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2020.12.11 06:00 entry
2020.12.11 09:25 modified
Seung-gwan Lim, Director of Anseong Hospital, Gyeonggi Medical Center
Elevation of physical (social) distancing steps and preventive prevention of infection through epidemiological investigations and diagnostic tests rarely work. ‘K Defense’, which effectively prevented the first and second epidemics, disappeared as the number of new corona19 confirmed daily registered 600 people a day. We are now experiencing a real pandemic (infectious disease pandemic).
The problem of bed shortages is more serious than ever. In the metropolitan area, more than 500 patients were waiting at home because hospital beds were not assigned after the diagnosis was confirmed. There were days when the number of critically ill beds available immediately was practically nil in the metropolitan area.
Im Seung-gwan, director of Anseong Hospital of Gyeonggi Medical Center, said: “Not only beds for critically ill patients, but also general beds are insufficient. Director Lim, co-director of Corona 19 Emergency Response Group in Gyeonggi-do , has been in charge of medical response and patient treatment at a dedicated infectious disease hospital, the forefront of Corona 19, since the beginning of this year. He said, “It’s not just the time to think about the method in the first and second rounds, but now is the time to think about how to improve treatment efficiency with limited medical resources. “
On the 9th, I summarized the story I had with director Lim at the Kyunghyang Shinmunsa in Jung-gu, Seoul.
Lack of general beds, delay in hospitalization should be admitted
Waiting for pregnant women 2-3 days before delivery
Dialysis patient patience call 119
I don’t know about the government measures
-As in the first epidemic in Daegu, there are patients waiting at home because the beds are not assigned.
“In Gyeonggi province, it is common to wait 1-2 days because beds cannot be assigned as far as the situation is concerned and there are cases of waiting of up to 4 days. Last weekend, two weeks before the due date, a mother waited at home for 2-3 days and a dialysis patient called a 119 ambulance while waiting at home. One patient who was in a nursing hospital was unable to receive dialysis for 5 days and then everyone was disconnected. Similar cases are likely to occur in other municipalities ”.
-There are still hospitals and life treatment centers dedicated to infectious diseases. The Accident Control Headquarters (Jungsubon) explained that of 4,900 hospitals dedicated to infectious diseases, 1,700 remain (from 9 days) and another 2,000 people can enter the life treatment center.
“When the total number of patients is small, they can be unconditionally hospitalized in a hospital dedicated to infectious diseases. However, if the bed utilization rate (the proportion of beds in which patients are actually hospitalized) increases, there will be no choice but to wait. The fact that there is a qualification guideline does not mean that you can be admitted immediately. Hospitals typically assign beds based on severity, underlying disease, and gender. Hospitals are not a place where 100% of beds can be turned over at once. If the bed utilization rate is 90%, it is a receiving condition for many patients. “
Currently, treatment centers are limited
Participate in the treatment of hospitals for the elderly
Facilitate discharge standards and operate home care
Find ways to secure multiple beds
-Infectious disease hospitals and life treatment centers are also protected to prepare for the general bed shortage.
“If it happens on the same scale as now, it won’t last a few days. Even if a few thousand people are insured at the Life Therapy Center, if it continues to occur at a scale of 1,000, it will be completed in a few days. It is not a sustainable model. The Life Therapy Center is a “look-alike” medical institution. Although between 100 and 300 people are hospitalized, the number of doctors and nurses caring for these patients is much lower than in general hospitals. It can be effective for the “isolation” of confirmed cases, but it cannot serve as a medical institution. Approximately 40% of all confirmed cases must be in a real hospital to be managed ”.
-How to solve the problem of the shortage of beds.
“It cannot be solved one way. First of all, public hospitals cannot handle all confirmed cases, so it is necessary to participate in treatment in private medical institutions. Mokpo Medical Center offered to accept 30 patients from Gyeonggi province, but they have to travel 300 km. Finding a bed and sending a patient to an area hundreds of miles away is less efficient. The government must recognize and respond to the lack of beds and delays in hospitalization. The current government seems to be taboo on the term “home treatment”. Gyeonggi-do is operating a ‘home care’ system in which medical staff monitor their health status by phone once a day for confirmed patients waiting at home. Clinically experienced medical personnel can check the patient’s condition and provide psychological stability. On top of that, it’s time to find a way for patients who have fully recovered to go home early, or for children to consider treatment at home. “
Critically ill beds, it’s not just about securing numbers
-The number of critically ill patients is increasing rapidly. The National Medical Center said there are no beds available for critically ill patients in the metropolitan area, but the government announced that there were 10 to 20 beds available for critically ill patients.
“It happened because the government was unaware of the situation on the site. If there are 10 treatment beds dedicated to seriously ill patients in the metropolitan area, it cannot be used immediately. In a hospital dedicated to infectious diseases, one or two should be left for those who have the potential to progress to serious illness among bedridden patients in general. Private medical institutions are similar. In proliferation, where epidemiological investigations of confirmed cases cannot be performed correctly, confirmed cases are diagnosed in the emergency room as acute conditions. In hospitals, one or two beds should be left in critical condition. If you don’t know this reality and ask why it doesn’t offer a bed for critically ill patients, you won’t be able to trust the government in the field. “
-If so, how should I secure a bed for critically ill patients? The government said it will seek the cooperation of private hospitals for the elderly as much as possible. There was also an opinion in the medical community that a hospital dedicated to critically ill patients should be established.
“The total size of the beds exceeds 300 beds, and more private medical institutions with experience in intensive care treatment should join. It is a good idea for these medical institutions to provide a room (50 to 60 beds) as a general bed and some of the beds for critically ill patients. It is good to see a general patient and send him to a semi-critical bed if the symptoms become severe and if it worsens, a “ stepping stone ” and vice versa, a “ stepping stone ” in a hospital. It is unreasonable for patients and medical personnel to generally send patients to an area several tens of kilometers away when symptoms become severe. It is inefficient for private medical institutions to approach only one or two beds in critical condition to empty them. “
Do not use the first and second time methods such as distance.
-Despite the reinforcement of the distance step several times, the number of confirmed cases continues to increase.
“It is a property of a pandemic. If you compare it to a wave, the height of the wave keeps going up, but it gets bigger and bigger as it moves towards the 1st, 2nd and 3rd. The cycle of fashion is also shortened. The pandemic prevails in the form of an exponential increase in which the number of confirmed cases increases in square units. It seemed to decrease as I pressed the distance, but overall it is increasing. “
-It seems that the preparation scenario for the third outbreak was insufficient.
“The experience of being repressed in the first and second rounds gave me so much confidence that I ignored the nature of the pandemic. Of course, the current trend must be a distance away. However, distance cannot be the correct answer. I think only the natural sciences, not the behavioral sciences. Changes in the behavior of population groups due to remote fatigue and exhaustion are not reflected in the current system. I would like to point out the attitude that our society has had, thinking that the nature of the pandemic is not being studied and that quarantine or K distancing is the only answer. When I met the Korean Centers for Disease Control and Prevention after the Korean epidemic began in January, I realized that medical resources cannot be obtained by just consulting. In preparation for the third epidemic, it has also created a home care system, and said that it is necessary to establish a database of confirmed patients (DB) in case the number of confirmed patients increases. However, he ran into the limits of the bureaucratic system. Bureaucrats are not used to having to do things that are not in the usual division of labor and prepare for things that do not come. They told me, ‘I can’t do this even if I’m prepared like this, and I’ll do everything when I shut up.’
-How should we respond to the current 3rd trend and the 4th trend that may come in the future?
“In the first and second rounds, the method should not be considered the correct answer. The core of K’s quarantine is a “containment” strategy that quickly finds confirmed patients through tracing, testing and isolation, and sends them to a life treatment center for quarantine. It is effective, but it is a less effective method when the scale of the outbreak increases and medical resources are limited. Flexible ways need to be found to expand medical resources more actively, such as slightly loosening the discharge standard or introducing a home care system. Even if vaccination is possible in the second trimester of next year, the effect will only appear in the third trimester. Be humble about infectious diseases. Quarantine K may not always be the correct answer. “
