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Wednesday, April 01, 2020

How South Korea Solved Its Face Mask Shortage

How South Korea Solved Its Face Mask Shortage

Neighborhood pharmacists and government intervention were the secret weapons.

Ed Jones/Agence France-Presse — Getty Images

The coronavirus erupted in South Korea in late January, six months into Yoo Yoon-sook’s new job. She had just moved from Seoul, where she spent three decades working in the same pharmacy, to open the Hankyeol (“Steadfast”) Pharmacy in the city of Incheon, near the international airport. Ms. Yoo hadn’t really gotten a sense of the neighborhood around her new pharmacy “before this all happened,” she told me. It became all coronavirus, all the time.

Incheon’s 1,100 pharmacies, including Ms. Yoo’s, began to sell out of KF-94 face masks, the equivalent of the American N95. So did corner stores and large retail chains like E-Mart. As Koreans learned of the scale and aggressiveness of Covid-19, first from Chinese reports, then from a surge of cases at home, the mask with the weave and construction that proved most effective against the virus could not be found, except at exorbitant prices online. Customers grew angry waiting outside stores. One Incheon pharmacy posted a sign saying, “Regarding masks: Threats, physical violence and insults against employees are punishable under criminal law.”

Such was the extent of the “mask crisis” when the central government decided to intervene in production and distribution. At the end of February, it announced that it would purchase 50 percent of KF-94 masks from the nation’s 130 or so manufacturers. The government began to ship these masks, at a discounted price of 1,500 won each (about $1.23), to some 23,000 pharmacies, in cooperation with the Korean Pharmaceutical Association.

Pharmacies would earn no more than a few dozen cents on each sale — a few even reported losing money because of credit-card fees — but they embraced their role in the epidemic response. Licensed pharmacists were ideally placed to answer questions about Covid-19, give instructions on social distancing and proper use of masks, and refer sick people to field testing stations and hospitals. (In rural areas of South Korea, where there are fewer pharmacies, agricultural cooperative offices and post offices sell the face masks.)

At Hankyeol Pharmacy, Ms. Yoo posted a sign on the door, telling customers that the sale of KF-94s would begin at 9 a.m. every morning. It was impossible to fill prescriptions or sell anything else during the mask rush. “All of us local pharmacists posted the various times of sale on our door and a map of all the nearby locations,” she told me. Popular mapping apps from Kakao and Naver also showed information on pharmacies and real-time numbers of available masks.

Ms. Yoo was initially allotted 50 masks per day, six days a week, but this wasn’t nearly enough. As South Korea’s infection and fatality numbers grew, people felt desperate for protection. Across the country, pharmacists continued to face long lines and insults when masks sold out.

On March 5, the government increased its share of mask purchases to 80 percent of national production. The following day, Ms. Yoo received a text message from President Moon Jae-in, addressed to “the pharmacists of Korea.” In addition to expanding mask manufacturing, the government was about to start a new rationing system.

“Starting today, 70 percent of all masks acquired through the public distribution system will be sold at pharmacies,” Mr. Moon wrote. “Pharmacies are the primary on-the-ground node in our public health system.” All citizens and registered noncitizens could buy two masks per week on an assigned weekday, depending on their year of birth — a system similar to one used in Taiwan since early February.

The Incheon Pharmaceutical Association encouraged its members to stay open on Sundays, to receive as many daily shipments as possible, so Ms. Yoo began working seven days a week. Her daily shipment went from 50 to 400 masks, with more on the weekends.

This week, the Centers for Disease Control and Prevention is weighing whether to recommend that everyone — not just health care workers and people infected with the coronavirus — wear masks. If this advice is issued, Americans may finally embrace wearing face masks, something that has long been common in East Asia, not only during disease outbreaks, but also during cold season and whenever air pollution levels rise.

Such guidance could also worsen the already dire shortage of N95 face masks and other personal protective equipment. 3M has promised to make more than a billion N95 masks by the end of the year. But without a vast expansion of complementary manufacturing or imports, supplies will be inadequate.

South Korea and Taiwan responded to their mask crises with significant market interventions. America needs to do the same. The U.S. government, and state and municipal bodies, should immediately enter into large-scale contracts to produce masks that can be sold at an affordable, standard price.

These masks (and other personal protective equipment) should go first to health providers and hospitals, then to essential workers in sanitation, warehouses, transportation, food service, child-care centers, and people in prisons and detention facilities. A distribution plan along the lines of those in East Asia could then get masks to the public, perhaps through pharmacies, corner stores and post offices. Some of those masks should also be allocated, free of charge, to people who are homeless or living below the federal poverty level.

For most of us, an N95 mask is not strictly necessary. Last weekend, I used a free online pattern to sew masks for myself and family members, using old handkerchiefs, shirts and elastic hair ties. I wore my homemade mask, reinforced with a large gauze bandage, to the grocery store and bodega, while trying to stay six feet away from fellow shoppers.

To survive this pandemic, we Americans must stop viewing masks as a sign of disease, and see them instead as a social kindness, a courtesy as common as “please” and “thank you.” As Choi Gwi-ok, a pharmacist in northern Seoul, told me, “Koreans wear masks to protect themselves from infections, but, even more important, to show consideration for others in public.”

Kuk Seung-gon, the president of the pharmacists’ association in Gimcheon, near South Korea’s Covid-19 hot spot, told me: “It’s been terrible to see what’s been happening in Europe and America. I really hope that, in the West, people develop a culture of mask wearing. A mask is not just for sick patients.”

By the end of March, the lines for masks outside South Korea’s pharmacies had become manageable. “Now that people are able to buy two masks per week, they feel reassured,” Ms. Yoo told me. “We pharmacists do, too.”

“After three weeks of constant work, the fatigue has built up. I’m very tired,” she said. But she feels a duty to the public, and plans to keep the pharmacy open seven days a week until the crisis is over.“

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