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A cafeteria for elderly people operated by Yangcheon District reopens on Apr. 27 after being shut down because of the COVID-19 epidemic. (Park Jong-shik, staff photographer)

Apr. 28 marked the 100th day since South Korea saw its first confirmed case of the novel coronavirus. While the number of new cases had surged because of an infection cluster among members of the Shincheonji religious sect and infected people arriving from overseas, it has declined sharply in the last few weeks, falling to around 10 new cases a day. The government is likely to adopt a more relaxed approach to its social distancing guidelines on May 6, reorienting them to better suit people’s daily routines. Nevertheless, the country’s disease control authorities are determined to stay on their guard.

Jung Eun-kyeong, director of the Korea Centers for Disease Control and Prevention (KCDC), warned on Apr. 27 that “the COVID-19 outbreak is still in progress.” Previously, she’d voiced her concerns that Korea could see a second wave of infections this winter. Experts agree that if Korea is to prepare for that second wave — which could be triggered at any time by “silent spreaders” — it will have to focus on developing a robust system for treating serious patients and tracking down hidden patients.

The biggest problem during Korea’s surge of patients was the people who died while waiting to be assigned a hospital bed. Daegu and North Gyeongsang Province saw an explosion in the number of cases that led to a shortage of hospital beds.

COVID-19 patients in serious condition often suffer hypoxia, or a shortage of oxygen in the body. They require treatment by a trained medical staff with access to a heart-lung machine, which provides extracorporeal membrane oxygenation.

But because of serious regional disparities in the distribution of medical resources, a lack of preparation at the metropolitan or provincial level would inevitably lead to disaster. The disease control authorities have said the current healthcare system can handle about 50 new patients a day, but preparations should be made for even more cases than that.

There are 26 million people living in the densely populated Seoul Capital Area (SCA), which comprises Seoul and Incheon, along with Gyeonggi Province, which encircles the two metropolises. While Gyeonggi Province’s population is 30% larger than Seoul’s, the province has just five tertiary hospitals (and Incheon just three) compared to 13 in Seoul. (Tertiary hospitals are a legal category that includes Korea’s largest and most advanced medical facilities.)

Compared to Seoul, Gyeonggi also has a larger proportion of the crowded retirement homes and nursing homes whose residents are highly vulnerable to COVID-19. Gyeonggi has three and a half times the number of retirement homes (1,814 in Gyeonggi, 514 in Seoul) and more than two and a half times the number of nursing homes (345 in Gyeonggi, 124 in Seoul).

“Since the outbreak wasn’t very severe outside of Daegu and North Gyeongsang Province, I wouldn’t say that other regions have truly dealt with a coronavirus epidemic. If the SCA sees a sharp increase in patients, we’ll need to set up a cooperative system in which Seoul shares its medical resources for critical care with Gyeonggi and in which Gyeonggi, which has more available space, opens up residential treatment centers to Seoul patients with mild cases,” said Lim Seung-gwan, director of the Gyeonggi Province Medical Center Anseong Hospital.

“Private and public hospitals in each region should develop a network so that they can quickly share medical resources in the event of a surge of patients,” said Lee Gyeong-su, a professor of preventive medicine at Yeungnam University Medical Center.

Another challenge is to track down hidden patients who could set off huge transmission clusters. An analysis of some of Korea’s biggest clusters shows that 8.2% of patients at the call center in Seoul’s Guro District had no symptoms when they tested positive. That was also true of 30% of patients at the Uijeongbu branch of St. Mary’s Hospital, under the Catholic University of Korea, and 36% in Yecheon County, North Gyeongsang Province. Interestingly, four of the eight asymptomatic patients at the Guro District call center were released from quarantine without ever presenting symptoms, while the other four developed symptoms sometime after testing positive.

This is leading some to call for the establishment of an ongoing monitoring system to complement the current rapid testing system. “While the number of patients is decreasing, we don’t have any objective indicators to confirm whether infections are actually subsiding,” said Lee Jae-gap, professor of infectious disease at Hallym University.

That’s the background of an effort by the Korea National Institute of Health, which is affiliated with the KCDC, to collect a large number of samples from patients with the goal of determining the rate of antibody possession in specific groups.

“For us to predict how much damage might occur in the future and to devise contingency plans, we need to know how many patients went under the radar because they had very mild symptoms or didn’t even realize they were infected. But since we can’t test the entire population, we need to take appropriate samples from specific regions or high-risk group homes,” said Choi Won-seok, a professor of infectious disease at Korea University Ansan Hospital.

South Korea’s disease control authorities are already acquiring blood samples from people who gave blood in Daegu and North Gyeongsang Province, where there were a large number of patients. The authorities are also considering the option of running tests in connection with a national health and nutrition study.

Another vexing question involved apparently recovered patients who test positive again, who could be another vector for transmission. The number of such patients has been steadily rising in recent weeks, hitting 268 on Apr. 27. While the disease control authorities think such people have virtually no chance of transmitting the disease, since the positive tests are mostly picking up fragments of inactive viruses, they remain vigilant and continue to study the phenomenon.

By Choi Ha-yan, Park Da-hae, and Kwon Ji-dam, staff reporters

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