key: cord-1010954-ncqyvtj2
authors: Oh, Hong Sang; Woong, Seog
title: Strict Containment Strategy and Rigid Social Distancing Successfully Contained COVID-19 in the Military in South Korea
date: 2020-08-06
journal: Mil Med
DOI: 10.1093/milmed/usaa211
sha: 7cf3481e5a94565c2f2f9d1606aa80ed42b20724
doc_id: 1010954
cord_uid: ncqyvtj2

nan

With regard to the ongoing COVID-19 pandemic, as of June 30, 2020, South Korea has had 12,800 confirmed cases (24.69 cases per 100,000 persons) and 282 deaths since the first case recorded on January 19. 1 Historically, the military has been vulnerable to infectious diseases. 2 Because of the closecontact environment in the military, outbreaks of infectious diseases can easily occur within the bases. Noncombat casualties result in the loss of precious life and combat power. A wellknown example of COVID-19 in the military is the recent massive outbreak in the USS Theodore Roosevelt. 3 For this reason, the South Korean military has been making great efforts to block the inflow and transmission of COVID-19. Consequently, only 58 confirmed cases have been reported in a military strength of 599,000 personnel (9.68 cases per 100,000 persons). This is a valuable achievement of the military's strict containment and rigid social distancing policy.

STRICT CONTAINMENT: I WILL FIND YOU, TRACE YOU, AND BLOCK YOU

All military measures were implemented immediately after the first civilian patient case was reported in January 19. A curfew that no soldiers are allowed to go out after 6 p.m. was imposed to block any source of the disease from the community (Figure 1 ). Officers also had to remain at home after duty hours. Personnel were allowed to take only transition leave before retirement and sick leave. The schedule of transition leave was adjusted to the very end of the service so that soldiers would not have to return to the base during the pandemic. International travel of personnel was banned except for official trips.

All military personnel had to wear a facial mask before entering the base. They were asked to undergo check-up for body temperature and health condition at the main gate of the base. Those who had fever of 37.5 • C (99.5 • F) and higher or suspected symptoms were advised to visit the nearest military hospital's screening clinic for a confirmatory test. As of January 23, the Central Disaster and Safety Countermeasures Headquarters increased a crisis warning level to the highest 'Red Alert' because of massive outbreak in Daegu city, and the Ministry of National Defense declared lockdown in the military.

The military's central epidemiological investigation teams (35 officers on three teams) were dispatched to conduct epidemiological investigations such as contact tracing when suspected cases were reported in the base. The team consisted of 20 medical officers and 15 veterinary officers who serve as military preventive medicine specialists. By early March, the military began to operate its own laboratories (at three different institutions) to actively identify patients, processing a maximum of 280 tests per day. A recruit with a history of travel to any hotspot and/or development of any symptoms consistent with COVID-19 was considered as a high-risk group and underwent a confirmatory test and isolation. As of May 18, active surveillance with a confirmatory test began for all new recruits to aid early detection.

Military quarantine standards have been more stringent than those set by public health authorities (Table I) . All overseas travelers, visitors to the country's outbreak hotspot areas, secondary contacts of confirmed patients, and contacts of the patients under investigation were in "preventive isolation" for 14 days from the date of contact. Self-isolation was recommended to prohibit contact with other people, and the travelers were checked twice a day, as per the isolation management guidelines. If COVID-19 symptoms were observed, the affected person was advised to visit a screening clinic at a nearby military hospital. To establish space for preventive isolation, each base converted the bachelor officer quarters, resorts, and old barracks into single rooms. Environmental cleaning and disinfection with 500 ppm sodium hypochlorite or 70% alcohol were performed at least daily in the base. At the end of February, the total number of preventive isolation cases reached over 10,000. For low-risk cases, such as contacts of soldiers who had traveled abroad and contacts of visitors to massive outbreak area, "preventive observation" was conducted to observe any symptoms daily, including body temperature without isolation until 14 days after contact.

After taking care of confirmed patients in the epidemic areas, medical officers were allowed to return to work if they showed negative findings on confirmatory tests on the first and the 14th day of isolation. As for recruits, those who came from massive outbreak areas such as Daegu city began training after 14 days of quarantine in the training center. Approximately, 43,000 recruits were present at training centers during March 9-May 11. Among these, 2,300 (5.3%) high-risk trainees were quarantined for 14 days.

To reduce contact rate, face-to-face meetings in the military were restricted and tele-conferences were encouraged. All social gatherings in the base were banned. Duty hours were changed from fixed routine to flexible working hours and work from home. Major events such as graduation ceremonies and commissioned ceremonies were postponed or cancelled as much as possible. No family members, relatives, or other civilians were allowed to attend the events, and the events were broadcast live. In inevitable cases, small-scale events were held. Military benefit facilities such as country clubs and resorts, where many people gather, were temporarily suspended.

Field training exercises involving large troops were conducted in the form of command post exercises or war games. Rather than field tactical training, shooting training focused on firearms was conducted, and indoor education was conducted while maintaining physical distance and taking preventive measures such as frequently washing hands and wearing facial masks. Annual training for military reserve force has been postponed. Combined or joint exercises with other military troops have also delayed. Military guidelines for social distancing have been disseminated and implemented.

With around 10 confirmed cases a day in April, the government of South Korea considered easing the current restrictions to prevent economic damage and stress among the citizens and decided to reopen the country at the early of May 5 . The military also faced fatigue and stress, known as "Corona Blues", because of long-term response measures in place. Thus, the military has regularly assessed degrees of stress among troops by self-rating questionnaire, evaluated a high-risk group, and provided them with counseling by professional counselors, including tele-counseling for isolated personnel. As of April 24, the Ministry of National Defense partially lifted lockdown in the military, and soldiers began to go out. As soon as the country reopened, a cluster of infections occurred around clubs and bars in the early of May. Additional confirmed cases in the military were linked with these clusters.

As a result of these efforts, there have been no more confirmed cases than the 58 reported cases by the end of June (Figure 1 

The update of COVID-19 in Korea as of

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Sailors are 'struggling' with coronavirus aboard USS Theodore Roosevelt. NY Post

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Announcement of 'keeping physical distancing in daily life