South Korea | 319,777 cases, 2,513 deaths (as at 5 October 2021)

South Korea’s decision to treat all cases within healthcare facilities highlights useful lessons for Victoria

South Korea, while initially struggling to contain COVID-19, quickly become a leading example on how to contain COVID-19 and embrace a ‘new normal’. However, the ongoing pandemic response, and repeated waves of infection demonstrate the need to ensure the health system is adequately prepared.

 

Quick response

South Korea, for its initial outbreak in Daegu, was quickly able to locally scale infrastructure and resources. In Daegu, officials created about 400 additional negative pressure beds during the crisis, while 2,400 additional healthcare workers were recruited and spread out among screening clinics, infectious disease hospitals, and community treatment centres. However, there was a shortage of hospital beds in the initial Daegu outbreak, with a triage system developed to manage demand.

 

Centralised approaches

After the Daegu surge, South Korea took a series of steps to manage capacity in the health system in preparation for any future outbreaks. A key feature of this was that the Central Disaster and Safety Countermeasure committee restructured the healthcare system to form six regional clusters (instead of 17 state and city jurisdictions) to make it easier to transfer patients between facilities and manage capacity. A variation of the triage system first used in Daegu was also used nationally, with four different categories: asymptomatic, mild, moderate, or severe. Asymptomatic and mild cases were placed in ‘community treatment centers’ instead of hospitals to help manage hospital demand but suppress the virus.

The South Korean Government also took the approach of designating hospitals as either ‘Infectious Disease Hospitals’, dedicated to COVID-19 treatment, or ‘National Safe Hospitals’ for people seeking non-COVID-19 treatment. This meant 43 hospitals, with 4,075 hospital beds, were meant to be solely focused on pandemic care. This centralised approach to hospital capacity has continued throughout the pandemic response, with government orders having since mandated that hospitals have needed to set aside at least one per cent and, for some, five per cent of their ICU beds to support pandemic care.

 

Need for capacity

South Korea’s health system is centred on hospital-based care. The number of hospital beds per capita, 12.3 beds per 1,000 population, is two times higher than the average in Organisation of Economic Cooperation and Development (OECD) countries. Yet, South Korea, despite its initial quick preparation and high numbers of beds, has struggled to meet the health system demand.

On three separate occasions in the past 18 months there has been an acute shortage of hospital beds. At one stage there were only 43 available ICU beds in the entire country, while in the Seoul metropolitan area, home to half of the country’s population, there were just six beds. This has continued despite government attempts, as above, to mandate COVID beds. Some have argued that the government’s delay in adding capacity to the health sector was due to complacency after its initial successful response. The situation, at times, has become so severe that beds have been built in containers. In recent months, this lack of capacity has prompted the South Korean Government to explore alternatives to treating mild and asymptomatic cases in ‘community treatment centers’.

 

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