뉴스레터

Is the epidemic of COVID-19 a crisis or an opportunity? Civilization makes disease, and disease makes civilization. The global epidemic of infectious diseases such as Ebola, SARS, MERS and Zika, and the WHO's Pandemic Declaration suggest that the current civilization, public health and industrial systems have reached a turning point. A country or organization that can not adapt to a new environment will be culled, and a country and organization that overcomes the crisis will lead a new civilization.

Global Village of 2020, taken over by COVID-19

In December 2019, the COVID-19 virus, which started in Wuhan, China, had 4.66 million confirmed cases worldwide and 310,000 deaths as of May 18, 2020, with a fatality rate of 6.7%. Let's look at the status of the three East Asian countries. China has 82,954 confirmed cases and 4,634 deaths (5.6% fatality rate), Japan has 16,305 confirmed cases, 749 deaths (4.6% fatality rate), Korea has 11,078 confirmed cases, and 263 deaths (2.4% fatality rate). Compared to the global average and the continental Europe and North America, the three East Asian countries have relatively low infection rates and fatality rates. However, considering the differences in the way in which each country compiles statistics and inconspicuous statistics, it is difficult to be sure that the three East Asian countries are safe from COVID-19.

With the world's confirmed cases heading for more than 5 million people, new confirmed cases are rising in Europe, the United States, the Middle East, Russia and Brazil. For the time being, the virus is spreading because it is difficult to develop vaccines or therapeutic agents. Therefore, this situation is likely to continue in the long term.

Moreover, since COVID-19 group infections started in China, tensions in the prevention of the disease will increase not only in neighboring countries such as Korea, Japan, Russia and North Korea but also in Southeast Asian countries. In particular, it is true that Korea, China and Japan are actively engaged in human exchange and trade, and information exchange and joint action on infectious diseases are closely required.

Nevertheless, this time, the world is responding to and overcoming COVID-19, and it is building barriers between countries rather than mutual cooperation and support and doing prevention of epidemics in its own way. Thus, the results of prevention of epidemics are different according to the method in which each country responds to COVID-19.

The raid of cholera and the beginning of modern disease control and prevention

Modern disease control and prevention began in East Asian countries due to cholera pandemic. Among them, Japan was the first to improve the modern disease control and prevention system. Japan was defenseless in the event of a cholera outbreak in 1822. After the Meiji Restoration in 1868, the Disease Control and Prevention system was established, but in 1879, more than 100,000 people died due to cholera. With this in mind, Japan enacted in 1879 and in 1880, and the sanitary police led the disease control and prevention system. Japan's disease control and prevention laws and systems have become standard in East Asian countries.

The Joseon government strengthened the quarantine system of the state in response to the cholera epidemic in the 1880s, and appointed the missionary Horace Newton Allen as a doctor of the Inspector General of Customs in 1885 to take charge of quarantine. Joseon also tried to strengthen the national quarantine by declaring in 1886, but it was not able to carry out proper disease control and prevention in response to the opposition of great power of Europe and America. So, It was in 1899 that the disease control and prevention system was established by proclaiming 『the Infectious Disease Prevention Rule』.

China also overhauled its quarantine system in preparation for the cholera epidemic in 1873, but this was only a disease control and prevention for the opening port area. In 1894, 'Hong Kong Plague' became an important turning point in disease control and prevention administration in China and East Asia.

However, China began to have a national disease control and prevention system only after the Manchurian plague epidemic in 1910. As such, the global spread of infectious diseases has become an important opportunity for East Asian countries to establish modern disease control and prevention systems.

Cholera vaccination in 1919 (Incheon)

Two community doctors are conducting cholera vaccinations,

and sanitary police are controlling the surroundings.

Carrying and disinfecting persons who died of cholera in 1920 (Jangheung, Jeonnam)

When the death occurred due to cholera,

community doctor and sanitary police were mobilized to disinfect and cremate the body.

The plague prevention unit in 1921 (Harbin)

Medical staff belonging to the plague prevention team

are equipped with protective equipment such as masks to prevent infection.

East Asia in the Imperial Age Against Infectious Diseases

Around 1920, 100 years ago, East Asia continued to attack various infectious diseases. Diseases such as Spanish flu, smallpox, cholera, plague and typhoid were simultaneously occurring. Among them, notable infectious diseases were Spanish flu, smallpox, cholera and plague. The Spanish flu, a viral infection, spread from September 1918 to January 1919, and was the worst infectious disease to have killed more than 20 million people worldwide despite low fatality rate. In colonial Joseon, more than 7.5 million people were infected, and 140,000 died; the fatality rate was only 1.86%. However, the Spanish flu was not a nationally notifiable communicable disease that the state designated as a quarantine target for disease prevention, infection prevention and treatment. Even if each hospital found a patient, it was not obligated to report to the quarantine authorities. Since there were few diagnoses, preventive vaccines, and treatment methods, people were forced to be helpless in the offensive of infectious diseases at the time.

The only infectious disease that humans could control was Smallpox, in contrast to the flu that didn’t know the path of infection, had no way to prevent it, and was untreatable. This was possible because Smallpox Vaccination existed. In the late Joseon Dynasty, Jung Yak-yong introduced Smallpox Inoculation and Smallpox Vaccination, and in the during the End of Joseon, Ji Seok-young tried to spread Smallpox Vaccination. On this basis, Smallpox Inoculation Projects were carried out nationwide during the Korean Empire and early Japanese colonial period, and patients could be suppressed by less than 50 people every year. In 1919, 2,140 patients and 700 deaths occurred. In 1920, 11,532 patients and 3,614 deaths occurred. The Joseon Government-General excused the surge in Smallpox due to the March 1 movement. The sanitary police, who have to work on disease control and prevention, were mobilized to suppress the demonstration, so the workload increased and they could not control the disease. However, in 1922 and 1923, when the demonstrations were reduced, there were more than 3,000 smallpox patients, and more than 1,000 deaths occurred each year.

The colonial authorities tried to change the phase by increasing the number of inoculations, but they could not eradicate smallpox during the colonial period due to various factors such as manpower, finance, and technology. Because disease control and prevention were generally poor, the colonial Koreans distrusted the colonial authorities and did not cooperate with them.

Cholera spread dramatically in the summer of 1919 and 1920. Called 'unidentified epidemiic' or 'hoyeolja', cholera is a waterborne infectious disease that features fast propagation and high fatability rates. In 1919, 407 patients (356 deaths) were reported in Japan, 16,991 patients (11,084 deaths) in Joseon, and 3,836 patients (2,693 deaths) in Taiwan. In 1920, 4,969 patients (death 3,417) were reported in Japan, 24,229 patients (death 13,568) in Joseon, and 2,700 patients (1,675 deaths) in Taiwan. In the case of Joseon and Japan, except Taiwan, the number of patients and deaths as well as the damage increased significantly.

It should be noted that Taiwan has relatively small damage and fewer cholera patients compared to the previous year. Taiwan has shown the effect of strengthening Maritime Quarantine to prevent infection from the outside, but colonial Joseon has done little quarantine in sea ports, trains, and land routes due to concerns about economic blockade. In particular, border quarantine accounted for only 1%, and focused only on community quarantine, which relied on sanitary police. However, the Japanese imperialists used the public power of sanitary police to search for houses and violate human rights, and the opposition of the people of Joseon grew even bigger. As a result, there were not many victims.

The plague that spread from October 1920 to October 1921 is a lung plague that is infected by inhaling droplets. This is a disease with strong propagation, high fatality rate, and very poor prognosis. Japan accumulated information on disease control and prevention after the Hong Kong plague in 1894, and China secured clinical information after the Manchurian plague in 1910. The Joseon Governor-General strengthened quarantine at sea ports, trains and overland, taking lessons from the failure of the 1910 plague and the 1920 cholera prevention. As a result, most of the patients were able to be found during border quarantine. This allowed Joseon to prevent pandemics even during the spread of the flag in the northeastern region.

As such, 100 years ago, various infectious diseases occurred in East Asia. People died of typhoid fever after suffering from the flu, and were exposed to various infectious diseases at the same time. The simultaneous offensive of infectious diseases has added to the threat to life and the medical crisis. Still, in the imperial era, East Asia was trying to share information on infectious diseases and build a common disease control and prevention front.

Medical staff are checking the patient's body temperature at the COVID-19 drive-through inspection center

installed at Jamsil Sports Complex in Songpa-gu, Seoul. ⓒYonhap News

Changes in disease control and prevention, and East Asian Network

Over the past 100 years, Japan has been trying to accumulate the highest level of medical knowledge in the field of bacterial research and vaccine development such as cholera and plague, and has been active in establishing an information network for East Asia. They also made many mistakes of statistical manipulation and research ethics violations, but they were in a leading position in disease control and prevention in East Asia.

China has some areas that implement pioneering disease control and prevention measures centered on Jogyeji, but it did not use unified methods at the central government level. Among these, the new turning point of disease control and prevention administration was through Manchuria Plague which occurred in 1910-11. As Western medicine took the initiative in Chinese medicine, some of the results of the Plague study overwhelmed Japan. However, it was difficult to operate a unified control and prevention system under the pressure of anti-colonialism and checks of local warlords.

In addition, under the Cold War system, exchanges and cooperation with Korea and Japan were limited. On the other hand, Korea had to establish a national quarantine and disease control and prevention system after exposure to infectious diseases after the open the port, but it was difficult to establish a strong system because of foreign interference and weak national power. In addition, while experiencing colonies and divisions, even information about infectious diseases was concealed or manipulated according to the taste of power.

So what is the implication of the disease control and prevention process over the last 100 years? The fact that the state that led control and prevention of infectious diseases during imperialism and the Cold War led modern civilization, and that international solidarity and cooperation are essential to counter infectious diseases. In this regard, it is even surprising that Korea, which has never taken the initiative in preventing infectious diseases, has been attracting worldwide attention as a leading country in the COVID-19 phase.

In history, the state has made more efforts to control the people and the media than to control the disease against the epidemic of infectious diseases, and rationalized the cover-up and manipulation of information with the pretext of social stability. Especially, the highest priority of disease control and prevention in imperialism and Cold War was isolation and blockade, but in the 21st century, everything was transparently disclosed and open-level control and prevention was attracting attention. On the other hand, however, it is unfortunate that the information about infectious diseases is manipulated and concealed while putting the interests of the country first, or barriers between countries are built by prohibition of entry and excessive control. We already know the answer: whether to lock the door and find my own way to live alone, or to seek solidarity and cooperation against the invisible public enemy of the virus.