‘COVID-19 battle should shift focus from containment to mitigation’

Song Soo-youn  Published 2020.02.20  14:38  Updated 2020.02.20 14:38


As patients infected with the new coronavirus (COVID-19) spiked in the last few days in Korea, experts called for the government to revise its response strategy.

The increasing reports of local transmissions signaled that the fight against the novel coronavirus should focus more on “mitigation,” which is to divide patients depending on the level of symptoms, rather than on “containment,” which concentrates on isolating infected patients, they emphasized.

The medical community raised the need to rearrange the medical delivery system to take care of patients with a new type of infectious disease. To prevent a shortage of medical care, the government should ease the criteria for shutting down an emergency room and isolating medical staff, physicians said.

The Korean Hospital Association, the Korean Society of Infectious Diseases, the Korean Society for Healthcare-associated Infection Control and Prevention, and the Korean Society for Preventive Medicine held an urgent symposium at the Korea Press Center in downtown Seoul on Wednesday to discuss the response system to fight the new coronavirus.

The government has tried to slow the pace of local transmissions as much as possible with the containment strategy, but not is the time to move on to the mitigation strategy, panelists at the symposium said.

Lee Wang-jun (third from left), chairman of Myongji Hospital and head of the Working Group of the Korean Hospital Association’s New Coronavirus Emergency Response Headquarters, and other panelists discuss the response system to fight the new coronavirus at a symposium at the Press Center on Wednesday. The event was co-organized by the Korean Society of Infectious Diseases, the Korean Society for Healthcare-associated Infection Control and Prevention, and the Korean Society for Preventive Medicine.

‘Mitigation policy needed to reduce population density’

Ki Mo-ran, head of the Korean Society for Preventive Medicine’s COVID-19 Response Committee, and a professor at the National Cancer Center, said when the authorities identify a confirmed case of local transmission, it is the time to shift the strategy to mitigation.

“When a local transmission occurs, it is impossible to quarantine people who contacted the patient, epidemiologically,” Ki said. “Because the number of patients surges, those with mild symptoms should do a self-quarantine, and those with severe ones should be isolated at a hospital.”

The most notable difference between containment and mitigation lies in social difference, she noted. During the containment phase, the authorities strengthen the quarantine of people who contacted the patient and isolate all infected patients at hospitals. In the mitigation stage, however, it is impossible to screen people who contacted patients, and medical staff should distinguish symptom levels of patients, she added.

Office workers should not only enhance personal hygiene and environment but work from home for a limited time or use a flexible work hour schedule, Ki emphasized.

Eom Joong-sik, policy director of the Korean Society for Healthcare-associated Infection Control and Prevention, and an infectious disease specialist at Gachon University Gil Medical Center, proposed operating “Fever Respiratory Clinic” to separate moving routes of patients with the respiratory disease from those of other patients.

“Greater China with the experience of fighting the SARS (Severe Acute Respiratory Syndrome) outbreak operated respiratory fever clinics to isolate moving routes of respiratory disease patients from the entrance of the hospital,” Eom said. “We also need to secure an independent entrance and a separate patient care room.”

An introduction of fever respiratory clinics will require sufficient discussion, much workforce and resources, thus, the government should prepare for support and compensations for medical institutions willing to introduce it first, he said.

To meet the surging demand for collecting samples from suspected patients for the coronavirus test, hospitals should simplify the process of wearing protective gear to the level when they did to fight the MERS (Middle East Respiratory Syndrome) outbreak in 2015, Eom added.

‘Screening center-base hospital-severe patient treatment hospital needed’

Lee Wang-jun, the leader of the Working Group of the Korean Hospital Association’s New Coronavirus Emergency Response Headquarters, and chairman of Myongji Hospital, called the current situation of local transmissions “a gray zone.”

“To minimize confusion, we have to build a new COVID-19 medical delivery system by combining the response strategies against the 2009 flu pandemic and the 2015 MERS outbreak,” Lee said.

The start of local transmission in Korea was about two weeks later than Japan or Singapore, which means that the country successfully responded to the early stage of the new coronavirus outbreak, he added.

If public health center-centered isolation examination rooms are shifted to screening centers to collect samples from suspected patients, the bottleneck for collecting samples could be relieved, Lee said.

“Some medical institutions cannot see patients in separate spaces. So, we need to select those which can separate respiratory disease patients from existing outpatients and send respiratory patients there,” he explained.

Also, he went on to say that the government should designate regional emergency medical centers or higher-level hospitals as base hospitals for COVID-19 and make them serve as a triage to sort patients out.

Medical institutions with state-designated isolation wards should become tertiary hospitals to treat patients with severe symptoms, he emphasized.

Lee Sung-soon, director of the Inje University Ilsan Paik Hospital, said as the new coronavirus outbreak entered into a new phase of local transmissions, the containment strategy was no longer working. Instead, the medical community should concentrate on making an early diagnosis and lowering the fatality rate, he said.

“Except for Hubei Province in China, the fatality rate of the new coronavirus is about 0.3 percent. We should regard it as dangerous flu and set up response measures accordingly,” Lee said.

If a hospital shuts down an emergency room where a suspected patient visited and isolated medical staff for 14 days, other urgent patients could miss the right timing for treatment, he went on to say.

“If COVID-19 is as fatal as MERS or SARS, healthcare workers need an immediate quarantine in such a situation. If not, however, we should ease the criteria for isolating medical staff.”

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