Doctors protest 20-day cap on ICU stay of COVID-19 patients

Front-line doctors in Korea are calling on the government to retract new guidelines limiting the amount of time COVID-19 patients can be admitted to intensive care to 20 days.

In an effort to ease the bed crisis, the government told hospitals last week that it would be imposing a cap of 20 days for how long a COVID-19 patient can stay in an intensive care unit. Beyond the 20-day period, the national health insurance waiver for COVID-19-related treatment costs will end for patients and hospitals will no longer be given aid.

Doctors at COVID-19 ICUs have asked for the discharge rule to be put off -- if not scrapped.

The Korean Society of Critical Care Medicine said in Monday’s statement that the hospital bed policies being put forth by the government jeopardized patient safety. They also said it failed to take into account the critical care needs of patients who don’t have COVID-19, as the patients will have to be transferred to other wards.

“The latest measures risk care not getting to patients who are critically sick, but not with COVID-19, in time, and the government should communicate these ramifications to the public openly and clearly,” the society said.

Past day 20, patients in COVID-19 ICUs will need to be transferred to other wards, most likely general ICUs, whose beds have been reduced a number of times to be turned into COVID-19 beds.

The society said decisions regarding the allotment of already strained critical care resources, which are rife with ethical implications, should have been preceded by a public conversation.

“By giving COVID-19 patients a priority in ICU admission, non-COVID-19 patients are being deprived of their chance at treatment,” it said.

The society said also being overlooked were cases requiring ICU admission that cannot be planned ahead of time, such as patients whose conditions deteriorate while in general wards, emergency patients who need to be shifted to ICUs and more.

Dr. Eom Joong-sik, an infectious disease specialist at Gachon University Medical Center in Incheon, said his hospital has decided not to follow the 20-day discharge rule.

“First of all, where would these ICU patients go? Hospitals have already maxed out their ICU and semi-ICU beds and are running at nearly full capacities,” he said.

Besides, although patients are believed to stop spreading the virus after about 20 days on average, putting them in non-isolation wards full of vulnerable patients was “risky, contagion-wise,” he said. Then there were patients who need to stay on ventilators and extracorporeal membrane oxygenation or ECMOs and in an unsafe conditions to be moved.

“So we’ve decided against following through with the government protocol at the expense of compromising the safety of patients,” he said.

Park Hyang, a senior Ministry of Health and Welfare official, told Tuesday’s briefing that based on the data of patients in the country, most patients stopped being infectious after seven days since symptoms appeared, and that by day 20, there was “almost no infectivity.”

She said there have been “a lot of instances where a patient would remain in ICUs out of insecurity or other circumstances,” rather than out of necessity, and the updated guidelines would allow hospitals to operate more economically.

But this may not necessarily be what is going on at hospitals, according to Eom of Gachon University Medical Center.

“I don’t think hospitals can afford to let patients overstay as it is. Isolation beds at emergency rooms are full of patients waiting to be admitted into a hospital for an ICU or non-ICU bed,” he said.

He added that doctors were facing a pressure to let patients go early. For one thing, they were having to justify through paper why a patient would need to stay longer than the government-set time.

In a Dec. 17 statement, the Korean Medical Association’s COVID-19 response committee pointed out that although the US CDC or the Europe CDC also recommend 20 days since the onset of symptoms for isolation to be lifted, that was not applicable for most hospitals in Korea.

“Most wards at Korean hospitals are multi-bed, including the ICUs,” the committee said. “For immunocompromised patients 20 days might not be enough to be clear them of infectivity.”

The committee also denounced the move to have ICU patients cover their medical bills after 20 days pass, saying that during a public health crisis like COVID-19, that fell within the government’s responsibility.

Meanwhile ICU beds for COVID-19 patients continue to remain around 85 percent occupied in Seoul and its neighboring cities. In the rest of the country the occupancy rate was 80 percent.

So far through December, 57 patients have died of COVID-19 each day on average, more than double the daily average of 25 seen in November. 

Since most restrictions were lifted on Nov. 1 in line with the government‘s plan to return to normal life, at least 52 patients have died while waiting for a hospital bed to open up, according to the official statistics.

By Kim Arin (arin@heraldcorp.com)