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https://doi.org/10.1177/0275074020942412
American Review of Public Administration
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Article
Introduction
The world is suffering miserably from the unprecedented and
unforeseen spread of a new coronavirus disease 2019
(COVID-19). Conventional approaches do not seem to work
in the face of new challenges with extreme uncertainty and
complexity. Many developed countries such as the United
States and Japan have not been successful, at least initially,
in their efforts to address this “wicked problem” despite solid
foundation, infrastructure, formal procedures, and resources
for managing disastrous events.
Although the numbers of confirmed and death cases are
still adding up around the world as we write this article,
some countries are impressing the rest by reversing the
curve early on and even declaring zero daily confirmed
case of domestic origin. Among them, South Korea has
shown notable performances:
Korea is the only country with a population of over 50 million
that has slowed the spread of the virus, and flattened the curve of
new infections without shutting down the country nor the city at
the epicenter of the outbreak, without imposing an extreme
personal travel or movement restriction, and without closing
airports or taking other authoritarian actions. (The Ministry of
Economy and Finance, 2020, p. 3)
Since the first case was reported on January 20, followed
by several spikes of cases in February, the number of daily
cases has declined to an average of 9 in the first week of
May. The number of active cases surged to 7,362 on March
11 but dropped to 1,264 as of May 10. Considerable world-
wide attention has been paid to South Korea’s response to
COVID-19 and what happened behind the scenes.
In this commentary, drawing on the literature of emergency
and crisis management, we examine how South Korea has
responded to the COVID-19 outbreak and managed the public
health crisis. We highlight the role of “distributed cognition” in
South Korea’s well-structured but remarkably adaptive crisis
management system. Distributed cognition refers to the cogni-
tive properties of a group implemented in the minds of mem-
bers of the group (Hutchins, 2000; Salomon, 1993). South
942412ARPXXX10.1177/0275074020942412The American Review of Public AdministrationLee et al.
research-article2020
1New York University, New York City, USA
2University of Central Florida, Orlando, USA
3The City University of New York, New York City, USA
Corresponding Author:
Chongmin Na, John Jay College & The Graduate Center, The City
University of New York, 524 West 59th Street, New York, NY 10019,
USA.
Email: chongmin20@gmail.com
Learning From the Past: Distributed
Cognition and Crisis Management
Capabilities for Tackling COVID-19
Seulki Lee1, Jungwon Yeo2, and Chongmin Na3
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) has presented an unprecedented public health crisis across the globe.
Governments have developed different approaches to tackle the complex and intractable challenge, showing variations in
their effectiveness and results. South Korea has achieved exceptional performance thus far: It has flattened the curve of new
infections and brought the outbreak under control without imposing forceful measures such as lockdowns and travel ban.
This commentary addresses the South Korean government’s response to COVID-19 and highlights distributed cognition
and crisis management capabilities as critical factors. The authors discuss how the South Korean government has cultivated
distributed cognition and three core capabilities—reflective-improvement, collaborative, and data-analytical capabilities—
after its painful experience with 2015 Middle East respiratory syndrome-coronavirus (MERS-CoV). South Korea’s adaptive
approaches and its learning path examined in this commentary provide practical implications for managing potential additional
waves of COVID-19 and a future public health crisis.
Keywords
COVID-19, public health crisis, emergency and crisis management, distributed cognition, state capability
2 American Review of Public Administration 00(0)
Korea experienced a different coronavirus, Middle East respi-
ratory syndrome-coronavirus (MERS-CoV) in 2015 and its
response failure contributed to the development of distributed
cognition. Based on the hard lessons and painful memory from
the 2015 MERS-CoV, fighting against the infectious disease
became the primary rationale widely distributed and shared
across the diverse individual actors in the immediate context.
Distributed cognition, in turn, triggered a set of structural
reforms aimed at enhancing three core capabilities for infec-
tious disease control—reflective-improvement, collaborative,
and data-analytical capabilities. We suggest that crisis manage-
ment capabilities and distributed cognition across diverse
actors are fundamental for managing potential additional waves
of COVID-19 and a future public health crisis.
Painful Past Experience of a Different
Corona Virus, MERS-CoV
In 2015, the outbreak of the MERS-CoV in South Korea
resulted in a public health crisis: An official total of 186
cases were confirmed, with 38 deaths and 16,752 suspected
cases. After the first case, confirmed on May 11, the number
of cases rose sharply over a short time. The number of daily
cases peaked on June 17 at 19, followed by the last case on
July 4. It was the largest mass outbreak of the disease outside
of the Middle East.
Studies of South Korea’s MERS-CoV outbreak highlight
the initial failure to contain the pathogen. Public health
authorities, not recognizing the potential risks, did not take
any preventive measures, resulting in a lack of cognition
among diverse actors in the health care system and general
citizens. The first patient visited three hospitals seeking
treatment, infecting 26 people, including health care work-
ers, winning the title of “super spreader.” This led to a vicious
cycle: Patients transmitted the disease to health care workers,
who in turn infected other health care workers and patients
(D. H. Kim, 2015). The government did not provide guide-
lines for isolation or fully conduct an epidemic investigation.
Although the infection was mostly nosocomial (intrahospital
and hospital-to-hospital transmission), the Korean govern-
ment refused to disclose information about the hospitals
where MERS-CoV patients had been treated.
Comprehensively, the MERS-CoV outbreak revealed
structural problems in the Korean infection management sys-
tem, including the following (D. H. Kim, 2015; K. H. Kim
et al., 2017; The Ministry of Health and Welfare [MOHW],
2016):
Lack of recognition of infectious disease risk
Failure of preemptive quarantines and isolation
Limitations in epidemic investigation
Inadequate health crisis manuals
Failure to identify an agency to act as the control
tower
Coordination disruptions among central and local
governments
Poor crisis communication by government
Inadequate hospital infection management and lack of
medical supplies/equipment
These reported problems suggest that the Korean govern-
ment approached the crisis in a convenient way, fitting it into
existing institutions and capabilities rather than adapting
these capabilities to the actual present challenge. For exam-
ple, health officials mechanically applied existing testing
standards, which later proved wrong, without learning about
the new disease. The response failed to exhibit the capacity
to recognize public problems, align collective efforts, and
adjust to a fluid situation. More importantly, the underlying
problem was the lack of “cognition,” defined as “the capac-
ity to recognize the degree of emerging risk to which a com-
munity is exposed and to act on that information” (Comfort,
2007, p. 187). The impact of the failed government response
to MERS-CoV was disastrous. It damaged the Korean econ-
omy and led to substantial social ills. Public trust in govern-
ment plummeted and fear of the unprecedented disease
outbreak grew.
The South Korean government turned this challenge into
an opportunity to fundamentally reform its crisis manage-
ment system and build its capabilities for problem-oriented
governance (Mayne et al., 2020). In the following section,
using Mayne et al.’s (2020) problem-oriented governance
framework, we describe how the South Korean government
implemented many changes to the design, processes, and
practices in disease control response after its experience with
MERS-CoV.
After the 2015 MERS-CoV: Developing
Capabilities for Infectious Disease
Control
Infectious diseases like MERS-CoV and COVID-19 reflect
complex, “wicked” problems in contemporary governance.
They are unprecedented and lack a set of clear causes and
scientific solutions. The recognition of wicked policy prob-
lems has called for problem-oriented governance, which
refers to “an approach to policy design and implementation
that emphasizes the need for organizations to adapt their
form and functioning to the nature of the public problems
they seek to address” (Mayne et al., 2020, p. 34). Learning
and adaptation are at the heart of this approach.
Problem-oriented governance is epitomized in the South
Korean government’s reform of the public health emergency
system. It engaged in reflective practices, revised laws and
manuals, redesigned work processes and organizational
arrangements, and invested in human resources and health
care systems. The learning and adaptation processes allowed
public health officials and diverse policy actors to share
Lee et al. 3
understandings of the problem and build core capacities for
future infectious disease control, namely, reflective-
improvement capability, collaborative capability, and data-
analytic capability (Mayne et al., 2020).
Reflective-Improvement Capability
Reflective-improvement capability refers to an “ability to
articulate a theory of change around a nominated public
problem and its ability to measure performance, learn, and
adapt” (Mayne et al., 2020, p. 37). Public health authori-
ties in South Korea conducted a careful evaluation to
extract lessons, implementing internal reviews (published
in Whitepaper, MOHW, 2016) and participating in the
voluntary World Health Organization (WHO) Joint
External Evaluation (WHO, 2017). Based on recommen-
dations from these reviews, specific legislation and guide-
lines have been developed, in hopes of avoiding the
mistakes of the past by ensuring the successful implemen-
tation of a common operating framework.
First, the Standard Manuals for Crisis Management were
revised to address coordination problems found during the
MERS-CoV outbreak.1 The Korean Centers for Disease
Control (KCDC) was promoted to a vice-ministerial-level
agency and designated as a control tower for infectious dis-
ease response. The KCDC amended its organizational struc-
ture (e.g., to establish the Emergency Operations Center
which works 24/7). The manuals specify the mission, task,
and specific procedures and actions to be taken by each cen-
tral and local government at each stage of emergency pro-
gression (Infectious Disease Alert Level 1–4). The manuals
have been revised annually (2017–2020) to accommodate
feedback from field officials.
Second, the Infectious Disease Control and Prevention
Act was revised to provide legal grounds for rigorous contact
tracing, quarantine measures, and the public sharing of
patient information. To facilitate early detection and isola-
tion, found to be critical during the MERS-CoV crisis, the
law mandated that the KCDC and local governments increase
recruitment and training in the epidemiological investigation
(requiring 30 officers in the central government and two in
each municipal/provincial government).
Third, the nosocomial transmission in 2015 highlighted
the need for improvements in health care infrastructure and
hospital infection management systems. The South Korean
government designated national and regional hub hospitals
(69 in total) and required medical personnel to research and
treat infectious diseases with financial support from govern-
ments. The Emergency Medical Service Act was revised to
minimize the risk of hospital transmission.
Changes to formal rules and governance arrangements
influenced working practices and informal norms. Shared
experiences and common training based on comprehensive
and granular manuals allowed multiple actors from different
organizations to share a “common operating picture”
(Comfort, 2007). Clear accountability structures enhanced
participants’ motivation to continuously learn and adapt.
Public health authorities committed to “correcting actions
that fail to address the problem and double down on reme-
dies that work” (Mayne et al., 2020, p. 34).
This set of reform initiatives was put to the test in
September 2018, when a single case of MERS-CoV was con-
firmed. Thanks to early detection and control measures, no
transmission was found. The reform process was iterative,
which Andrews et al. (2017) would call “problem-driven
iterative adaptation.”
Collaborative Capability
One of the lessons from the 2015 MERS-CoV experience
was that no single organization can tackle a public health
crisis. Resources, expertise, and skills are dispersed.
Coordination and communication between central and local
governments and across different sectors are vital to produce
concerted efforts. In 2015, there was confusion over each
party’s responsibilities and the barriers to information shar-
ing among governments. Comprehensive Public-Private
Response Task Force for MERS-CoV was created but with-
out empowering private professionals (KCDC, 2019).
Government organizations from different departments
and levels of government have built collaborative capability
by promoting information sharing, continuously revising the
strategies and manuals developed, and aligning their efforts.
The governments conducted multiple hands-on drills and
held common training every year. For example, the KCDC
Emergency Operations Center conducted emergency drills
using a scenario of the hypothetical Ebola outbreak that mul-
tiple central government departments, local governments,
and private sector experts participated in. Similar drills and
training were conducted at local governments and private
hospitals. Years of the shared experiences reinforced actors’
shared goals and motivation and thus enhanced the depth of
collaboration.
Empowerment enhanced mutual trust and joint capacity.
Health crisis governance arrangements were restructured
such that central governments empower local governments.
The Standard Manuals for Crisis Management require each
local government to form its Local Disaster and Safety
Countermeasures Headquarters (LDSCHQ). The Central
Disaster and Safety Countermeasures Headquarters
(CDSCHQ) should provide supplies, manpower, and other
necessary resources to the local counterpart.
In addition, the KCDC sought to build cross-sector rela-
tionships to leverage diverse skills and perspectives. It estab-
lished the Public-Private Alliance on Infectious Disease
Testing in 2017 and has strengthened the partnerships since
then. The role of public-private partnerships was critical in
the response to COVID-19 (described later).
4 American Review of Public Administration 00(0)
Data-Analytical Capability
The South Korean government strengthened its ability to
collect and analyze different types of data to implement the
common operating framework and facilitate cross-silo infor-
mation sharing. For example, health authorities recruited
more epidemiological intelligence (EI) officers and enhanced
training for them. The revised Infectious Disease Control
and Prevention Act allowed EI officers to collect information
necessary for epidemiological investigation (e.g., medical
records, location information). It should be noted that the
need for collecting privacy-sensitive data is carefully
assessed within the scope of the act (KCDC, 2020).
Another example is the data-sharing platforms. The
KCDC established International Traveler Information
System to share patients’ travel histories with hospitals when
needed (KCDC, 2019). Communication channels between
central and local governments were created to facilitate
information sharing (e.g., social media and daily meetings in
the outbreak of 2018 MERS-CoV).
The KCDC established the Crisis Communication Office
and 1339 Hotline Call Center in 2016. Information about a
disease outbreak, patients’ movement paths, and treatment
hospitals were fully disclosed when a MERS-CoV case was
confirmed in 2018, which is in contrast to crisis communica-
tion in 2015. Information disclosure improved civic aware-
ness and facilitated innovation including the development of
mobile apps, technologies, and products that proved fruitful
in the outbreak of COVID-19.
Three capabilities for the South Korean government’s
infectious disease response have been developed, imple-
mented, and reimagined over time. With years of the reform
efforts and shared experiences, diverse policy actors devel-
oped shared understandings of the problem. Goal-driven
learning and adaptation made South Korea prepared for a
future infectious disease, which unfortunately happened in
2020.
Response to COVID-19: Distributed
Cognition and Four Cs of Crisis
Management
South Korea’s response to the COVID-19 has been complex
and dynamic. Situations have been constantly evolving with
some unexpected incidents, that is, several mass-cluster-
infections. The whole response process has to cope with dis-
ease control with multiple other issues simultaneously. The
complex and dynamic situation challenges previous logics
and controls of formal response systems. Yet, the South
Korean government took adaptive and decisive approaches
supported by cognition, coordination, communication, and
control—four Cs of emergency and crisis management
(Comfort, 2007).2 It recognized the emerging risk before the
crisis occurred, intervened swiftly and effectively, and under-
took innovative actions. This was possible due to widely
distributed cognition and crisis management capabilities cul-
tivated from years of shared experience, repeated interac-
tions, routinized practices, and continued structural reform.
The process of building capabilities for infectious disease
control over the past 5 years instilled a crisis management
mindset into the infection management system actors and dis-
tributed cognition. Different actors might have different stakes
or interests for their involvement in the COVID-19 response.
However, the common goal provides the sense-making lan-
guage for communication across the different stakeholders,
which enables coordination among these diverse actors with
different capacities and resources. The distributed cognition
also supports the government’s decisions on the adaptive mea-
sures in taking control of evolving situations. The distributed
cognition has been supporting interdependent processes among
coordination, communication, and control requisite for collec-
tive COVID-19 response in South Korea.
In the following sections, we present multiple cases of
how the distributed cognition supported the collective opera-
tion among coordination, communication, and controls dur-
ing different phases of disease control (or crisis management)
in South Korea.
Before It is a Crisis: Cognition of the Emerging
Risk
Multiple cases of unknown pneumonia were reported in
December 2019 in China. The KCDC recognized the emerg-
ing risk and raised its infectious disease alert level to Level I
on January 3. Public health officials monitored the disease
and communicated relevant information with professionals
and stakeholders who readily understood the risk. Officials
also swiftly undertook the diagnostic kit development
(January 13). A shared understanding of the potential threat
between actors from different organizations activated the ini-
tial response to the approaching crisis.
Initial Response: Widespread Testing and
Contact Tracing
South Korea raised its alert level to Level II right after the
first case was confirmed on January 20. The KCDC began
identifying and testing suspected cases to halt the virus’
spread. Early detection based on widespread testing and the
epidemiological investigation was key to save a golden time
(Moon, 2020). At maximum capacity, 20,000 diagnostic tests
can be performed at 118 institutions (KCDC, 2020). A very
high level of testing capacity was possible due to collabora-
tive efforts between government, private organizations, and
professional groups. The KCDC developed the testing kit
(real-time reverse transcription polymerase chain reaction
[RT-PCR]) by collaborating with professional groups and
disclosed its technologies so that private companies produce
the kits (January 27). The Ministry of Food and Drug Safety
Lee et al. 5
granted fast-track approval on February 4. Shared motivation
and distributed cognition led to the coordination of diverse
actors’ efforts in one direction.
Adaptive practices and innovation also contributed to
massive testing. Public health centers and hospitals estab-
lished screening clinics to inhibit transmission at health care
institutions. This was informed by reflective learning from
the 2015 MERS-CoV. Health care professionals and govern-
ment interacted with each other sharing knowledge and
information and adopted drive-through centers and phone
booth–style testing facilities. In sum, South Korea has sys-
temized and diversified its operating models to respond more
effectively to the increasing demand for diagnostic testing
and treatment of infected patients.
Rigorous epidemiological investigations were conducted
based on the enhanced capacity of and investment in EI offi-
cers. KCDC officers were dispatched to regions with mas-
sive outbreaks to jointly conduct contact tracing with local
government officers. Governments disclosed investigation
results including patients’ movement paths. The disclosed
information was analyzed and used by private firms and citi-
zens who produced mobile apps and websites (e.g., patients’
movement path map). These examples illustrate cognition
dispersed across boundaries which led to concerted efforts
and innovative results.
Challenges and Adaptation: Sudden Surge of
Cases
Early detection along with isolation seemed to have brought
the outbreak under control. However, an abrupt surge of new
confirmed cases emerged, changing the situation upside
down. One patient, who participated in religious worship in
a church, infected many other members of the religious
group. The number of daily confirmed cases peaked at 909
on February 29 and they were clustered in the city of Daegu
and North Gyeongsang province. The surge in the region
went beyond the capacity of the region’s health care and dis-
ease control. The South Korean government raised its infec-
tious disease alert to the highest level on February 23.
Coordination and communication allowed for adaptive
and effective response. The CDSCHQ urged concerting all
the efforts across different levels of government and diverse
social actors to respond to the crisis. Central governments
provided supplies and resources and dispatched public health
officials and health care workers to the regions with the
patient spike. The patient management system was devel-
oped to classify the patients according to their severity for
more rigorous treatment in emergencies. Hospitals shared
sickbeds and facilities. Many doctors and health workers
volunteered to work at emergency medical centers to help
mitigate the crisis in Daegu and North Gyeongsang.
A number of new measures were developed in a short
period, which could have caused confusion. However,
distributed cognition and the mindset for crisis management
made the focus stay on the problem: tackling COVID-19.
Because diverse actors had years of shared experiences and
habituated practices and behaviors, coordination and com-
munication operated.
Civic Awareness and Citizen Cooperation
Upholding Government Response
Distributed cognition is evident in citizen participation in
South Korea’s response to COVID-19. Citizens, aware of the
disease risk, have practiced social distancing and face cover-
ings recommended by the government. Health care workers
volunteered to work at hospitals experiencing the spikes of
patients in Daegu and North Gyeongsang. Private firms and
ordinary citizens developed websites and mobile apps for
sharing disease information.3 The cognition of risk and the
importance of collaboration were shared by citizens as well
as governments and policy actors.
Conclusion
This commentary has demonstrated how South Korea
became a notable example to emulate for the COVID-19
response worldwide. In particular, we highlighted the distrib-
uted cognition and crisis management capabilities that have
been cultivated from years of shared experience, repeated
interactions, routinized practices, and continued institutional
and structural reform. The distributed cognition then sup-
ported agile coordination, transparent communication, and
adaptive control within and across the governments as well
as diverse stakeholders including the ordinary citizens in
South Korea so far.
Fortunately, many countries are seeing the flatten curve
after many weeks of aggressive isolation or lockdowns. Now
countries are preparing for cautious opening ups. Yet, before
the actual movement back to normal operations, many coun-
tries may want to check whether they have learned enough
from the recent harsh experiences with COVID-19 and
developed crisis management capabilities to deal with pos-
sible second or third waves that may be consequent from the
openings. In particular, they may want to start from whether
they established a certain level of distributed cognition
within and across the governments at all levels and all par-
ticipants of diverse segments of society.
By presenting and sharing the experience of South Korea’s
notable COVID-19 responses, we hope to provide some
administrative insights and practical implications for other
countries to think about, and to be better equipped for similar
disastrous situations in the future.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
6 American Review of Public Administration 00(0)
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
Notes
1. While South Korea has a relatively long history of building a
standardized operating system for emergency/crisis manage-
ment, politics intervened and impeded its progress. In 2003,
then-President Roh expanded the National Security Council
(NSC) and created the Crisis Management Center within the
presidential office, to function as a control tower to manage
crises. The NSC created standard manuals (33 in total) speci-
fying the basic structure of an operating system for emergency/
crisis management. Based on these official guidelines, each
department and agency developed its practical manuals (276)
and action plans (more than 2,400) with more details. This was
followed by multiple hands-on nationwide drills and training
to enhance the capacity in the field. As a result, Korea success-
fully controlled the very first coronavirus (severe acute respi-
ratory syndrome [SARS]) crisis in 2003, under the leadership
of the prime minister and NSC. However, the next president
nullified the emergency/crisis management systems for politi-
cal reasons. Consequently, Korea came to experience chaotic
situations when the second coronavirus (Middle East respira-
tory syndrome-coronavirus [MERS-CoV]) attacked in 2015.
As a long-time political comrade of the former President Roh,
the current President Moon reestablished the system by revi-
talizing and updating the discarded manuals right after he took
office in 2017.
2. The interplay among coordination, communication, and con-
trol seems a very classic emergency and crisis management
response approach in theory. Yet, the literature highlights the
difficulty of operation of such a classic approach in emer-
gency and crisis management practice (Comfort, 2007; Yeo &
Comfort, 2017). When diverse issues clash, often, rationales
and interest of individuals rupture what is rational for the
group (Hardin, 1968; Hutchins, 2000). Individual stakeholders
become passive and defensive to protect their stakes and posi-
tions from emerging tensions across diverse actors (Comfort
et al., 2019). To this end, distributed cognition is critical for
supporting interdependent processes among coordination,
communication, and control requisite for emergency and crisis
management.
3. One example is an online map showing movement paths of
coronavirus disease 2019 (COVID-19) patients (https://coro-
namap.site/). Developers made this geographic information
using the information provided by the Korean Centers for
Disease Control (KCDC).
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Author Biographies
Seulki Lee received her PhD in Public Administration from New
York University and joins the faculty in the School of Social
Sciences at Singapore Management University as of July 2020. Her
primary research focuses on accountability challenges in collabora-
tive governance. Other research interests include performance man-
agement, emergency management, and collective leadership.
Jungwon Yeo, PhD, is an assistant professor of public administra-
tion and emergency management in the School of Public
Administration at the University of Central Florida. Her pri-
mary research interests are organizational behavior, collective
Lee et al. 7
decision-making, interorganizational collaboration, accountability,
and emergency/crisis management. Her work has appeared in
American Review of Public Administration, International Journal
of Public Administration, Journal of Homeland Security and
Emergency Management, Natural Hazards Review, Safety Science,
and so on. She is a recipient of 2019 Emerald Literati Awards.
Chongmin Na, PhD, is an assistant professor of John Jay College
& The Graduate Center at the City University of New York. He is
a former staff member of the Crisis Management Center of the
South Korea’s National Security Council (NSC). His primary
interests are crime prevention/control, public safety, and crisis/
emergency management. His work has appeared in Criminology,
Justice Quarterly, Journal of Quantitative Criminology, Journal of
Research in Crime and Delinquency, Journal of Criminal Justice,
and so on. He received the 2014 Outstanding Article Award and
2017 Outstanding Contribution Award from the American Society
of Criminology (ASC).