hankyoreh

Jeon Gwang-hun, a pastor at the Christian Council of Korea, leads a combined service at Sarang Jeil Church in Seoul’s Seongbuk District on Apr. 5, despite the government’s advisories against holding religious gatherings. (Baek So-ah, staff photographer)

Following the announcement that intense social distancing will be extended through Apr. 19 to stop the spread of COVID-19, the South Korean government is planning to have disease control officials focus on quickly identifying patients at facilities with a high risk of transmission. As more doctors and health workers fall sick with the novel coronavirus, the government has released new guidelines for preventing infection among medical personnel, which include setting aside a space for quarantine treatment in emergency rooms. Experts say the government should focus on preventing the spread of transmission in hospitals, especially in the Seoul Capital Area (SCA), and consider using the multiple sample techniques to expand testing.

The disease control authorities have credited two weeks of intense social distancing with reducing the number of COVID-19 cases of uncertain provenance from 37 (19.8%) on Mar. 6 to three (6.1%) on Mar. 31. The number of new transmission clusters has also fallen from 11 (Mar. 12-21) to four (Mar. 22-31).

“Over the next weeks, our actions will be informed by the view that our most critical task [is reducing] the occurrence of patients for whom the community transmission links are unclear,” said Kwon Jun-wook, deputy director of the Korea Centers for Disease Control and Prevention (KCDC), during a daily briefing on Apr. 5.

On the surface, there are no major differences between the first and second rounds of intense social distancing. Their main provisions are recommending the closure of churches, some indoor sports facilities, and nightlife establishments and requiring those establishments, if they do open, to abide by the guidelines provided by the disease control authorities.

During this second round of social distancing, however, the government has made it mandatory for large group facilities, including churches and nursing homes, to make someone responsible for carrying out regular quarantine checks and reporting the results. This person will have to check patients or workers at least twice a day for fever and, if any unusual symptoms are detected, to immediately discharge them from the facility and report the symptoms. The goal of these measures is to identify dangers at each facility at an early stage.

The disease control authorities have also developed measures for preventing transmission among medical staff, which include setting up a preliminary sorting station for patients and a quarantine treatment zone inside emergency rooms, developing a standard movement tracking model for screening clinics, and providing consulting about preventing transmission of the disease.

As of Apr. 3, 241 medical staff had been diagnosed with COVID-19, representing 2.4% of the total. 41.9% (101) of them were infected in their communities, while 27.3% (66) were infected during the course of providing normal medical care. The government has also decided to set up teams of infectious disease specialists in each region to provide one-on-one consulting for small clinics, nursing homes, psychiatric hospitals, and other medical institutions that are poorly equipped for handling infectious diseases.

Experts are in agreement that, in order to reduce the number of new patients and the percentage who are in critical condition, the government needs to expand its network of testing at high-risk facilities -- including retirement homes, nursing homes, and psychiatric hospitals -- in the SCA, where the number of patients has continued to rise.

“Since a considerable number of asymptomatic people are testing positive, it might be too late if we wait until fever or respiratory symptoms appear. Just as we were able to find more patients by testing all the residents at nursing homes in Daegu, we need to be expanding the number of facilities that are eligible for full testing,” said Ki Mo-ran, a professor of preventive medicine at the National Cancer Center. But because of the massive amount of testing this would involve, Gi said the government should try out multiple sample testing, in which several people’s samples are first tested together and then, if the results come back positive, are tested separately. Another option, Gi said, is population sample testing.

“The main thing is reducing the range of social activity inside the community, strictly policing both Koreans and non-Koreans who break quarantine, and preventing additional transmission inside hospitals. A critical question is how to prevent outbreaks at nursing homes, which have weaker infrastructure,” said Eom Joong-sik, a professor of infectious diseases at Gachon University Gil Medical Center.

The position of the disease control authorities is that the priority should be on investigating hospitals and communities where transmission is occurring sporadically, rather than on trying to test everyone at nursing homes in the SCA. When suspicious symptoms turn up at retirement homes or nursing homes, the authorities plan to first test a sample of residents there and, if some of them test positive, to test all the residents. At the same time, the government is considering the option of adopting the multiple testing approach, in which 10 samples would be tested at once.

By Park Da-hae, staff reporter

Please direct comments or questions to [english@hani.co.kr]