Risk Assessment of Importation and Local Transmission of COVID-19 in South Korea: Statistical Modeling Approach (Preprint)

Abstract

BACKGROUND The emergence of COVID-19 has posed a serious threat to humans all around the world despite recent achievements of vaccines, antiviral drugs, and medical infrastructure. Our modern society has evolved too complex and most of the countries are tightly connected on a global scale. This makes it nearly impossible to implement perfect and prompt mitigation strategies for the COVID-19 outbreaks. Especially, due to the explosive growth of international travels, the diverse network and complexity of human mobility become an essential factor that gives rise to the spread of COVID-19 globally within a very short time. OBJECTIVE South Korea is one of the countries that have experienced the early stage of the COVID-19 pandemic. In the absence of vaccines and treatments, South Korea has implemented and maintained stringent interventions such as large-scale epidemiological investigation, rapid diagnosis, social distancing, and prompt clinical classification of severe patients with appropriate medical measures. In particular, South Korea has been implementing effective screening and quarantine at the airport. In this work, we aim to investigate the impacts of such effective interventions on international travels which can prevent local transmission of COVID-19. METHODS The relation between the number of passengers and the number of imported cases were analyzed. Based on the relation, we have assessed the country-specific risk as the spread of COVID-19 gets expanded from January to October 2020. Moreover, a renewal mathematical modeling has been employed incorporating the risk assessment to capture both imported and local cases of COVID-19 in South Korea. We have estimated the basic reproduction number and the effective reproduction number accounting for both imported and local cases. RESULTS The basic reproduction number (R_0) was estimated at 1.87 (95% CI : 1.47, 2.35) with the rate (α =0.07)of the secondary transmission caused by the imported cases. The time-varying basic reproduction number (effective reproduction number, R_t) was estimated. Our results indicate that the prompt implementation of case-isolation and quarantine were effective to reduce the. secondary cases from imported cases in spite of constant inflows from high-risk countries of COVID-19 all throughout the year 2020. Moreover, various mitigation interventions including social distancing and movement restriction have been maintained effectively to reduce the spread of local cases in South Korea. CONCLUSIONS We have investigated the relative risk of importation of COVID-19, using the country-specific epidemiological data, and passenger volume. By combining the social distancing, screening, and self-quarantine for all travelers entering Korea, the mitigation of COVID-19 transmission caused by imported cases in Korea was highly successful. Those efforts, accompanied by identification of the source of infection, the strengthened quarantine measures for travelers from overseas countries, should be continued. However, the recent new coronavirus variant originated from South Africa has been threatening to get back to the strict border control and lockdown of all around the world again. Therefore, it is urgent to assess the importation risk and maintain an effective surveillance system of COVID-19 in South Korea.