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Sources of Infection Among Confirmed Cases of COVID-19 in Jeju Province, Korea

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Sources of Infection Among Confirmed Cases of COVID-19 in Jeju Province, Korea Journal of Journal of Preventive Medicine Original Article Preventive Medicine & Public Health J Prev Med Public Health 2021;54:245-250 • https://doi.org/10.3961/jpmph.21.286 & Public Health pISSN 1975-8375 eISSN 2233-4521 Sources of Infection Among Confirmed Cases of COVID-19 in Jeju Province, Korea Moonkyong Hwang1, Jong-Myon Bae1,2 1Jeju Center for Infectious Diseases Control and Prevention, Jeju, Korea; 2Department of Preventive Medicine, Jeju National University College of Medicine, Jeju, Korea Objectives: Jeju Province in Korea reported 627 coronavirus disease 2019 (COVID-19) cases between January 20, 2020, and March 31, 2021. This study analyzed the sources of infection among confirmed cases in Jeju Province, a self-governed island. Methods: The sources of infection were broadly categorized as follows: (1) infections from overseas (confirmed patients who reported travel overseas or contact with overseas travelers); (2) infections from outside Jeju Province (confirmed patients who had visited other provinces or had contact with individuals who had traveled to other provinces in Korea); and (3) unknown sources of infection (con- firmed patients who were infected following contact with an infected person whose source of infection was unknown). The chi-square test was used to analyze the differences in the distributions of related variables for each source of infection. Results: Of the 627 confirmed cases, 38 (6.1%) were infections from overseas sources, 199 (31.7%) were from outside of Jeju Province, and 390 (62.2%) were from unknown sources. Jeju Province had no cases with an unknown source of infection during the first and second waves of the nationwide outbreak. Conclusions: Infections from overseas sources could be blocked from spreading to local communities in Jeju Province by conducting screening at the airport, along with the preemptive suspension of visa-free entry. In addition, considering the scale of the nationwide outbreak, measures must be established to delay outbreaks from unknown sources of infection caused by sources outside Jeju Province. Key words: COVID-19, SARS-CoV-2, Outbreaks, Communicable disease control INTRODUCTION caused by severe acute respiratory syndrome coronavirus 2; since then, COVID-19 has become a pandemic posing a global On February 11, 2020, the World Health Organization offi- threat to public health, with outbreaks continuing worldwide cially designated the disease that had been referred to as the as of March 2021 [1]. In Korea, the first confirmed case was re- “novel coronavirus” as coronavirus disease 2019 (COVID-19), ported in a Chinese tourist who passed through immigration on January 20, 2020. The crisis alert level was subsequently raised to the highest level (level IV) on February 23, 2020 [2]. Received: May 24, 2021 Accepted: June 16, 2021 Jeju Province, which consists of islands located at a consid- Corresponding author: Jong-Myon Bae Department of Preventive Medicine, Jeju National University College erable distance from the Korean mainland and offers visa-free of Medicine, 102 Jejudaehak-ro, Jeju 63243, Korea entry for overseas travelers, immediately suspended visa-free E-mail: [email protected] entry on January 27, 2020, because of the influx of COVID-19 This is an Open Access article distributed under the terms of the Creative Commons cases from overseas. Since the nationwide level IV (highest) Attribution Non-Commercial License (https://creativecommons.org/licenses/by- alert was issued on February 23, 2020 [2], Jeju’s response was nc/4.0/) which permits unrestricted non-commercial use, distribution, and repro- duction in any medium, provided the original work is properly cited. considered preemptive. However, despite this preemptive re- PB Copyright © 2021 The Korean Society for Preventive Medicine Copyright © 2021 The Korean Society for Preventive Medicine 245 Moonkyong Hwang, et al. sponse, an unofficial report of the Jeju Provincial Office indi- Ethics Statement cated that a Chinese resident of Wuhan had stayed in Jeju as a This study was approved by the Institutional Review Board tourist without a visa from January 22 to January 25, 2020, of Jeju National University (2021-035). and was confirmed to have COVID-19 on January 30, 2020, af- ter returning home [3]. That report clearly illustrates the risk of RESULTS the introduction of an infectious disease to Jeju Province fol- lowing a pattern distinct from that affecting the rest of the Distribution of Sources of Infection country. Of the 627 confirmed cases, 38 cases (6.1%) were from over- As of March 2021, more than 1 year has passed since the is- seas sources, 199 cases (31.7%) were from other provinces in suance of the level IV alert, with 3 outbreak waves occurring Korea, and 390 cases (62.2%) were from unknown sources (Ta- nationwide [4]. Jeju has had 627 confirmed cases to date. ble 1). Among those with an overseas source of infection (trav- Thus, this study aimed to analyze the sources of infection of eled overseas or had contact with someone who had traveled COVID-19 in Jeju Province. This study will serve as the basis for overseas), most had a history of visiting foreign countries (37 establishing Jeju’s own quarantine strategy to prevent the in- cases, 5.9%). flux of infectious diseases from overseas sources [5]. The cases with a source of infection from other provinces were METHODS Table 1. Coronavirus disease 2019 cases by sources of infec- tion This study included confirmed patients in Jeju Province who Group Source of infection n (%) tested positive for COVID-19 by reverse transcription-polymerase Total 627 (100) chain reaction (RT-PCR). Accordingly, 627 cases confirmed be- Group A (n=38) tween February 21, 2020, when the first confirmed case was Source from a. Imported cases 37 (5.9) overseas reported in Jeju Province, and March 31, 2021, were selected b. Linked to imported cases (a) 1 (0.2) from the database of the Integrated Management System for Group B (n=199) Source from c. Visit/contact cases in other cities/ 97 (15.5) Diseases, an infectious disease-reporting system of the Korea outside Jeju provinces Disease Control and Prevention Agency (http://is.kdca.go.kr). province d. Major clusters of visit/contact cases in 52 (8.3) Information on the socio-demographic characteristics, in- other cities/provinces (c) cluding sex and age, and the clinical symptoms of confirmed Seogwipo-si, S sauna 7 patients was extracted from the database of COVID-19 reports Jeju-si, Development Center 5 of the Korea Disease Control and Prevention Agency and 627 Jeju-si, guest house 5 Gyeongnam Jinju-si, group training 14 in-depth epidemiology survey reports conducted by the six Jeju-si, mission group 12 public health centers within Jeju Province. We also reviewed Jeju-si, occupational rehabilitation center 9 COVID-19 statistical data from the Infectious Disease Control e. Linked to visit/contact cases in other 50 (8.0) Team of Jeju Province and broadly categorized the sources of cities/provinces (c) infection into the following three categories, based on the la- Group C (n=390) tency period of the virus and the timing of contact: (A) over- Unknown f. Major clusters in Jeju 244 (38.9) source of Jeju-si, high school 13 seas: confirmed patients who traveled overseas or came into infection contact with individuals who had traveled overseas, (B) out- Jeju-si East, religious facility 33 Jeju-si, academy 8 side Jeju Province: confirmed patients who had visited other Jeju-si, H sauna 86 provinces in Korea or came into contact with those who did; Jeju-si, live café 61 and (C) unknown: confirmed patients with no identifiable source Jeju-si, welfare facility for disabled 21 of infection in Jeju Province. Jeju-si, welfare facility for children 15 The chi-square test was used to analyze the differences in Jeju-si, restaurant 7 the distributions of the 3 sources of infection, with a statistical g. Under investigation 47 (7.5) significance level of 5%. h. Linked to under investigation (g) 99 (15.8) 246 COVID-19 Sources in Jeju Group A Group B Group C (n) Trend of Group A Trend of Group B Trend of Group C 300 240 250 190 200 140 150 90 100 50 40 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar -10 2020 2021 1400 120 000 3rd outbreaks 1st outbreaks (Nov 13, 2020- 1200 (Feb 18-May 5) Mar 31, 2021) 100 000 Large-scale outbreak 2nd outbreaks A large outbreak 1000 related to Shincheonji nationwide Church (Aug 12-Nov 12) 80 000 Small and medium-scale 800 clusters many outbreaks in the center of the 60 000 600 metropolitan area 40 000 400 200 20 000 0 0 Confirmed cases in Korea Cumulative confirmed cases in Korea Year 2020 2021 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Group A (n=38) People coming from overseas, sporadic individual cases (38) Linked Individual cases, Group B Individual cases, small-scale clusters by Visit in Daegu to small-scale clusters by (n=199) visit/contact case in other cites/province (4) Itaewon visit/contact case in other (161) Total club (1) cites/province (33) (627) Occurrence of the large-scale Group C cluster with unknown paths of (n=390) infection, individual and small-scale clusters between family members and acquaintances by contact with confirmed persons in Jeju (390) Figure 1. Trends of confirmed coronavirus disease 2019 cases in Jeju Province by month and year. Group A: confirmed patients who traveled overseas or came into contact with individuals who had traveled overseas; Group B: confirmed patients who had visited other provinces in Korea or came into contact with those who did; Group C: confirmed patients with no identifiable source of infection in Jeju Province.
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