Adventure #2: How we traveled 6,700 miles for COVID tests (Part 2)

Part 1 of this post described our unsuccessful attempt to get tested for COVID-19 before leaving Philadelphia. What we found in Seoul is a completely different response system and a different set of priorities for managing the pandemic crisis. Here is the rest of our testing story, preceded by some background information I had fun researching.

According to Business Insider, in early March the U.S. “had done fewer COVID-19 tests per capita than many other countries with large coronavirus outbreaks.” Conversely, by February 28, just a few weeks after identifying the first case of COVID-19 in South Korea, that country was able to conduct up to 15,000 tests per day. The government initially covered the up-front cost of testing anyone with symptoms or with suspected contact with a confirmed case, and anyone else could be tested on request for about $125 USD. Even that fee is reimbursable through the national healthcare plan. Drive-through and walk-through testing also was quickly established (Lee & Lee, April 2020). In early June, the city of Seoul announced free COVID testing on demand for all residents (TBSeFM News, June 2020).

Comparing the number of coronavirus tests completed per capita in different countries is difficult because there are no requirements for how governments must report their testing numbers. For instance, South Korea counts the total number of people tested, and the U.S. counts the total number of tests performed. This means that if the same person is tested in the U.S. multiple times, including during a hospital stay when an individual could be tested many times, each test is reported separately. The U.S. also counts antibody tests in their reported total, which is not true in every country. (Mostly because the antibody test is not recommended for diagnosing current infections, including by the CDC.) Thus, even counting the number of tests performed per thousand people (a number that is often reported) is not terribly meaningful in terms of making comparisons (Our World in Data, August 2020).

There are some more meaningful numbers that can be used to discuss the level of testing in different countries. For instance, as of today the U.S. reports 12.2 tests completed per confirmed case of COVID-19, with a 10% positivity rate, while South Korea reports 174.5 tests per confirmed case, with a 0.9% positivity rate. For comparison, The Democratic Republic of the Congo reports 9 tests per confirmed case, with an 11.1% positivity rate. Although the U.S. has increased testing efforts substantially over the past few months, the 10% positivity rate suggests that still not enough people with mild and asymptomatic cases of coronavirus are being tested.

A lower number of tests per confirmed case suggests that a country is not testing widely enough to identify most positive cases, a measure that is thought to be vital in controlling virus outbreaks (World Health Organization; Our World in Data). This is the limitation that Peter and I encountered when trying to get tested in Philadelphia. Without testing asymptomatic people, it’s not possible to lower substantially the U.S.’s higher positivity rate. According to Johns Hopkins University, the WHO recommends a positivity rate of 5% or lower prior to a region re-opening, so this information really is vital to a society’s ability to function reasonably within the pandemic.

As of April 13, 2020, South Korea began requiring all inbound travelers from the U.S. to receive tests for coronavirus within three days of arriving in the country. When Peter and I arrived at Incheon Airport, one of the many screening stations provided us with information about where and how to get tested as quickly as possible upon our arrival in Seoul. Admittedly, we did have some challenges understanding exactly what to do given our limited knowledge of the Korean language, but we felt sure we could figure it out based on the information we had been given. Bonus: more incentive to work on our language skills!

Given the very strict quarantine requirements for travelers to South Korea, we felt some trepidation at leaving our apartment on our first full day in Seoul in order to walk to the Yongsan-gu Health Center. Thankfully, the government had provided some numbers we could call for information, and the official we reached kindly provided an English interpreter over the phone to assist us. After receiving reassurance that we could indeed leave our apartment for the purpose of getting tested, we took our only sanctioned outing for the 14-day period of our quarantine. Despite the rain, we felt grateful for the unexpected opportunity to be outside and moving!

We had no trouble finding the walk-through testing site at the Health Center, and everyone we met there was very helpful and reassuring. The only person with whom we had face-to-face contact assisted us in filling out paperwork (because we have already learned that in South Korea there is always plenty of paperwork!), and we encountered him outdoors at a distance while he wore full PPE. The second station was staffed by the person who received our paperwork and who communicated with us from behind a Plexiglas window, while she also wore a mask and gloves. At a third station, another person wearing a mask and gloves behind a Plexiglas window handed us our test kits, which we handed over at the final stop.

At the final station was the medical provider who administered our tests, which she did in full PPE and from behind a full Plexiglas window, out of which only her gloved arms emerged. Peter was most interested in this as he uses gloveboxes in his lab to work with samples. In this case, we were the samples in the glovebox! Thanks to this set-up, any potential exposure to the healthcare workers was negligible.

Based on the many reports I had heard about the potential discomfort involved, I was feeling anxious about getting tested. However, despite this site using the infamously uncomfortable nasopharyngeal swab along with a cheek swab, I didn’t find the test bad at all. It was a little uncomfortable, causing my eyes to sting and water, but the whole thing was over in 5 seconds. If I had to do it again I wouldn’t feel anxious. We were coached through how to break the swabs in the correct spot, place them in the test vial, and store them in a refrigerator on our side of the Plexiglas barrier, so the medical provider never had to handle our samples after they were collected.

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We were not asked to pay for the tests, regardless of the fact that we are not Korean citizens and are not currently covered by the national health plan. We were told we could expect a call with our test results within 48 hours. Only about 18 hours after we were tested, we received a text stating that we were negative for the virus. 6,700 miles from where we started, we had finally been successfully tested for COVID-19.