It has been 4 weeks since the transition to 'with Corona', a step-by-step recovery of daily life.
As the red light on the quarantine indicator lights up, voices are growing that it is difficult to catch the spread with the current quarantine guidelines.
The government announced on the 29th that it would announce measures to strengthen quarantine measures to counter the spread of the corona virus.
With Corona stood at a critical crossroads.
The increase in the number of confirmed cases after Weed Corona was expected to some extent.
Initially, the authorities predicted that the number of patients would increase two to three times during the gradual transition to normal life.
This included the premise that even if a breakthrough infection occurs, the probability of serious illness or death due to the effect of vaccination would fall.
With Corona implies that it will focus on preventing death and managing critically ill patients rather than suppressing the outbreak itself.
However, the situation took a different direction than expected.
There are not enough beds for critically ill patients.
[What's going on?] They said they were preparing for '10,000 people'... there are no beds in the hospital
As the number of confirmed cases increases, the shortage of hospital beds is serious.
There are virtually no intensive care beds left in the metropolitan area.
In fact, there are cases where the patient's condition worsens or death occurs while waiting for hospitalization because there are no hospital beds.
According to the Central Accident Management Headquarters on the 25th, the utilization rate of the critically ill beds in Seoul was 85.5% as of 5 pm on the 24th.
Only 50 beds can be admitted.
In the Gyeonggi region, 224 out of 271 are operating, with 47 remaining beds and a utilization rate of 82.7%.
In the metropolitan area, 83.9% of the beds are occupied.
The government said that it would send patients from the metropolitan area to regions with relatively low margins, such as Chungcheong and Gangwon, but the nationwide utilization rate was 71.5%, which is not a lot to spare.
As of the 25th, the number of people waiting for more than a day to be assigned a hospital bed in the metropolitan area is 940.
There were 433 people waiting for one day, 162 people with two days, and 140 people with three days.
The high-risk group with underlying diseases such as high blood pressure or diabetes is 99%.
It is a high-risk group for Corona, but the allocation of beds is delayed.
Corona patients who cannot receive a bed while waiting for hospitalization or die during bed assignment are also increasing.
The quarantine authorities announced on the 23rd that there were three confirmed cases of coronavirus that died while waiting because there were no hospital beds in the week from the 14th to the 20th.
Since the 31st of last month, before Weed Corona, at least 6 people have died while waiting in hospital beds.
This situation is very different from the 'resolvable level' that the government initially expected.
The government has announced that it will prepare to respond even if there are more than 10,000 confirmed cases a day.
However, the medical system is in emergency at the level of 4,000, which is less than half of that.
[What's the problem?] There are no beds, but the number of patients with severe cases is increasing.
What is exacerbating the sense of crisis is the increase in the number of severe cases and deaths.
The 'centralized neutralization rate', which worsened to severe after being confirmed, was at 1.6% until September, but rose to 2.6% in October and November.
Until September, 16 out of 1,000 confirmed cases had worsened to severe symptoms, but recently the number of worsening cases has risen to 26.
85% of patients with severe gastritis are older than 60 years of age.
The daily death toll was 39 on the 24th, the highest since the fourth epidemic.
The health authorities are also shocked by this result.
Son Young-rae, head of the social strategy division at the Central Accident Resolving Headquarters, said, “The current epidemic is at the level expected while recovering from daily life.
The incidence of severe cases is equivalent to the level of 5,000 new cases based on the previous confirmed cases,” he explained.
On the 5th and 12th, the government secured intensive care beds in the metropolitan area and semi-intensive care beds that can move the improved critically ill patients, and then secured semi-intensive care beds in non-metropolitan areas.
In the past month alone, he has issued an executive order three times and is moving with urgency.
Minister of Health and Welfare Kwon Deok-cheol said, "We plan to quickly secure 454 beds for semi-severe cases and 692 beds for moderate-to-severe conditions, and to efficiently operate beds with a focus on critically ill patients."
However, considering that it takes at least three to four weeks for the ward to be ready, it is difficult to avoid the point that he started his daily recovery without being sufficiently prepared and that the response was delayed.
[Why?] ⓵ Lack of beds? there is no system
The shortage of beds is also a problem, but it is difficult to allocate the existing beds because there is no bed allocation system.
The person in charge of allocating hospital beds in the metropolitan area pointed out that there is no 'systematic system'.
Currently, only the number of vacant intensive care units nationwide can be identified.
It is unknown whether there are medical staff and equipment to treat patients with severe coronavirus.
The person in charge of bed assignment has to call all hospitals one by one and ask if they can accept patients with severe coronavirus.
The process of receiving basic information about critically ill patients from public health centers and hospitals and checking whether they are hospitalized relies on KakaoTalk.
People in charge complain that they have to watch as many as 60 KakaoTalk rooms.
It is the public health physician who is primarily responsible for this task.
While doing patient care, they hold on to the phone and ask for permission to receive the patient at the hospital.
A system and control tower that can quickly identify critically ill beds are urgently needed.
Click▶ "You have to call the hospital one by one..." There
is another problem with
unsystematic bed allocation
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Even if there are beds, treatment is not easy without medical staff.
The medical community points out that the physical strength of doctors, nurses, and administrative personnel in the respiratory medicine department and intensive care unit, which mainly treats corona patients, has reached the limit.
Due to the shortage of manpower, there are also many university hospitals that have had to reduce the number of critically ill beds that need to be increased.
A sharp increase in the number of patients cannot increase the number of specialists in a short period of time.
There is an urgent need to expand medical manpower and support measures, but there are critics about what they have done in the meantime.
[Why is that?] ⓶ Is the death toll in severe cases increasing? Two reasons the government said
The government sees two reasons for the high number of severe cases and deaths despite the 80% vaccination rate.
Breakthrough infection among the elderly and increase in those who are not vaccinated.
Jung Eun-kyung, director of the Korea Centers for Disease Control and Prevention, said on the 22nd, “As a result of analyzing the effects of infection, severe severity, and death of the corona vaccination for people 12 years of age or older for 9 months from February 26 to last month 13, the risk of infection in the unvaccinated group was 2.3. The risk of death was increased by 11 times, and the risk of death was 4 times higher.”
Quarantine authorities said that even if confirmed, those who received the vaccine are less likely to develop severe or death.
The government cited the rapid decline in the effectiveness of vaccination among the elderly as the main cause of the surge in the number of severe cases and deaths.
It was analyzed that as the effect of preventing infection or preventing the severity of infection among the elderly who completed vaccination in the first half of the year decreased, a cluster outbreak occurred mainly in nursing homes and nursing hospitals, and the fatality rate rose more than expected.
For this reason, it is emphasized that a booster shot (boost shot) is necessary.
[What will happen?] Damage to patients with other diseases has begun
As critically ill patients are being used as corona beds due to the rapid increase in patients with severe cases, serious patients with other diseases such as cancer cannot be treated in a timely manner.
In the case of large hospitals, the waiting time for organ transplantation, cancer patients, and cardiovascular disease patients has increased.
As medical personnel and systems are concentrated on treating corona patients, other urgent patients are being harmed.
This phenomenon is not unique to Korea.
A professor at Harvard Medical School in the United States said that the number of cancer patients in the United States has recently been decreasing.
Because patients who should be diagnosed with cancer are being pushed behind because of the corona virus, it means that they are not finding the cancer they need to find in time.
There are also signs of this in Korea.
An official from a large hospital said, “The intensive care unit beds are full due to corona patients, and terminal cancer patients are moving from one hospital to another.” “In the end, after going home and holding on to death, they went to the emergency room to perform CPR and ventilator treatment. He died while receiving it,” he said.
The Korean Academy of Critical Care Medicine emphasizes that the government should make efforts to minimize the gap in the treatment of critically ill patients, not the Corona virus, as it is difficult to predict the future situation, such as the number of patients with severe cases recording a daily high.
“As the number of non-corona intensive care beds has been reduced, there is concern that high-level operations such as cancer, organ transplantation, heart and brain surgery that require intensive care will be delayed, and critically ill emergency patients will not be able to receive appropriate treatment,” the society said. .
[What should I do?] Reinforcing social distancing?
There is no choice but to be cautious about raising the level of social distancing. The announcement of measures to strengthen quarantine measures scheduled for yesterday (26th) was also postponed without a conclusion. Some in the medical community argue that the level of social distancing should be raised again and the quarantine should be tightened. However, there was great opposition from small business owners and self-employed groups saying that the economy could no longer be ignored. There are also ongoing criticisms about the effectiveness of raising the level of distancing. The main targets for social distancing, such as restrictions on restaurants and bars, are those in their 50s or younger who are active in social activities. However, most of the seriously ill patients are the elderly over the age of 60, especially those in nursing homes, who are not the main targets of social distancing. Those who are subject to strengthening social distancing and those at risk of severe corona virus are different.
The government's measure to address the shortage of beds is to expand home treatment. The plan is to reduce the burden on the medical system by encouraging people to receive treatment at home unless it is a dangerous situation that requires hospitalization and intensive treatment. Home treatment subjects are asymptomatic or mild confirmed cases under the age of 70 without hospitalization factors. Those over 70 years old can receive home treatment if there is a guardian and no hospitalization factors. The local government's patient management team has decided on the final target and is requesting and assigning it to a cooperating hospital for home treatment monitoring of COVID-19 patients.
Currently, more than two out of three confirmed cases in Singapore are being treated at home.
Hospitalization criteria are strict, with only 6% receiving inpatient treatment.
Only those who have severe symptoms, have a serious underlying medical condition, or who have been vaccinated over the age of 80 can be hospitalized.
They do so in order to maintain their ability to treat critically ill patients with other diseases, such as cancer, brain or cardiovascular disease.
Because the majority of coronavirus patients are being treated at home, Singapore's intensive care unit utilization rate remains at 55%.
This does not mean that the number of corona deaths has not increased, and the fatality rate is stable at 0.2%.
In order to expand home treatment, a treatment system that can supplement remote treatment centered on non-face-to-face treatment must be established.
Due to the current medical system in Korea, it is not possible to prescribe through remote treatment.
Along with home treatment, the government plans to speed up vaccinations, including booster shots.
Jung Eun-kyung, director of the Korea Centers for Disease Control and Prevention, said, "We will intensively carry out booster vaccinations with the goal of completing booster vaccinations for those aged 60 and over in December." We need to implement some policies,” he said.
Currently, the government is implementing additional vaccinations for some citizens, such as those vaccinated by Janssen, the elderly, and those living in vulnerable facilities.
Vaccination of children and adolescents will also be recommended.