CDC Raises South Korea Travel Advisory: Level 3, Avoid Nonessential Travel

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Over the past 6 days South Korea has become the 2nd hardest hit country in the world (after Mainland China) with COVID-19, adding as many as 200 cases a day. At any given time there are more than 200,000 Americans either living or visiting South Korea, including over 28,000 military personnel (and some dependents) stationed there.

Three days ago, the CDC's raised their travel advice to  Alert - Level 2, Practice Enhanced Precautions. Yesterday, we saw the number of COVID-19 cases climb above 800 in South Korea, and a report from the USFK: 1st Dependent Tests Positive For COVID-19 In South Korea.

Late yesterday the CDC raised their travel advisory to Warning - Level 3, Avoid Nonessential Travel, making South Korea only the 2nd country (after China) to be placed on this highest alert due to COVID-19.

While a modern country, we saw how quickly a much smaller outbreak of MERS-CoV overwhelmed South Korea's hospital system in 2015. Add in the possibility of being quarantined, or unable to return home, and you might want to seriously reconsider any travel plans to the ROK right now. 

 The text of the CDC's travel advisory follows, after which I'll have a postscript.

Coronavirus in South Korea

Warning - Level 3, Avoid Nonessential Travel

Warning - Level 3, Avoid Nonessential Travel—Widespread Community Transmission

Key Points

CDC recommends that travelers avoid all nonessential travel to South Korea.

There is a widespread, ongoing outbreak of respiratory illness caused by a novel (new) coronavirus that can be spread from person to person.

Older adults and people with chronic medical conditions may be at increased risk for severe disease.

What is the current situation?

CDC recommends that travelers avoid all nonessential travel to South Korea. There is limited access to adequate medical care in affected areas.

A novel coronavirus is causing an outbreak of respiratory illness (COVID-19) in South Korea. Illness with this virus has ranged from mild to severe. Signs and symptoms of infection include fever, cough, and difficulty breathing. Sore throat also has been reported in some patients. Some patients also have reported diarrhea without other symptoms. This new coronavirus has caused severe disease and death in patients who developed pneumonia. Risk factors for severe illness are not yet clear, although older adults and those with chronic medical conditions may be at higher risk for severe illness.

What can travelers do to protect themselves and others?

CDC recommends avoiding nonessential travel to South Korea. If you must travel:

• Avoid contact with sick people.

• Avoid touching your eyes, nose, or mouth with unwashed hands.

• Discuss travel to South Korea with your healthcare provider. Older adults and travelers with chronic medical conditions may be at risk for more severe disease.

• Clean your hands often by washing them with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer that contains 60%–95% alcohol. Soap and water should be used if hands are visibly dirty.

• It is especially important to clean hands after going to the bathroom; before eating; and after coughing, sneezing or blowing your nose.

If you spent time in South Korea during the past 14 days and feel sick with fever or cough, or have difficulty breathing:

• Seek medical advice. Call ahead before you go to a doctor’s office or emergency room. Tell them about your recent travel and your symptoms.

• Avoid contact with others.

• Do not travel while sick.

• Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.

• Clean your hands often by washing them with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer that contains 60%–95% alcohol immediately after coughing, sneezing or blowing your nose. Soap and water should be used if hands are visibly dirty.

Clinician Information

Healthcare providers should obtain a detailed travel history for patients with fever or acute respiratory symptoms. For patients with these symptoms who were in South Korea and had onset of illness within 2 weeks of leaving, consider the novel coronavirus and notify infection control personnel and your local health department immediately.

Although routes of transmission have yet to be definitively determined, CDC recommends a cautious approach to interacting with patients under investigation. Ask such patients to wear a face mask as soon as they are identified. Conduct patient evaluation in a private room with the door closed, ideally an airborne infection isolation room, if available. Personnel entering the room should use standard precautions, contact precautions, and airborne precautions, and use eye protection (goggles or a face shield). For additional healthcare infection control recommendations, visit CDC's Infection Control webpage.

For additional information, please see:
Coronavirus Disease 2019Information for Healthcare ProfessionalsWHO, Coronavirus

While this advisory is mostly about protecting the health and safety of Americans planning to travel to South Korea, is may also help slow the introduction of the virus into the United States.  We are still in a heavy flu season, and it would be preferable if we can stave off community transmission of the virus for another month or two. 

But there is little expectation that we can keep the virus out forever.  Only the timing, and it's impact, are still unknown. 

While the focus of our national strategy is currently on prevention and containment, at some point that will have to give way to mitigation (see Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017), where we find ways to live and work with the virus circulating in our community.

Perhaps the hardest concept for people to accept is that - no matter how careful they are - they are likely to be exposed to this virus sometime over the next 12 months.  We've seen that many will be lucky enough to only be asymptomatically infected, while many others will experience just mild to moderate illness.

Some smaller percentage (and that will likely vary by region) will experience more severe illness, and their outcome will depend upon individual factors - like age, and comorbidities - and the availability of good medical care. 

While none of this will be easy, it is doable. 

And by understanding the threat, taking basic precautions -  and being even modestly prepared - we can all do our part to reduce the impact of this looming public health threat on our families, and our communities.