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Перемогти коронавірус без диктатури та карантину: чого може навчити досвід Південної Кореї?

  • 4 Квітня 2020, 17:13
  • 135 Коментарів

Ще місяць тому здавалось, що Південна Корея програє боротьбу зі стрімким поширенням коронавірусу — за один день там виявляли по 600-800 інфікованих.

Тепер це число знизилося до 100. Корея змогла сповільнити епідемію і при цьому уникнути жорстких обмежень, соціального та економічного паралічу: її кордони відкриті, працюють магазини, ресторани та транспорт.

Як їй це вдалося, з якими викликами вона стикнулась і що з її досвіду можна перейняти?

Доступне тестування

Південна Корея є одним із світових лідерів за кількістю проведених тестів на коронавірус — їх зроблено вже 410 тисяч.

Чим більше хворих діагностують і чим раніше, тим швидше можна обмежити їхні соціальні контакти та запобігти поширенню інфекції.

Зазвичай корейці безкоштовно проходять ПЛР-тест за наявності симптомів хвороби та можливого контакту з інфікованими. Якщо, на думку лікарів, вагомих підстав для тесту немає, його все рівно можна пройти, заплативши 140 доларів. Якщо вірус виявлено, гроші повертають.

Протестуватись можна, не виходячи з машини. На десятках спеціальних станцій медпрацівники у захисних костюмах отримують інформацію про пацієнта та збирають матеріал для аналізу. Результат зазвичай стає відомим зранку наступного дня.

Доступність тестування допомогла Кореї справитися з блискавичним поширенням вірусу в другій половині лютого. 61-річна жінка, відома як «пацієнт №31», двічі відвідала службу в церкві «Шінчонджі» в місті Тегу.

Вона заразила декілька десятків відвідувачів, які швидко розповсюдили хворобу серед своїх родин та інших членів релігійної організації. 130 детективів Центру профілактики та контролю за хворобами та їхні помічники провели розмову із понад 240 тисячами членів церкви по всій країні і протестували всіх, що проживають в Тегу.

Близько 5 тисяч виявилися хворими, сотні з них — без симптомів.


Виявлення контактів хворих

Щойно стає відомо про інфікування, детективи розпочинають виявляти осіб, з якими людина контактувала і кого могла заразити. У неї збирають інформацію про всі контакти та пересування за останні два тижні.

Дані доповнюють за допомогою мобільного телефону, історії використання банківських карток та камер спостереження — завдяки запровадженій 26 березня програмі тепер це займає менше 10 хвилин. 

Зрештою, дані про пересування хворого публікують онлайн — без вказання імені. Всі жителі місцевості отримують смс-повідомлення про новий випадок та посилання на інформацію про хворого.

Ті з них, хто має симптоми чи контактував із хворим, розпочинають самоізоляцію вдома і проходять тестування.

Виявлення контактів не завжди є простим завданням. Наприклад, члени церкви «Шінчонджі» звикли тримати свою належність до неї у таємниці — вона має не найкращу репутацію. Не всі йшли на контакт із владою, а її лідера підозрювали у наданні неповних списків її членів.

Ще однією проблемою є порушення приватності пацієнтів. Хоча урядові повідомлення не вказують імен, інформація про них є настільки детальною, що стає нескладно зрозуміти, про кого йдеться. Це призводить до розкриття чутливої інформації та цькування в інтернеті.

Так, інтернет-користувачі звинуватили одного з пацієнтів у аморальності через те, що він довгий час перебував у районі «червоних ліхтарів». Згодом виявилось, що там він обідав у ресторані. Двох пацієнтів викрили у подружній зраді. 

Через страх людей страждають і заклади, які відвідували хворі — побачити їх на карті може кожен охочий.

Як наслідок, корейська влада тепер розкриває менше деталей про хворих — наприклад, не повідомляє про їхнє місце роботи.


Ізоляція ймовірних хворих та новоприбулих

Ті корейці, що близько контактували з хворими, обов’язково розпочинають 14-денну самоізоляцію. Якщо у них виявляють вірус, але симптоми мінімальні і не вимагають постійного нагляду лікаря, інфіковані залишаються вдома. 

Сім’я журналіста Ювона Парка опинилася в самоізоляції після того, як захворіла колега його матері. Вони добровільно встановили на телефон програму, що фіксує місце їхнього перебування за допомогою GPS.

При порушенні карантину лунає звуковий сигнал — як у пацієнта, так і у закріпленого за ним фахівця. До того ж, хворий двічі на день вводить, або повідомляє телефоном, інформацію про своє самопочуття. 

Кожен із пацієнтів отримує безплатний набір води та їжі вартістю $80, а також захисні маски, антисептики та спеціальний пакет для використаних гігієнічних засобів. Ті, хто не може працювати з дому, отримують фінансову допомогу.

28 березня кількість тих, хто одужав, вперше перевищила кількість хворих. Тепер близько 20-30% нових інфікованих складають ті, хто приїжджає до країни з-за кордону.

Віднедавна всі новоприбулі проходять обов’язкову 14-денну самоізоляцію вдома, а за відсутності адреси в Кореї — у спеціальних центрах на платній основі. Всіх приїжджих із Європи обов'язково тестують. За порушення карантину іноземцям загрожує депортація, корейцям — штраф у $8100 або рік ув’язнення.



Соціальне дистанціювання

В жоден момент епідемії Південна Корея не обмежувала пересування громадян, не забороняла роботу магазинів чи ресторанів. Припинили роботу лише навчальні заклади. 

Втім зараз — як у кризовий період в лютому — уряд проводить кампанію з соціального дистанціювання і закликає корейців уникати публічних місць та закладів. З 22 березня влада настійливо рекомендує церквам, кінотеатрам та спортивним центрам не приймати відвідувачів — або ж виконувати суворі вимоги щодо дистанції між відвідувачами.

Переважна більшість дотримується рекомендацій. Метро в Сеулі напівпорожнє, чимало ресторанів навіть у епіцентрі епідемії, місті Тегу, працюють, але клієнтів відчутно поменшало. Корейці є соціально активними, проте для багатьох дуже важливо не нашкодити іншим. Натомість вони відвідують кінотеатри та навіть церкви для автомобілістів — службу там можна слухати по радіо на парковці.

Є й винятки. Віряни деяких церков протестували проти закриття храмів через недотримання правил соціального дистанціювання. В іншій церкві 46 осіб заразились вірусом після того, як їм обробили горло спреєм із солоною водою, що мала захистити їх від хвороби. Всіх обробили одним і тим же розпилювачем.

З потеплінням людей на вулицях стає дедалі більше і дотримуватись дистанції стає складніше. Влада вже закрила популярний сеульський парк. Ймовірно, відмовляться і від відновлення навчання, яке планували на 6 квітня. Наразі корейці міркують над перегородками на партах та методами розсаджування школярів у класі.



Захист медперсоналу та маски  

Тоді як в Італії близько 10% інфікованих — це медичні працівники, у Кореї лікарі та медсестри склали 1% хворих. Жоден із них не помер. У корейських лікарнях якісна система захисту персоналу.

Наприклад, реанімації мають нижчий атмосферний тиск, що запобігає поширенню інфекції в інші приміщення.

Щоб захистити медиків, для тестування — крім станцій для автомобілістів — розробили безконтактні пункти. Тут медпрацівники не потребують спеціального костюму, який є тяжким та незручним.

Клієнт заходить у невелике приміщення, на кшталт телефонної будки. У ній для забору матеріалу на тест зроблено два отвори з рукавами для рук медпрацівника. Після кожного відвідувача її дезінфікують.

Крім того, тисячі пацієнтів із легкими симптомами не госпіталізують, а відправляють у тимчасові центри догляду. Приміщення надали великі корейські компанії, а персонал поповнили медиками-волонтерами.

Це знизило навантаження на медперсонал лікарень і дозволило надати допомогу майже всім, хто її критично потребував у період найшвидшого поширення вірусу. Також це більш ефективно, ніж ізоляція вдома — адже вона створює ризик для здорових співмешканців у невеликих корейських квартирах.

На думку корейських фахівців, захищає корейців і масове, хоча й не обов’язкове, носіння масок.

На початку епідемії ціни на маски різко підскочили, виникли черги. Владу критикували через експорт масок у Китай.

Згодом держава взяла під нагляд виробництво та розподіл масок, заборонила експорт і ввела штрафи за підвищення цін та нагромадження масок. Щоб знизити черги, право придбати маски в парні дні отримували лише народжені в парні дні. 

Масок досі бракує, тому передусім ними забезпечують медиків та правоохоронців. Всі інші отримують тижневу норму — 2 маски для дорослого.



Чи можна копіювати ці рішення?

Стримувати поширення вірусу без жорсткого карантину наразі вдається також Сінгапуру, Гонконгу і Тайваню. Вони не проводять стільки ж тестів, як Південна Корея, але лише частково обмежили звичне життя і спираються на раннє виявлення хворих, відстеження їхніх контактів та ізоляцію. У Тайвані та Сінгапурі частково закриті кордони, але відчинені школи.

Деякі оглядачі сумніваються у тому, наскільки цей досвід можна відтворити. Зокрема, підкреслюють культурні особливості — менше фізичних контактів, готовність іти на жертви заради безпеки інших, покірність владі та високу централізацію.

Втім начебто менш демократичні азійські нації уникнули настільки жорсткого обмеження свободи, яке зараз переживають європейські країни. Не завадила їм і висока щільність населення.

Частково успіх Кореї та інших азійських країн пояснює досвід попередніх епідемій. Саме після епідемії MERS у 2015 році Корея облаштувала лікарні, спростила бюрократичні процедури при розробці тестів та створила механізм реагування і координації дій різних міністерств. Як наслідок, розробляти тести почали ще до виявлення першого хворого, і невдовзі їх почали виробляти корейські компанії.

Більшість країн схожого досвіду не мають, а за кількістю хворих наздоганяють або вже перегнали Корею. Втім тестування, відстеження контактів, ізоляція залишаються універсальними складовими стримування вірусу. Їх все більш широко використовують європейські країни, зокрема Німеччина, та радить Всесвітня організація охорони здоров’я.

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