PMC:7224658 / 17709-25940 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7224658","sourcedb":"PMC","sourceid":"7224658","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7224658","text":"Discussion\nThis study analyzed the relationship between traffic trends and the spread of COVID-19 after the first COVID-19 patient was confirmed in South Korea. This was carried out at both national and regional levels.\nSince the first confirmed patient in South Korea on January 19, the mass media (e.g. TV news, newspapers, the Internet) and other studies have shown a decrease in peoples’ engagement in outdoor activities as a result of self-isolation, working from home, voluntarily staying indoors, delaying the commencement of schools and universities, and the delivery of educational messages for COVID-19 prevention (e.g. via the Internet, broadcast media, and written articles) (Chinazzi et al., 2020, Magal and Webb, 2020). Similarly, our study showed that, following the COVID-19 outbreak in South Korea, nationwide traffic decreased by 9.7% compared with 2019, indicating a decrease in citizens’ outdoor activities. In particular, after the KCDC raised the infectious disease alert level to ‘orange’ on January 27, a large decrease was observed in nationwide traffic. After the alert level was raised to ‘red’ on February 22, traffic in the fourth week of February was down by 26.1% compared with 2019 (Figure 4).\nTo counteract the rapid increase in confirmed COVID-19 patients, the South Korean government implemented policies such as advising the restriction of outdoor activities, implementing a work-from-home system in public organizations, encouraging private organizations to employ work-from-home systems, advising educational institutions (kindergartens, after-school academies, etc.) to close, and delaying the commencement of elementary/middle/high schools and universities. The effectiveness of these policies was evidenced by the decrease in nationwide traffic. In particular, the data show that although the Korean government did not forcefully prohibit public excursions, citizens voluntarily adhered to the government’s guidelines and restricted outdoor activities. Various studies and media opinions have suggested that these results are due to a high level of existing public health education, good information accessibility due to the rapid Internet environment, and effective delivery of educational messages. It would be valuable for future research to identify the most effective measures among the South Korean government’s COVID-19 policies.\nAlthough the nationwide traffic in South Korea showed a continuously decreasing trend after the initial COVID-19 outbreak, it shifted to an increasing trend after March 7. This was the day after the numbers of daily new confirmed COVID-19 cases in South Korea shifted to a decreasing trend on March 6, when the Korean press and media had begun reporting decreasing trends in COVID-19 (The Briefing, 2020). Moreover, immediately after the WHO Director-General, Tedros Adhanom Ghebreyesus, at a foreign media briefing on March 5, reported that ‘the numbers of new confirmed COVID-19 patients in South Korea are decreasing, and there are encouraging signs’, corresponding news articles were published on March 6 in Korean Standard Time – the day before the nationwide traffic shifted to an increasing trend (The Associated Press, 2020). In the cases of Daegu, Cheongdo, and Gyeongsan city, the KCDC recommended that citizens in these areas undergo self-isolation for prevention from 23 February to 8 March, which contributed to the subsequent increase in traffic.\nThe shift to an increasing trend in nationwide traffic from March may have been caused by: (1) a change in COVID-19 prevention attitudes toward decreasing compliance; (2) a decrease in people working from home; (3) increased usage of personal vehicles; and (4) an increase in outdoor excursions due to seasonal changes. These are discussed below.\nFirst, as the number of new daily confirmed COVID-19 patients decreased and the number of persons released from isolation increased, it is likely that the attitudes of the public shifted toward decreasing compliance. According to previous research, 2 months following the first COVID-19 case in South Korea, citizens became increasingly fatigued by the preventive measures, and their attitudes to prevention became less stringent (Remuzzi and Remuzzi, 2020). For instance, analysis of public data from Seoul showed that the number of Seoul Metro passengers in March increased by 3.3% compared with March 2 (Won, 2020).\nSecond, employees following work-from-home policies since February started commuting to work again once the spread of COVID-19 had decreased in March, and this led to increased traffic. Indeed, employees working from home reached their highest levels of movement in the first week of March, after which they showed a decreasing trend.\nThird, citizens who had previously used public transport (the Metro, buses, taxis, etc.) showed increased use of their personal vehicles for outings to avoid public transport, which is susceptible to COVID-19 spread.\nFourth, South Korea is a country with four distinct seasons, and has a culture where people frequently go out in the springtime. The culture, sports, and tourism ministries in individual cities, provinces, and counties attempted to prevent outdoor activities by closing or reducing the operating hours of major tourism sites; however, the number of tourists visiting these sights increased as the weather got warmer.\nWhen the regional COVID-19 and traffic trends were analyzed in this study, the traffic in Seoul, Gyeonggi, and Incheon showed smaller changes compared with the other regions. This is because the Korean citizens, including overseas students, started returning to the country as COVID-19 began rapidly spreading overseas, such as in Europe and the US (Cho, 2020). The number of Korean citizens returning from overseas and requiring control was estimated to be 210 000 individuals, making the risk of a resurgence of COVID-19 considerably high. Indeed, 23.8% of the confirmed cases in Seoul in the third week of March were individuals returning from abroad (Young-kyung et al., 2020). Thus, Seoul, Gyeonggi, and Incheon, which are closer to the airport and the residences of many citizens returning from abroad, showed increased COVID-19 and traffic trends compared with other regions. In particular, Incheon showed a positive linear relationship between traffic and new confirmed COVID-19 patients, prompting increasing concern about a secondary COVID-19 outbreak in this region compared with others.\nThis study had some limitations. First, it did not collect data on the total national traffic volume, instead relying on VDS data, although these are representative of the national trend. Moreover, the data collected included drive-through traffic, which would need to be excluded in future studies. Second, this study did not preclude the causal effects of regional influences, such as public policy, the media, education, etc. A future study should include a comparison of experiences in each city with those in other outbreak cities pursuing different policies (Pan, 2020).\nGlobally, COVID-19 is an ongoing pandemic. At present, the spread of COVID-19 is concentrated in Europe and the US, with WHO declaring Europe to be the second epicenter of COVID-19 (Johnson et al., 2020, Lin et al., 2020, Qasim et al., 2020). As of March 31, 2020, outside of Asia, the five countries with the highest numbers of confirmed COVID-19 cases were, in descending order, the US (163 479 cases), Italy (101 739 cases), Spain (87 956 cases), Germany (66 885 cases), and France (44 550 cases). All these countries allow Koreans to freely travel there and, consequently, South Korea is currently experiencing a persistent increase in the cases of infection re-entering the country from overseas regions such as Europe and the US. Preparing various physical and institutional measures, including social distancing, will be necessary to prepare for a secondary outbreak of COVID-19 in South Korea. In particular, increased traffic implies a rise in outdoor excursions, which elevates the risk of spread of COVID-19 due to increased social contact. The government needs to devise policies similar to social distancing to restrict citizens’ excursions and other risks of 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