In South Korea, outbreaks of illness and fear

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The usually-bustling emergency room of Samsung Medical Center, a sprawling state-of-the-art 2,000-bed hospital in Seoul's upscale Gangnam district, is deathly quiet.

It's not officially closed, but ambulances have been diverted and patients asked to seek care elsewhere. Not that they need much urging to stay away, mind you.

Thursday morning, South Korean health officials announced there were nine new cases of MERS (Middle East Respiratory Syndrome), eight of them at Samsung. Since the outbreak began three weeks ago, there have been 126 cases (including 10 deaths), and an embarrassing 46 of those originated at what is widely viewed as the country's top hospital.

In response, Samsung has pulled out all the stops. Large white triage tents have been set up outside the ER to screen patients, visitors and staff for fever that may point to MERS exposure. Everyone must wear a mask. There are disinfectant dispensers at every turn. The hospital is being scrubbed and disinfected.

Similar precautions are being taken in the city. Workers in hazmat suits disinfect the already-pristine subway network each morning. Baseball games, concerts and other public events have been cancelled. More than 2,600 schools have been closed. Shopping malls are almost deserted. More than 3,800 people have been quarantined and the authorities are tracking their cell phones to ensure they stay put. Even the two camels at the Seoul Zoo have been quarantined.

South Korea is not so much fighting MERS as it is fighting fear of MERS.

"Measures are being taken to control the outbreak so we don't need to worry so much but, it's true, we do have a lot of fear," said Dr. Sung-Han Kim, an infectious disease specialist at Asan Medical Center in Seoul.

On paper, there is little to be afraid of, especially for healthy people in the community. MERS is essentially a nosocomial infection, one that spreads in the hospital setting and hits vulnerable people. Three-quarters of those infected already had respiratory illnesses.

The precise way MERS spreads is not currently well understood, but it is likely via respiratory secretions, such as through coughing. However, the coronavirus is not highly contagious, and usually infects only people in close proximity.

Much of the fear stems from distrust in government.

"When they say the situation is under control, I don't believe them," said Kim Jung-min, a bank employee wearing a mask during his morning commute to work. "They also said the ferries were safe." (The sinking of the MV Sewol last year claimed 304 lives and the government was condemned for poor regulation and trying to downplay its role in the tragedy.)

One of the reasons MERS gained a foothold in Korea was because officials tried to hush up the news, fearing it would have a negative economic impact. That secrecy meant no one was on the lookout for new cases and, paradoxically, the impact has been much greater than it would have been had the outbreak been nipped in the bud. Visitors from nearby Japan and China are staying away in droves. Popular tourist attractions are closed. South Korean President Park Geun-hye has even cancelled her much-anticipated trip to the U.S. to deal with the fallout.

MERS is a coronavirus, a close genetic cousin to SARS (Severe Acute Respiratory Syndrome), which hit Canada hard in 2003, and the impact is eerily similar.

The disease was first reported in Saudi Arabia in September 2012 and, since then there have been more than 1,200 cases and 450 deaths. While the majority of cases are in Saudi Arabia and the United Arab Emirates, there have been sporadic cases in 30 countries, but nowhere has MERS spread rapidly and broadly like it has South Korea.

The index case was discovered on May 20 – a 68-year-old man who had travelled to several countries in the Middle East. But he was not isolated; rather, he was treated at several hospitals, before and after his diagnosis.

"There were mistakes made," Dr. Kim said, including poor history-taking that missed where the man had travelled, long delays in testing and failure to track and isolate other patients. One patient who shared a room with the index patient moved to another hospital where he infected 35 others.

Another reason MERS has not been contained – it has now affected 24 hospitals – is cultural. South Korea has universal public health insurance but the quality of care varies widely between institutions, so patients do "hospital shopping," moving often between facilities. Hospitals are also crowded, with an average six beds per room. It is also commonplace for family members to stay with their loved ones during hospital stays, doing things like emptying bedpans and changing sheets, all of which has facilitated the spread of MERS.

Because MERS is not mutating and there has been no spread outside of hospitals, Dr. Kim thinks the outbreak has likely peaked and will be under control within a week or two.

What is less clear how quickly the fear can be quelled, and what the lasting political and economic impact of MERS will be.