COVID-19 screening center models in South Korea

On World Malaria Day 2012, the World Health Organization (WHO) launched an initiative called ‘T3: Test, Treat, Track’ [15]. After 'testing', it is important to quarantine confirmed cases for initial management of infectious diseases. According to Yamey, South Korea flattened the curve through rapid and bold actions, exemplified by establishment of screening centers, including drive-through centers, that enabled large-scale testing [16]. South Korea focused on screening centers to prevent COVID-19. (see Fig. 2 for the distribution of these screening centers across regions of South Korea.) The government quickly installed general COVID-19 screening centers connected with public health centers, public hospitals, and private hospitals. This allowed for COVID-19 screening centers to be operated in all administrative districts. And the general centers systematically helped to prevent community spread across the country. Previous studies showed the necessity to prevent spread of COVID-19 in areas with high population density through control measures [17,18,19]. For this reason, South Korea appeared to distribute the general and DT screening centers in Seoul, Gyeonggi-do, and six large cities with high population density. The spread of COVID-19 is related to traffic volume and transportation trends [20]. Both traffic volume and population density appear to have influenced locations for the DT screening centers. The Namhae Highway, that connects Gyeongsangnam-do and Jeollabuk-do, carries a high volume of traffic [19]; thus these DT screening centers would enable efficient screening of people in automobiles. Distribution of DT screening centers in central South Korea along the Gyeongbu Highway addressed the route with the highest volume of traffic and enabled those in cars to be tested for COVID-19 at these sites. Only one DT screening center operated in Gangneung, and none in Gangwon-do. Gangwon-do is close to Seoul and Gyeonggi-do, and connected to the Yeongdong Highway that carries the second highest traffic volume in South Korea [21]. Establishment of more DT screening centers in the areas with high population density around the Yeongdong Highway would facilitate better geographic balance in distribution of COVID-19 screening centers. If resources for establishing screening centers are limited and the screening centers cannot be established in all the areas, a local screening cooperation system, as implemented by Goyang city in Gyeonggi-do could also be used to make the screening centers with different roles [22]. The Cooperation system worked with local clinic or health center and COVID-19 public relief hospital, connecting information about COVID-19 screening cases.

South Korea is improving COVID-19 screening center models to prevent secondary infections between HCWs conducting COVID-19 screening and those they test, and to enable rapid and efficient screening. Model A is not adequate to manage highly infectious diseases, such as COVID-19. South Korea implemented Model B in the early stage of COVID-19 transmission to manage this highly infectious disease. Screening centers located outside the hospital buildings or public health centers can be used for rapid responses to infectious diseases because those to be tested must wait outside these screening centers. Thus, risk of secondary infection is lower in model B than in model A. However, model B requires more time to collect each sample, and HCWs must change all PPEs (coveralls, plastic gowns, and N95 masks) after each test. This leads to high levels of fatigue in HCWs [23]. Because those waiting for tests line up without implementing ‘Social distancing through markings on the ground’, the risk of droplet infection is also very high [24, 25].

Model C, a now famous model of screening centers developed in South Korea, proved to be efficient, effective, and safe in many countries across Europe, the USA, and Latin America [26]. South Korea (Fig. 2) distributed model C screening centers in the outskirts of cities with high population density, and along the highways with high volumes of traffic. Model C screening centers serve well where traffic volume is high. Model C can be useful in countries with high population density, such as South Korea, and where a vast expanse of land may hinder effective management of screening centers, as in the USA, Australia, and China. Because cars serve as the isolation booths, implementation of model C can help to prevent secondary transmission among those waiting. HCWs should still change all the PPE after each screening to prevent contamination. Increased fatigue in HCWs remains as a limitation of this model.

Model D may be necessary at local healthcare facilities, such as public health centers and their branch offices. Although DT screening centers (Model C) ensure safe and convenient sample collection, they depend on those being tested arriving in their own cars. Therefore, those who do not own cars will visit other models of COVID-19 screening centers closest to where they live. Establishment of ‘Glove-walled WT COVID-19 screening centers’ at local healthcare facilities may be effective for safe management of those waiting for tests and prevent community-acquired infections [13, 27]. Because HCWs who screen these centers are also protected from the infection and experience less fatigue in the process, this model may be the most effective.

South Korea has not closed its borders for COVID-19 prevention. Instead, it tests all those entering from other countries and COVID-19 transmission through imported cases is rare in South Korea. Walk-through COVID-19 screening centers at Incheon Airport in South Korea prevent transmission of infectious diseases from those entering from other countries. The use of multiple COVID-19 testing booths and fast sample collection makes this possible.

Even if South Korea manages efficiently the confirmed COVID-19 cases, secondary transmission may still occur, most likely from imported cases. Therefore, model E is the most effective type of screening center for preventing secondary transmission of COVID-19 through importation. Its use will address problems associated with economic and social isolation resulting from closed borders.

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