Seoul’s Radical Experiment in Digital Contact Tracing

Seoul’s Radical Experiment in Digital Contact Tracing

In South Korea, the government is disseminating detailed tracking data on people with COVID-19.

By Max S. Kim

The New Yorker

April 17, 2020

In Seoul, local governments have been on the front lines of containment efforts: testing, monitoring, and tracking patients and disclosing critical information to the public.Photograph by SeongJoon Cho / Bloomberg / Getty

On the morning of March 23rd, I arrived at the Mapo District Office, a staid government building in northwestern Seoul, where I was greeted by Song In-su, the fifty-three-year-old deputy of the public-relations department. Instead of shaking hands, we awkwardly bumped elbows. Over the weekend, I had received my seventh local-government emergency alert—a text message with a red loudspeaker icon labelled “Mapo District Office”—informing me of new COVID-19 cases in the area where I live. Song had sent them all.

“Our biggest fear right now is a super-spreader,” Song told me. This had been apparent in the anti-COVID-19 fortifications I had noticed on my way up to his office, which is on the ninth floor. Bottles of hand sanitizer, now present in every imaginable public space in Mapo, from bus stops to bike racks, had been installed throughout the building. A heat sensor had scrutinized me as I’d walked through the lobby. The elevator buttons were covered with antiviral tape.

On one wall of the conference room where I met with Song, a banner reading “Coronavirus Disease Response Meeting” projected a mood of emergency. Before the pandemic, Song and his colleagues had been preparing voting booths for the local parliamentary elections, which are held every four years, in April. But in mid-February, the coronavirus spread throughout the southeastern city of Daegu, and the priorities of Mapo officials changed. “All our administrative power is concentrated on COVID-19,” Song said. “You don’t even see any mention of ‘Parasite’ in the news anymore.”

Although new cases in Daegu—where about seven thousand of the country’s roughly eleven thousand confirmed cases have originated—had slowed dramatically, inspiring hope that the worst was over for South Koreans, smaller but not insignificant clusters had been surfacing at call centers, churches, hospitals, and gaming cafés in and around Seoul, and also at the airport. on March 16th, President Moon Jae-in declared greater Seoul as the new battlefront. Experts had been warning that, as with any dense metropolis, things could quickly turn ugly. “Think Italy or New York,” one had told me.

In Seoul, local governments like the Mapo District Office have been at the front line of containment efforts: testing, monitoring, and tracking patients and disclosing critical information to the public. Like most municipal public-relations officials, Song used to spend his days compiling media coverage of the district office’s activities and publishing them in an office bulletin. Now, when a positive case is identified in Mapo, Song springs into action. He strips the information of any identifying markers before posting it on the district office’s Web site, blog, and social-media accounts; he also sends out the emergency text alerts. The disclosure of anonymized patient routes, a central feature in South Korea’s containment strategy, has set it apart from the United States, which has so far erred on the side of individual privacy, and from neighboring Japan, where testing has been deliberately limited.

South Korea’s COVID-19 policies reflect a larger regime of transparency. In daily press briefings, Jung Eun-kyeong, the head of the country’s Centers for Disease Control and Prevention (K.C.D.C.), has been delivering detailed reports in measured tones. In addition to sharing the routes of confirmed patients, the agency has been distributing infection and testing data to journalists with remarkable frequency. Emergency text alerts about significant developments are sent to every smartphone in the nation. Such openness has been rewarded by an abiding trust in the government’s containment protocols. Panic has been minimal; toilet paper is in abundant supply.

Jung has also been candid about the trade-off inherent in these measures. Under the terms of South Korea’s Infectious Disease Control and Prevention Act—passed after the 2015 MERS outbreak, during which the government’s withholding of critical information contributed to further transmissions and deaths—it is now required to publish information that can include infected people’s travel routes, the public transport they took, and the medical institutions that are treating them. As long as districts do not reveal the identities of confirmed patients, they have been free to decide levels of disclosure on their own. In a few instances, officials released enough information to make people with COVID-19 publicly identifiable, leading to cases of doxxing and online harassment. “Please don’t spread information about my identity,” one patient wrote on social media. “I’m so sorry to my friends and family that I’ve hurt, but more than the physical pain, it’s been very difficult mentally.” In February, a survey of a thousand people by researchers at Seoul National University found that respondents’ greatest fear about the disease was social stigmatization. The National Human Rights Commission of Korea issued a statement calling for stronger measures to protect individuals from being outed. Experts have also cautioned that over-disclosing can be counterproductive, as patients fearful of public censure may choose to hide instead of seeking treatment.

Following the National Human Rights Commission’s statement, the K.C.D.C. had distributed new guidelines on disclosure to local governments, a copy of which Song held in his hand. Mapo, as far as I could tell, had not committed any such blunders, but it was clear that the increased scrutiny weighed on Song, who repeatedly noted to me that his reports were carefully written. Still, he said, somewhat cautiously, “I think we should try to disclose as much information as we can, rather than holding back.” For Song, this has meant including patients’ age and gender, their neighborhood of residence, and the names of businesses and apartment complexes they had visited, which he sees as a way of assuaging other residents’ anxieties. “What most people ultimately want to know is whether their activities overlapped with patient routes,” he explained. In Mapo, this has also boosted testing. “A lot of people come in after seeing the published patient routes, concerned that they might have been in the same place,” one of the doctors at the local testing center, just outside Song’s building, said.

In the conference room, Song showed me the Mapo District Office Web site, where the dozen or so cases that had been confirmed in the area had been organized by date into a neat table. The entries, each appended with a detailed list of the stops the patient had made, in sparse, sterile language, read like a ship’s logbook. “08:00 left home (on foot) / mask worn,” began one entry for Mapo’s fourth patient, dated from March 6th to 10th. The post went on to note each bus and subway transfer (“Bus transfer to no. 7730 in front of Sangam High School → disembarked at Susaeggyo / mask worn”), as well as a six-minute stop at a local supermarket, before ending with “15:00 tested positive → 19:00 transferred to Seoul Medical Center.” Emergency text alerts, because of their character limit, linked recipients to these entries rather than relaying them in full. “For the text alerts, we use something called a ‘remote broadcasting apparatus,’ ” Song said. “Then it’s sent to every phone in a five-kilometre radius through a nearby base station.”

Public appetite for this information is voracious. “Most of the residents’ feedback is asking for more information, for us to be even more revealing,” Song said. Indeed, a beleaguered epidemiological investigator told me, “Sometimes when we go to an apartment complex office to collect C.C.T.V. footage, residents run up demanding we tell them the block and unit number. But then other people ask us not to disclose a certain location, especially if it’s where they live.” The naming of local businesses in particular, which some local governments have avoided, hasn’t always gone over well with their proprietors. “Because disclosure affects public perception of the place, there’s a bit of a financial blow,” Song said, apologetically.

“It’s a double-edged sword,” Seong Han-bit, the thirty-six-year-old owner of Stance Coffee, a small, independent coffee shop in Seoul, told me. His café has nice lighting and copies of Kinfolk, the chic Danish magazine, at every table. on the morning of March 28th, Mapo’s Patient 15, a woman in her twenties, had briefly stopped by to order a drink. Song’s writeup for her, posted two days later, was unusually long. The woman had arrived at the airport—where she initially tested negative at a screening checkpoint—after visiting the United States. In Seoul, she had visited a cosmetics store, a fried-chicken joint, a hair salon, a post office, and multiple convenience stores and restaurants, before testing positive on March 29th. According to the report, she was believed to have caught the virus in America.

On a popular local Facebook group, someone had written a post denouncing her for being so irresponsible. “Just die alone, why would you cause other people harm,” one member said. Another remarked that the patient should have been hit with a giant hospital bill in the United States. The original poster, perhaps sensing that this conversation was bringing out people’s worst impulses, locked the comments.

On Monday, March 30th, after district officials fumigated Stance Coffee, and a major broadcaster mentioned the shop by name in a report about “re-imported” COVID-19 cases, Seong opened up his café. “Because I personally don’t keep up with patient routes, I assumed that other people wouldn’t either,” he said. “But, after the post went up yesterday, I felt it in my bones. From 5 P.M. to 11 P.M. that day, not a single customer showed up. I thought, ‘Ah, this really does have a big impact after all.’ ”

Sitting in his now empty café, Seong had also received a string of interrogatory phone calls from customers, demanding to know things like whether the barista working on the day in question had since been self-isolating. In reality, Seong told me, Patient 15 had been in the store for only a minute or two while she waited for her order. The barista, who had been wearing a mask during his shift, had interacted with her for just a moment. “It would be nice if the detailed circumstances of the encounter were listed alongside the other information,” Seong said.

“I’m worried about the future, but I still have to stay open to pay the rent,” he continued. “Who knows whether people will come or not? I’m approaching it with the mind-set that I should try to make any sale that I can, even if it’s only ten thousand won”—about eight dollars. Business had already slowed once, after the outbreak in Daegu first began. Still, Seong seemed to be maintaining an admirable sense of social-mindedness. “If I selfishly consider only my café and nothing else, of course I’d think, Why would they publish this and ruin my business?” he said. “But thinking from the perspective of other people—a parent with a child, for example—I still think it’s right to publish it.”

In late March, the government’s pleas for social distancing grew more vigorous. In a national address, Prime Minister Chung Sye-kyun announced that the government would enforce a ban on large rallies and gatherings in Seoul, which hadn’t abated. Local governments like Mapo were ordered to take strong administrative action against businesses violating the city’s outbreak-prevention guidelines. “With the understanding that the next two weeks are a decisive time that offers us the chance to win the war against COVID-19, I ask that the South Korean public coöperate with several strong measures being taken,” Chung said. “For the next two weeks, we will calmly prepare for new everyday lives. We must change how we work, how our children learn, and we must practice everyday containment measures in every moment of our lives.”

In Mapo, I had been perceiving, by subtle degrees, the sort of change that Chung was talking about. The outbreak, now a global pandemic, had recast small daily routines. Like many others in South Korea, I obsessively combed through the trackers and maps created with disclosed-patient data. (This replaced checking the weather, which became meaningless once I stopped leaving the house.) For a while, as pins and lines indicating confirmed cases sprang up in neighborhoods outside of Mapo, we seemed to be avoiding the worst. But, in early March, after more than fifty patients emerged at an insurance call center in Guro, just two districts over, the emergency text alerts became more localized and frequent.

One patient from this cluster, as I had learned with a stab of alarm two weeks earlier, had passed through Mangwon Market—a long promenade, lined with street-food venders and open-air produce stalls, where I did much of my grocery shopping. District officials had shut down the shops for two days in order to sanitize the market, but I had avoided going back for a week. Song, upon hearing this, waved a hand dismissively. “Places where patients recently passed through are much safer, because we send out a sanitization team with our contact tracers,” he said.

After this incident, a fresh sense of crisis seemed to have been awakened in the neighborhood. During smoke breaks outside my apartment, I spoke with my landlady about local developments while she wiped down the entrance keypad with alcohol wipes. As the magnolias on my street bloomed into white, scalloped buds, masks appeared on faces everywhere. Outside of pharmacies, people lined up at the same time every day to buy their weekly allotment of masks, which the government had rationed to two per person. Businesses put up no-mask-no-entry posters. Delivery drivers began to plant their feet far back and crane forward to gingerly hand you your food.

In spite of such heightened awareness, social distancing in Mapo hadn’t been entirely successful. Most businesses escaped an outright ban, and cafés and restaurants remained open, albeit to fewer customers. “The biggest problems are gaming cafés, churches, and Hongdae clubs,” Song said. The neighborhood of Hongdae, several blocks east of Mangwon Market, is a night-life destination for tourists and for students from the nearby Hongik University. There, crowds of young people had been partying at clubs and bars that took your temperature before letting you in. A friend of mine, who recently shut down his bar in Hongdae, told me, “I was starting to get annoyed by the people even showing up.” This would amount to significant losses, he conceded—but he didn’t want to be stuck in a bar full of customers cavalier enough to show up in the midst of a pandemic.

Businesses and religious institutions that violate the outbreak-prevention guidelines—which mandate proprietors to enforce mask-wearing and the maintenance of a two-metre safety buffer between people on the premises, among other measures—are subject to a fine of up to twenty-five hundred dollars. on a recent Sunday, three hundred or so district officials visited several of the more stubborn local churches, in a final attempt to dissuade them from holding services. A few remain undeterred, but the vast majority have switched to online worship. And though some of Hongdae’s clubs had recently re-opened, looking to draw in social-distancing apostates, most shut down again after a round of inspections on April 1st. “It’s deserted out there,” Song told me.

The patient information that Song discloses comes from Kim Mi-ra, the head of infectious-disease management at Mapo’s community health center, which is next door to Song’s building. In front of the health center, a banner announced that all regular services had been halted. By the entrance, where two workers stood waiting to spritz any visitors with hand sanitizer, a plastic canopy had been erected to serve as a makeshift reception area. Inside an adjacent tent, doctors in full protective gear test thirty to forty people each day. The process takes just a few minutes, and results are usually delivered within twenty-four hours, by text message.

When a patient tests positive here, Kim’s team retraces their movements based on their oral testimony, and then combs through relevant C.C.T.V. footage in order to locate others who might have been exposed. Restaurants, where people must take their masks off to eat, are the most common sites of exposure. “Say there’s someone who was within two metres of the patient at a restaurant, but we don’t know who that person is, except what they look like in the C.C.T.V. footage,” Kim said. “Then we ask the credit-card company to pull up that customer’s information and ask them to tell them to contact us.” That person is then put under monitored self-isolation for two weeks, using an app that tracks his phone to insure that he isn’t breaking quarantine.

Behind this model of contact tracing is a vast surveillance apparatus expressly designed for such outbreak scenarios. Under South Korea’s Infectious Disease Control and Prevention Act, health authorities, with the approval of the police and other supervising agencies, can make use of cell-phone G.P.S. data, credit-card payment information, and travel and medical records. As of March 26th, the government has also officially launched the Epidemic Investigation Support System, a data-analysis platform that automates the process, allowing investigators to get clearance and pull up patient trajectories in under a minute. (Previously, the process took about a day.)

Although some had anticipated a backlash to such sweeping electronic surveillance, public outrage has been nearly nonexistent. According to Kim Min-ho, a law professor and one of the country’s human-rights commissioners, this is because these measures can be used only in the context of disease outbreaks, making it impossible for them to be co-opted for, say, anti-terrorism campaigns.

“I think there’s a difference in reasoning and perception at play here,” Kim told me, by phone. “The United States was quick to ban businesses, while countries like France instituted lockdowns. But South Korea hasn’t been able to do the same because we’re very cautious about these kinds of measures, in the same way that other countries are cautious about privacy.” Mere weeks after the initial flurry of articles pondering whether or not democracies were better equipped to deal with pandemics, few countries were getting away with not sacrificing some kinds of freedom. As Kim pointed out, the true question was which freedoms to prioritize. The chaos of the MERS outbreak had left the public with a grim conviction: sacrificing some individual privacy was simply the upfront cost of avoiding more debilitating consequences down the line.

South Koreans have decided that, during an infectious-disease outbreak, there is a strong, pragmatic case to be made in favor of what might be called virtuous surveillance—a radically transparent version of people-tracking that is subject to public scrutiny and paired with stringent legal safeguards against abuse. Despite its imperfections, South Korea’s policy is striking for the fact that it brings the mechanisms and outcomes of surveillance into the public forum. In doing so, it appeals to a deeper sense of civic trust—the belief that, in a crisis, the citizenry can be relied upon to play its part.

Late last month, I experienced the outbreak-surveillance system for myself. Upon walking through the front door of Gachon University Gil Medical Center in Incheon, I was surrounded by a contingent of hospital workers wearing goggles, masks, face shields, and plastic gowns. After taking my temperature, a nurse asked me if I’d recently travelled to any high-risk areas. I said no. At the next checkpoint, another nurse took my driver’s license and entered my personal identification number into her computer, where a modified version of the Drug Utilization Review—a drug-prescription cross-referencing system widely used in South Korea—pulled up my travel history to check whether I was lying. I wasn’t, so I received a yellow sticker. Eom Joong-sik, an infectious-disease physician who is advising the government on COVID-19, was waiting at the end of the checkpoint.

“This is one of the benefits of having a universal health-care system,” Eom told me, gesturing behind us. “When they enter your personal identification number, they can review your travel history.”

In the empty consultation room where we sat, Eom spoke bluntly about the current state of affairs. “We really don’t know whether the South Korean system has succeeded or not yet,” he said. “There has been a constant stream of new cases in the capital area.” With community-based cases steadily waning, re-imported cases seeping in through the airport have become the latest threat. A breach here could undo much of the painstakingly made progress so far. “It’s not enough that we alone are successful in containment efforts,” Kim Mi-ra had told me. “There’s a high likelihood that the disease can be brought back in from other countries at any time.”

Eom said, “If there’s a major outbreak here, what happened in Daegu may not even compare,” adding that more than half of South Korea’s population of roughly fifty million lives in the capital area. Moreover, Seoul is nearly twice as dense as New York City. If infections proliferated, he warned, “This sort of patient-movement disclosure or contact tracing will become meaningless.” Far more drastic measures, such as military-enforced lockdowns, might well occur.

Seoul poses a far more vexing set of challenges than Daegu did. The vastness of the greater capital area makes potential infection routes difficult to pin down or predict. There are too many blind spots, such as crowded subways and buses, where C.C.T.V. footage provides few usable leads. When I asked Eom what the likelihood of a major outbreak in Seoul is, he let out a loud, unsettled laugh. “I’m just praying it doesn’t happen,” he said.

Resisting complacency, Eom said, would be critical. But in recent days, public life in Seoul has begun filling out again. Despite the closure of high-risk businesses like clubs and churches, lines at popular eateries and cafés have reappeared. In the parks and on the esplanades along the Han, the river winding through Seoul, crowds of picnickers have begun to materialize among the cherry blossoms, with the dazed, sleepy air of animals emerging from their dens after a long winter. If another crisis loomed, it was hard to tell. “All of the control and containment procedures essentially rely on the same thing,” Eom told me. “And that is the coöperation and responsible conduct of the citizenry.”