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MERS-CoV, South Korea, and the Tragedy of the Commons

During the summer of 2015, the Middle Eastern Respiratory Syndrome (or “MERS-CoV”) corona-virus spread to South Korea when an infected man traveled back to the country after visiting Saudi Arabia. Due to a myriad of circumstances, the disease had spread to a large majority of hospitals and ultimately led to approximately 17,000 citizens quarantined, 187 confirmed cases, and 38 deaths. Recently on November 25, it was reported that the last patient to carry the MERS virus had passed away due to the virus (1). With our recent study into epidemics and their spread among networks, it seems fitting to analyze how the virus started and perhaps how Korea’s modern medical practices along with certain Korean societal attitudes towards diseases should be re-evalutaed.

MERS is a corona-virus similar to those that produce the common cold and SARS. As a result, it is possible to form a certain immunity against MERS once one has been in contact with it. It is also important to note that the disease, among humans, spreads via close contact alone; for example, simply walking past a MERS-infected patient will most likely not infect you (2).
Now, why did the virus spread so easily in SK even when in the past it was reported to not spread easily among humans? We can narrow down the causes of the outbreak in SK:

  1. Patient Zero: The first verified case of MERS had sought treatment for longer than a week and had visited four hospitals in the meantime, which may have contributed to the initial first stages of the spread of the virus.
  2. Culture: It is quite common for citizens to seek medical care in big hospitals in South Korea. More often than not, people visit the emergency rooms of these hospitals rather than the smaller doctors. This, combined with the fact that family members often visit hospitals to take care of their sick relatives, may have contributed to the 2nd and subsequent stages of the outbreak. There is also a phenomena in South Korean culture called “doctor shopping”, where sick people visit more than one doctor and/or hospital in order to seek various inputs about their conditions. This kind of behavior may have also contributed to the spread of the MERS virus in hospitals.
  3. Poor Quarantine Measures: Among the initial stages of infections in South Korea, people had complained about the lax attempts to quarantine those suspected to have contracted the virus. Numerous reports had stated that some under house quarantine had ignored the advice and warnings of their doctors and had continuously partaken in their normal lifestyles, such as the case with a businessman who had flown to China despite being under house quarantine and another case where a suspected case in Daegu had traveled to various public places such as massage parlors. It is also suspected that the virus spread through the ventilation systems in hospitals, leading to other patients in the hospital being infected in the process.

There are a multitude of other possible causes to the outbreak of the virus, but regardless these seem to stick out the most.

Fair enough, we have cited some of the most prevalent causes for MERS in South Korea. However, how does this relate to the Tragedy of Commons theory? Imagine that a big-name hospital¬† is the commonly-shared resource among a large majority of those who live in Seoul, South Korea. In this commonly-shared ground, patients go to get treated by doctors. According to Garnett Hardin, it would be inevitable that the hospital would be overused to the detriment of all patients who visit the hospital. This is certainly true in that if there is a crowding of patients looking for treatment, then there is a zero or negative payoff as people have to wait, may receive less-than-optimal treatment or may be susceptible to an infectious virus (like MERS). As long as there is a positive payoff to going to that hospital, people will continuously go there, which will eventually lead to such a payoff reducing to zero due to crowding. Again, why did the MERS virus spread so easily in that first stage of infection? Perhaps it can be ultimately attributed to the fact that patient zero decided to visit multiple hospitals (doctor-shopping), all of which were full of patients waiting in the emergency room due to the overabundance of patients looking for treatment in the emergency room (a cultural consequence). Perhaps it is not solely patient zero’s fault but also the fault of Korean society’s overuse of the hospital emergency room, which would indicate that there is a critical flaw in Korean society regarding hospital use.

So how would we prevent this kind of outbreak in the future? Hardin’s proposed solution is to impose a property right either by selling the common space to an individual who has best need for it (an unlikely case as such big hospitals are often owned by corporations who have ill-need of such resources on a day-to-day basis) or by limiting the number of patients visiting the emergency room. The second option sounds much more feasible, but in response society will need to change in order to accommodate such an option, something which is hard to do since we are talking about an entire culture as a whole. Regardless, perhaps such a change may also be required in not just South Korea but in hospitals around the world, as a form of precaution against the spread of infectious diseases. Korea is known for its superb medical practices, yet such practices could not prevent the early spread of the disease. A disease’s success is determined not only by the quality of medical treatment but also more importantly by the culture of the people in regards to hospital usage.




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