)
88% (93%) 82% (94%) 77% (91%)
8,162 (75) 9,786 (162) 10,591 (225)
are processing and assessing specimens with an rRT-PCR
test (Goo, 2020; KMHW, 2020b; Song, 2020).
In addition to broad-based testing, South Korea collabo-
rated with the private sector in making coronavirus treat-
ments and vaccines. The Korea National Institute of Health
(KNIH), which operates under the KCDC, is developing a
monoclonal antibody treatment with Celltrion and is devel-
oping a subunit (antigen-containing part of the virus) vaccine
with SK Bioscience (KCDC, 2020d). The KNIH also
invented a virus-like particle (VLP)-based vaccine candidate
and started to work with the International Vaccine Institute
(IVI) for testing a vaccine candidate in the deoxyribonucleic
acid (DNA) vaccine platform (KCDC, 2020e, 2020f).
Surveillance and Contact Tracing Were
Pursued to Inform the Public
Surveillance and contact tracing are monitoring processes
wherein public health agencies identify and inform persons
who have been in contact with an infected person. South
Korea has conducted rigorous and extensive epidemiologic
field investigations for coronavirus cases, using information
and communications technology (ICT) and intergovernmen-
tal cooperation. When someone tested positive for coronavi-
rus, South Korea determined the epidemiological links of the
confirmed patients. Thirty epidemiological rapid response
teams of the KCDC explored the causal paths and predicted
possible future infections by triangulating from multiple
sources of evidence. The KCDC integrated a variety of data
for improving reliability, such as interviews with a patient,
patient’s medical records, credit card transactions, global
positioning system (GPS) data from cellular phones and cars,
travel histories to highly coronavirus-affected countries, and
security camera footage (KCDC, 2020g).
Given the insufficient response to the 2015 MERS out-
break in Korea, the Infectious Disease Control and Prevention
Act (IDCPA) in South Korea was amended significantly to
prevent infectious disease and secure the public’s right to
know through surveillance and tracing techniques (ROK,
2016). Under the amended IDCPA, the South Korean gov-
ernment is authorized, during an infectious disease emer-
gency, to access private data of confirmed and potential
patients and disclose their information. The affected indi-
viduals’ data are deleted after the disease emergency.
4 American Review of Public Administration 00(0)
South Korea has used data and artificial intelligence (AI)
to increase its response time and improve its effectiveness in
coordinating pandemic response activities. South Korea uses
AI for big data analytics, which has culminated in the
“Covid-19 smart management system” (also known as
“Covid-19 epidemiologic investigation support system”).
This AI support system applied technology and algorithms
from a smart city data-sharing project, called “smart city data
hub platform,” which handles large-scale urban data at real
time, and decreased the investigation time to about 10 min
per patient (Park, Choi, & Ko, 2020).4 To reduce the risk of
community transmission, the investigation results were then
publicly released in an anonymized format. The confirmed
patient’s movement, between the day before symptoms
occurred and the first day of quarantine, was shared with the
public through several AI-based applications (e.g., Corona
Doctor, Corona Map, KMA Corona Fact). The national and
local governments also sent real-time alerts via an emer-
gency text message system. In addition, local governments
conducted a preliminary epidemiologic field investigation of
individual cases and shared the results with the national
government.
To allay concerns over civil rights and privacy, the gov-
ernment tried to balance public health and civil liberties. On
March 5, 2020, The Guardian and BBC cautioned that per-
sonal information provided by the South Korean government
disrupted some infected individuals’ private lives and
invoked social stigma (N. Kim, 2020). To address these con-
cerns, on March 14, 2020, the South Korean government
amended patients’ information disclosure guidelines, follow-
ing the recommendation of the National Human Rights
Commission of Korea (KCDC, 2020h). Information that
could identify an individual (e.g., full address and work-
place) was no longer included in the public notifications.
Using the disclosed information, citizens who may have
crossed paths with a confirmed patient can conduct symptom
monitoring, visit screening centers, and self-quarantine.
Meanwhile, those who have come into close contact with a
confirmed patient are informed by the government. Notified
people are tested and can be placed under self-quarantine and
monitored. The “self-quarantine safety protection app,” a
customized smartphone application developed by the gov-
ernment for quarantined individuals, allows those who have
been ordered to stay in isolation to keep in touch with health
care staff. In addition, a person who violates a mandatory
self-quarantine could face up to 10 million KRW (about
US$8,100) in fines or 1 year in prison, effective on April 5,
2020 (KCDC, 2020i).5
Health care System Response Was
Adaptive to the Situation
In the South Korean system, patients confirmed to have
Covid-19 were classified by the severity of symptoms and
treated accordingly. Moderate, mild, or asymptomatic
patients stayed at community treatment centers operated by
local governments. These patients were monitored by health
care staff and were transferred to hospitals or discharged if
symptoms changed. Community treatment centers, 18 cen-
ters in total, allowed the government to monitor cases effec-
tively, prevent transmission, and avoid the shortage of
hospital beds for serious cases (P. Park et al., 2020). Severe
or critical patients were immediately hospitalized for treat-
ment. As of January 2020, South Korea has operated 29
KCDC-designated hospitals that provide inpatient services
for infectious disease patients who need hospitalization,
reserving 198 negative pressure beds and 337 general medi-
cal beds (KCDC, 2020j).6 In responding to Covid-19, the
South Korean government designated 43 specialized infec-
tious disease hospitals on February 21, 2020, and operated
up to 74 such hospitals, securing additional 7,564 beds for
severe or critical coronavirus patients (KCDC, 2020k). The
Korean National Medical Center coordinated patient trans-
fers between hospitals if beds were in short supply in certain
regions. To impede coronavirus transmission in hospitals,
since February 26, 2020, South Korea has designated
“Covid-19 protection hospitals” (also known as “public
relief hospitals”) that operate clinics for respiratory patients
separately from patients needing medical care for other rea-
sons (KCDC, 2020a). As of April 15, 2020, South Korea is
operating 349 Covid-19 protection hospitals (KMHW,
2020c).
To maintain an adaptive health care system, additional
medical workers were necessary. In tackling the pandemic,
South Korea sufficiently and safely staffed medical workers
in needed areas through various channels. For example, 742
new public health physicians, serving in a medically under-
served area instead of mandatory military service, were sta-
tioned in physician shortage areas on March 9, 2020 (KCDC,
2020l). According to B. Kim et al. (2020), in Daegu city,
between February and April 2020, 2,392 medical workers
were recruited from Daegu and other regions, and 327 physi-
cians volunteered. They offered medical services at nation-
ally designated inpatient hospitals, specialized infectious
disease hospitals, community treatment centers, and Covid-
19 screening centers in Daegu. On February 27, 2020, the
South Korean government released “operational guidelines
for Covid-19 medical worker support.” The government pro-
vided personal protective equipment and financial compen-
sation to these medical workers and government-designated
medical institutions (KCDC, 2020b; KMHW, 2020d, 2020e).
Communication and Outreach Built
Public Trust
In 2017, after the 2015 MERS outbreak, South Korea imple-
mented a standard operating procedure for risk communica-
tion in public health emergencies, incorporating the risk
communication protocol of the WHO and CDC (KCDC,
2017). Based on the procedure, which underscores five
You 5
principles (be right, be first, build trust, express empathy, and
promote action), the KCDC held twice-daily press briefings
about the coronavirus emergency management beginning
January 30, 2020, when South Korea had four confirmed
coronavirus cases. Reporters were allowed to ask questions
related to the government’s actions.
In addition, the government operated a 24-hr coronavirus
hotline (1399) and portal site (http://ncov.mohw.go.kr/en/),
and it managed social media channels that delivered info-
graphics and corrected inaccurate news. These communica-
tion measures helped citizens wash hands frequently, wear
face masks, practice physical (social) distancing, and adjust
to the policy on public mask distribution (KCDC, 2020m).
This transparent and rapid communication also encouraged
voluntary, public compliance and enhanced the policy legiti-
macy of the Moon administration (French, 2011; Moon,
2020).
Conclusion
South Korea showed adaptability and resilience when at the
frontline of the coronavirus pandemic (Hsiang et al., 2020).
Although the outbreak is still a developing situation, the
South Korean government’s ability to keep the disease under
control offers new insights for public administration practi-
tioners and scholars elsewhere. As discussed in this article,
such insights include that the South Korean government pro-
actively found patients who contracted coronavirus, dis-
closed epidemiologic findings of confirmed patients to the
public, and provided differentiated treatments based on the
severity of symptoms.
In addition, this article proposes next steps for thinking
about the applicability of lessons from South Korea in other
contexts. Why did South Korea’s Covid-19 policy response
work and in what other settings could it be applied? First, a
mostly homogeneous cultural and institutional structure
helped facilitate an effective response. Citizens were willing
to sacrifice privacy for surveillance and contact tracing using
ICT. The Institute for Future Government’s survey in 2020
finds that 84% of South Koreans accept the loss of privacy as
a necessary tradeoff for public health security (Moon, 2020).
Political characteristics that emphasize a virtue-based politi-
cal morality and hierarchical collectivism also made their
policies and strategies fit in the Covid-19 responses (C. Park
& Shin, 2006). Therefore, it would be important to assess
whether different institutional structures and cultures could
facilitate or limit the transferability of these policy approaches
of South Korea (Destler, 2016).
Second, proper actions from the legislative and executive
branches were administered prior to the pandemic. In South
Korea, due to the previous MERS outbreaks, the government
expanded legal and administrative boundaries in regard to
pandemic responses before Covid-19 (e.g., IDCPA, standard
operating procedures). This enabled the government to have
a broader range of measures. Thus, public administrators
have to acknowledge differences in legislation and crisis
response procedures, differences which could be potential
barriers to adopting policy approaches from South Korea
(Rosenbloom, 2013).
Third, the public health budget and flexible fiscal man-
agement systems allowed the South Korean government to
provide adequate resources. On March 17, 2020, the South
Korean Legislature passed the supplementary budget of 11.7
trillion KRW (US$10.1 billion) in 12 days. The KMHW’s
supplementary budget passed in March 2020 is 3.7 trillion
KRW (US$3.2 billion), which enabled the KMHW to
increase Covid-19 prevention and treatment facilities and
supporting medical institutions and workers (KMHW,
2020f). As of April 15, 2020, the KMHW’s annual expendi-
tures in 2020, including the March 2020 supplementary bud-
get, is 86.2 trillion KRW (US$74.5 billion).7 The South
Korean government and national health insurance program
shouldered the full cost of coronavirus testing, quarantine,
and treatment for Korean citizens and noncitizens (KMHW,
2020g). A stable and predictable government budget affects
policy efficacy (Flink, 2018).
South Korea changed existing policies to address past
mistakes, built capacity in advance, and was prepared to
respond to this unprecedented threat. Through PPP in health
care, the country ramped up testing capacity quickly to
cover a sufficient percentage of the population; therefore,
stringent contact tracing and quarantine efforts were useful
in restricting local transmission of coronavirus. Furthermore,
the government-driven data collection and distribution pro-
vided accurate and timely information to the public, which
helped to alleviate citizens’ fear and prevent a system-wide
panic in public health and the economy. Additionally, the
country’s institutional structures and cultures, legislation,
and government budget made it possible to implement
responses necessary in a pandemic situation, which could
lead to dialogues fitting policy and programmatic responses
to these conditions.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
Notes
1. Daegu (Daegu Metropolitan City, population of 2.43 mil-
lion) is the fourth largest city in South Korea, and Gyeongbuk
(North Gyeongsang Province or Gyeongsangbuk-do, popula-
tion of 2.65 million) is the surrounding province of Daegu.
2. A city lockdown is a measure to control the impact of an epi-
demic, cutting access to the epicenter of the outbreak in the
country. This is different from regional quarantines or border
restrictions and travel bans at the national level. A less strict
6 American Review of Public Administration 00(0)
action than lockdown is a regional quarantine, which is the
separation of individuals who were known to be infected or
restricting the movement of individuals who might have been
exposed to an infectious disease, while access to the region
is not blocked physically. Stay-at-home or shelter-in-place
orders are not the same as quarantine but share some traits of
quarantine. Nonessential business operations that are not criti-
cal according to the order’s definition, such as public health
and safety, are suspended through the duration of the orders.
Nonessential travel, mass gatherings, and public events are
also curtailed.
3. On January 13, 2020, the Korea Centers for Disease Control
and Prevention (KCDC) started to develop a new assessment
method for coronavirus, based on genetic sequences that
China and the National Center for Biotechnology Information
(NCBI) released. At the same time, some Korean diagnostic
companies started to develop test kits. On January 27, 2020,
the KCDC had a discussion meeting with the Korean Society
for Laboratory Medicine (KSLM), the Korean Association of
External Quality Assessment Service (KAEQAS), and diag-
nostic companies, which included discussion of the emergency
use authorization process.
4. This system applies to certain confirmed cases when epidemic
investigators determine that the use of the system is necessary.
Only epidemic investigators can access the system, and all
access records are logged. The system uses location data from
telecommunication companies and credit card data, which
does not include security camera footage (Korean Ministry of
Land, Infrastructure and Transport, 2020).
5. In this article, the exchange rate at the end of 2019 is applied
(US$1 = 1,156.4 KRW).
6. On May 29, 2020, the KCDC announced to invest US$26 mil-
lion and add 83 negative pressure beds in the newly selected
10 nationally designated hospitals. This increases the number
of negative pressure beds that are directly controlled by the
KCDC to 281 beds (KMHW, 2020h).
7. This accounts for 16.5% of annual government expenditures in
South Korea (US$452.4 billion), as of April 15, 2020.
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—18-march-2020
Author Biography
Jongeun You is a doctoral student in the School of Public Affairs
at the University of Colorado Denver.