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[김범수의 응시] Interview with Kim Yeon-soo, President of the National Association of University Hospitals
Seoul National University Hospital Director Kim Yeon-soo said in an interview with Hankook Ilbo on the 15th: “I agree with the expansion of public health care, but it is more important to create a structure that can provide doctors in connection with the National University Hospital instead of expanding the local medical centers unconditionally. ” An actor
The number of people infected with Corona 19 peaked last weekend, registering 1,030 per day. The rapid increase in confirmed cases, the largest since the outbreak of corona infection in Korea, is also a problem, but more serious is concern about the collapse of the medical system. Not to mention the metropolitan area, where patients are concentrated, hospital beds for corona patients are close to saturation across the country. The government has been quick to prepare measures, but the number of waiting patients is increasing, regardless of whether it is mild or severe.
How to overcome this crisis that occurred with the announced vaccine supply plan? On the 15th, I met the director of Seoul National University Hospital Kim Yeon-soo, who is the director of the National University Hospitals Association, where 10 national university hospitals, which are responsible local medical institutions, participate in the office. from the Director of Seoul National University Hospital. Director Kim has been co-chairing the Seoul Disaster Medical Council, which has been in operation since July, and is closely involved in the response to the coronavirus in the Seoul area, such as securing beds.
-The situation of Corona 19 is unusual. Vaccination has started abroad, but domestic vaccination is expected to take several months. What do you think will be the situation for the crown in Korea until the vaccine is delivered?
“The Infectious Reproduction Index, which means the number of people infected by a newly infected person, went from 1.5 to 1.6 in the middle of last month, but it fell a little and is now at a level of 1.2. . If this number is maintained, there will be 900 to 1000 new cases per day. However, I think the effect of increasing the distance, which started in mid-November, will gradually come off this week. The infection is already spreading in the community, so the number of 500 to 600 people will continue. However, this is not the end, but another peak may come after the Lunar New Year holidays, when the movement increases and the new semester begins in early March. After all, vaccines are a problem, but if you start at least part of it from March as you want, the effects can show up in May and June. “
-There are many accusations that the supply of vaccines is later than in other countries.
“The Pfizer and Moder vaccines available now are made in a new way called mRNA. Development was quick, but since I haven’t used it, long-term stability is not guaranteed. The safety of vaccines is as important as their rapid development. The government recently announced that it has secured a vaccine for 44 million people, of which the AstraZeneca vaccine, which had a pre-purchase contract for 10 million people, is a conventional method in which the target viral antigen is loaded onto another virus that does not harm the human body, so it is safer than the mRNA method. There is also the opinion that it will not be done.
The size of the vaccine in the population is also important, but the immunity of the population should be at least 60%, and if the scope is reduced a little, it can drastically reduce the social burden even if it only shoots up to 30% from high-risk groups, such as the elderly, nursing homes, and medical personnel. It’s true that vaccination was delayed compared to abroad, but I don’t think it would be practical to respond to the coronavirus. “
-The shortage of beds for corona patients has come to life. Since public health care alone is not enough, it is understood that the government and local governments are asking for cooperation in higher-level hospitals. Is there progress?
In total, Seoul plans to secure an additional 37 critically ill beds in one week. It is still sufficient for seriously ill patients. Just as important as securing an intensive care unit is having a bed for patients to move when their condition improves. It is a so-called step-down hospital and currently has two private hospitals in Seoul. If this number is increased to four, the efficiency of the existing intensive care unit will be much higher.
It is important to manage the situation so that at least the collapse of the medical system does not occur, since the spike can reappear even if this obstacle is overcome. In the case of Seoul National University Hospital, the number of critically ill beds that can be equipped with a ventilator has increased from 8 to 20 for the first time, while 35 beds are secured for corona. In preparation for after mid-February, 48 beds will be built in Seocho-gu, and the professor’s lab will be vacated and fixed at the hospital to add 24 beds. As important as the hospital bed is the medical staff, and if we recruit and train from now on, we will be able to respond to critically ill patients after the third epidemic. “
-There are voices of concern about the shortage of medical personnel.
“In the general ward, a nurse cares for 12 people during the day, but it is difficult to see two in the intensive care unit. Also, ICU nursing is not something that just anyone can do. You need to receive additional training. For several months she has been teaching nurses dedicated to the intensive care unit. Since it is not enough to call a nurse who has confirmed employment next year, he plans to hire 150 nurses with prior intensive care unit experience. An attempt is made to respond to the immediate need by reducing the functions of the existing emergency center to one third and placing the remaining staff in the intensive care unit.
Unlike the Daegu and Gyeongbuk days in February, the problem of shortage of medical personnel must be solved by region, as it spreads simultaneously. The metropolitan area still has a workforce. It’s not enough, but it’s not enough to collapse, and it’s not an anxious situation because if you do a good role-play, you can come back to a certain point. “
-There is a growing voice that private hospitals should provide beds for critically ill patients.
“You can’t say that private hospitals do 120%, but they do enough. What should the patient do if he gives up a bed to a corona patient and cannot perform the necessary treatment or surgery? There seems to be a story about the introduction of the hospital, but now the medical system is more likely to collapse because of it. At least in Seoul, there are no communication problems between the government and the hospitals. In other regions, support from private hospitals has started at the city level ”.
-After the crown, interest in expanding public health has increased. The government also recently announced plans to expand public health care in the medium and long term. How do you assess the state of public health in Korea?
“As a result of not investing in public health, the reality that the share of private health care exceeds 90% must be improved. However, just increasing local medical centers is not the solution. Even now, there are several medical centers in the provinces, but people are not doing well. National expectations for health care are high and dependence on high-end hospitals has increased. The quality of medical care is important, but the increase in local medical centers does not guarantee the attraction of good doctors.
The branches of the National University Hospital should be expanded and important regional medical centers should be incorporated and operated in the medical system. It is about increasing the number of teachers and doctors that will be sent to the medical center of the National University Hospital so that they can circulate. It was hot last summer due to the problem of establishing a public medical school, but it is necessary to carefully consider whether the area needs a medical school or a teaching hospital. It takes 20 years to establish a new medical school and train physicians, but it would be less reliable and less time to devote more physicians to national university hospitals in that area. “
-With the aging of the population, the medical burden increases. Can you handle the scale of medical staff right now?
“Medical demand will increase to 1.8 times by 2030. However, the number of students in medical school decreased from 3,300 per year in 2000 to 3,050 after the medical division of labor that year. Altogether, there have been about 6,000 fewer doctors so far. Expansion of the medical school grounds is worth considering. In this way, it is desirable to close the regional gap where doctors are concentrated only in the metropolitan area.
The aging of the population makes it difficult for patients to arrive at the hospital, which is why home health care must also be activated. People with medical education should be properly placed in the field of medical industrialization. Epidemiological researchers at the Korea Centers for Disease Control and Prevention, public health centers, and fire departments also need doctors, but they are now at 20% of the required scale. It is necessary to train more doctors and public servants, taking as a model the educational system in charge of the military doctor ”.
-Although this crisis has passed, another infectious disease situation may occur. If it makes any sense to supplement the answer so far.
“Through this Corona, if we put a digital platform in the middle, it is new that we can equally distribute scarce resources and predict situations with high precision. When data such as the age of infected patients, initial fever status, and respiratory difficulties accumulate, the model can be predicted, and when hundreds of thousands of such data are accumulated, it will be possible to know how the disease is going.
Pfizer and Moderna are making and using a vaccine in 11 months. This development platform can be applied equally to other viral infectious diseases. The next new vaccine against infectious virus diseases may come out in six to seven months. Humanity has raised the standard of medical care by trying a new approach to infectious diseases.
Corona is an infectious disease that has never been experienced, but since it has such achievements, there is no need to be overly anxious or panic. In Korea, the death rate is relatively low. If you keep the medical system well, you can keep it at its current level. “
Beomsoo Kim Editorial writer [email protected]
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