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Comment by raspasov | Hacker News Reader

"So far, successful mitigaions in China/Korea have involved near-complete shutdown, very early in the epidemic, around the time of 100 confirmed cases."

From what I read, South Korea shut down almost nothing but had widespread testing available, including drive-through testing where people could sit in their car, get tested and receive the results via SMS next day. They also had the ability to very proactively search and locate people that had been potentially exposed to the virus via credit card transaction/location data.

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But SK also published that location data online for all to see, something the US cannot do because HIPPA. People would make fun of those with the virus, such as one man who was tracked to a hotel associated with prostitution.

Public safety aught to trump HIPPA

No it should not. People are a bit tricksy over this thing and a lynch mob is not out of the question. That way lies murder.

HIPPA is about public safety.

So should we publish lists of everyone who is HIV+ in our cities?

That didn't take long...

https://news.ycombinator.com/item?id=22613426

How did that help, and was it necessary?

It works roughly like this: Patient number #xxx, diagnosed today. Last Monday, he used a taxi (11:30-12:00) to visit McDonalds next to Hongdae station (12:00-12:50) and then walked to Woori bank nearby (1:30-2:00) and used another taxi to go home. Next Tuesday... blah blah...

And then you find out the taxi drivers, all the McDonalds workers, and everybody who used McDonalds and the bank at the same time, and tell them to go self-quarantine for two weeks. And also test them. The idea is basically catch all the virus before it has a chance to run into more people.

It does help that Koreans carry cell phones and use credit cards everywhere. (And, yes it does raise the question about privacy - which is something we should revisit once the emergency is over.)

History teaches that once you give up rights in time of emergency, it is very, very difficult to get them back. Americans are still not back to their pre-9/11 rights to privacy and at this point will likely never will be. Coronavirus will eventually fade away (even if it's a long, bloody road to get to that point), but the loss of rights will persist for generations.

That's an American thinking. The Korean thinking is that we never gave up our rights - our country was born without one, liberated by greater powers, split into half, ruled by dictators. We won our rights with fight, and because it's ours, and our government serves us, we can let them use our power when the society needs it, like a master trusting the key to its faithful servant.

And if they do not relinquish it later, no problem, we'll fight and get them back again.

Speaking 100% from a point of ignorance, how far do you need to "zoom out" to be in compliance with HIPPA? Can the name of the hospitals treating cases be disclosed? The city where the hospital is located? I noticed that many county websites are showing the origin of the case, whether it was travel-related/community spread/etc.. If you could have that level of granularity, maybe you can have some geographic detail (hospital location, for instance) so that people could at least get a better feel for how close to home this is, encouraging them to socially distance.

I remember health insurance companies were capturing this data during H1N1 (voluntary reporting from providers), but of course the data was limited by insurance company and voluntary reporting. So there is some leniency over aggregated data (remember the cost and quality calculators from the mid-2000s?). I wonder what the CDC requires providers to report?

This is a good starting point https://www.hhs.gov/hipaa/for-professionals/privacy/special-...

Malaysia publishes data too: https://newslab.malaysiakini.com/covid-19/en

This didn't help much. It created a false sense of security when it appeared that the first 21 cases were contained. People went to gatherings (which caused the recent spike). It also doesn't help if you know what hotels are infected; plenty of other spots can be infected as well.

Case 26 was blamed as "patient zero" but he had actually shown no symptoms 6 weeks after returning from China. He got infected elsewhere. But the media places unfair judgement on him.

> something the US cannot do because HIPPA [sic]

This is fine! We don't need to publish who is sick. (We shouldn't.) Just aggregated geographic statistics. HIPAA does not interfere with that.

SK published (and is publishing) logs of every establishment the infected people had been to with timestamps accurate to the minute. Like, "this particular Burger King branch from 2:23 to 2:55". For the entire two-week period in which the infected may be infectious. This allowed/forced said establishments to shut down for a day or so while they disinfected every surface. The USA most certainly cannot do this, and not just because of HIPAA. Neither the bureaucratic will nor capability is there.

NSA logs cell metadata and many other sources to build tracking databases, so the capability is there. But it's not supposed to exist, theoretically, so can't really be openly used in the way Taiwan and SK have been doing it.

The US could do it with one emergency bill. Mockery is better than "widespread ventilator shortages."

I hope public identifying information isn't strictly necessary for the South Korean model but let's keep this in perspective. The alternatives to SK's privacy invasions are total lockdown, or mass unnecessary death.

> People would make fun of those with the virus

I take humour over funerals any day.

How is it possible that SK has performed such an extensive testing, while other developped country state they don't have the technical ability to do more than a few thousands tests a week.. Did SK developp its own technics and device for testing ??

Seegene, a private company, did

https://www.cnn.com/2020/03/12/asia/coronavirus-south-korea-...

> How is it possible that SK has performed such an extensive testing

They made it an institutional priority. Other governments prioritized messaging and fiscal measures over medical action.

> Did SK developp its own technics and device for testing

Yes, but so did a number of other countries [1]. Seoul had no "secret sauce" [2]. Just institutional attention and competence.

[1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

[2] https://www.ncbi.nlm.nih.gov/pubmed/31987001?dopt=Abstract

As others have said, nothing magic other than focused attention.

South Korea and Singapore both were hit by the original SARS epidemic, and learned important lessons from it. They're applied those lessons now, for this SARS 2.

Other countries weren't as affected by SARS, and so didn't take as many lessons away from it. When this came, many were caught flat-footed. Some countries (like the United States) were even less-prepared than being flat-footed.

The more important factor is MERS, which SK seriously suffered a few years ago, (36 people killed) which was the highest fatality outside Middle East.

Totally fair and a good point.

Because you need high throughput machine or it is a very slow manual process. Such machine like the FilmArray from Biomérieux or the GeneXpert from Cepheid will only have their covid 19 add-on at the end of march, for the Cobas from Roche only now. When Korean had the homegrown Seegene one very quickly

Extensive testing needs the appropriate lab infrastructure and governance decisions to properly utilize them. Germany is another example of how to do that [0]

[0] https://apnews.com/ad9a6af47c3b55fd83080c9168afaaf4

South Korea had no mandatory shutdown, but according to Suki Kim nearly the entire city of Daegu voluntarily self-quarantined shortly after Patient 31 was confirmed positive. (Source: https://www.newyorker.com/news/news-desk/how-south-korea-los... plus personal communication)

SK has also instituted widespread work from home, closed schools, and people voluntarily wear masks and cancel events. Daegu was a ghost town for at least 2 weeks after patient 31 was detected, because each citizen decided to minimize activity.

Schools were shut down very early on in the outbreak region I believe.

Schools happened to be on winter break so they just didn't reopen.

They’ve also had a dress rehearsal in the less deadly MERS outbreak. I’m sure preparedness and public acceptance of gravity of the situation had a great sway in outcome

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