The Same Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) yet Different Outbreak Patterns and Public Health Impacts on the Far East Expert Opinion from the Rapid Response Team of the Republic of Korea

The joint Korean government and WHO mission concluded in June that the "identification and isolation of symptomatic cases early in the outbreak was not optimal" [10] . Officials argued that disclosing the names of healthcare institutions where transmission occurred could increase unnecessary panic. Nevertheless, public fears resulted in further concern because government reports naming MERS-CoV affected hospitals remained vague. ID specialists requested they receive more disclosure in order to handle the outbreak more efficiently. Although no evidence of community-based MERS-CoV spread existed, more than 2,000 schools closed because of parent complaints. These school closures contradicted both recommendations from medical specialists and international best practices. Interestingly, reports stated that the children of hospital workers, in particular, were refused to attend school. The unexpected MERS-CoV epidemic also caused far broader disruption and economic damage [11] . Strong involvement by authorities and the RRT are currently helping to control the MERS-CoV outbreak in Korea. The RRT has made many recommendations and tried numerous strategies to prevent the spread of MERS-CoV, including surveillance and preemptive isolation of hospitalized pneumonia patients, contact tracing, hospital quarantine, and point surveillance of pneumonia incidence. As of June 10th, 2015, 106 hospitals had participated in the ongoing strategic methods and identified seven suspected patients, although PCR testing for these patients was negative. Disease surveillance and preemptive isolation of pneumonia patients will be maintained until the end of the MERS outbreak. In addition, the RRT advised the government to publish the names of the hospitals where patients with MERS-CoV stayed or visited as well as to identify all MERS-CoV cases and their contacts. The RRT also advised repairing the country's hospital system by establishing the following: (1) restriction of patient visitation to hospital generated lists and (2) strengthening present infection control procedures by increasing appropriate healthcare personnel, monitoring fever daily, supplying proper infection control equipment, and seeking insurance coverage for the establishment of infection control measures. ID experts had already recommended initiating quick laboratory diagnosis by extending MERS-CoV related diagnostic laboratory capacities, previously limited to the KCDC, to the local public and environmental laboratory centers. Procuring quicker laboratory results reduces the time between identifying disease symptoms and diagnosis, thereby lowering contact rates and permitting earlier treatment. The RRT is expected to publish these MERS-CoV-related diagno- In conclusion, the MERS-CoV outbreak revealed fundamental systematic weaknesses in the Korean healthcare system. Although similar patterns (crowded ERs/hospital rooms and inadequate infection control system) were revealed during other disease outbreaks in Korea, notable differences were evident during this outbreak that contributed to disease spread, including cultural practices such as doctor shopping and the practice of allowing multiple hospital visitors.