[Weekender] COVID-19: The people who didn’t have to die

Not all lives lost due to the pandemic are from the virus. Nearly half a year into the coronavirus crisis, statistics show an uptick in fatality rates that are not officially linked to the virus, but may have been part of its repercussions.

According to data analyzed by preventive medicine professor Dr. Hong Yun-chul of Seoul National University, the number of excess deaths in Daegu -- the country’s former coronavirus epicenter -- was estimated to be 187 at the outbreak’s peak in March. This represents about a 15 percent increase from the expected death toll of 1,215, he said, explaining, excess mortality could be interpreted as “people who would not have otherwise died had it not been for the coronavirus situation.”

“Urgent and intensive care rooms are filling up with COVID-19 patients, leaving less space for other patients,” he said. “Korea’s health care system withstood the crisis better compared to other countries. But there needs to be measures in place to ensure care for non-coronavirus patients before there is another spike.”

Back in March, 17-year-old Jung Yu-yeop died in Gyeongsan, a city west of Daegu, after showing hallmark symptoms of the coronavirus such as a fever. Health authorities eventually reversed the diagnosis and concluded he wasn’t a case of COVID-19, but that was after he had already died from delayed medical attention due to infection concerns.

Speaking on the condition of anonymity, a staffer at the hospital where the teen had been treated said they were forced to be cautious. “The government said at the time medical institutions would be penalized for instances of COVID-19 spread, without offering any guidance on how patients suspected of infection are to be handled,” he said.

“The hospital was battling the outbreak at the very heart of the Korea’s epicenter at the time. Every day came with a fresh emergency. A lot of game time decisions were being made and you have to believe us when we say that in reaching each, we tried to minimize the risks for all those involved.”

Dr. Jang Yoo-suk, chief of the Korean Medical Association’s North Gyeongsang Province branch, said placing the blame on hospitals for the casualties was “convenient,” but by doing so institutional defects enabling such losses were being overlooked.

He said, for instance, there was a lack of resources to isolate patients with coronavirus symptoms from others -- ward that would allow suspected patients to receive care while they waited for test results. The teen’s death was “a tragedy that should not be repeated,” he said, but that it could easily happen again if the system was not remedied.

Jung was an example of “a patient we could have saved under normal circumstances,” said Pulmonologist Dr. Chun Eun-mi at Ewha University Medical Center in Seoul. “We do not lose a healthy teenager to a fever.”

Four months since the painful loss, not a lot has changed in the field, according to health care workers.

Dr. Paik Jin-hui, assistant director of emergency room at Inha University Hospital in Incheon, said patients displaying symptoms of COVID-19 were isolated and examined for signs of the infection before they can be treated.

“Our hospital is one of the better-equipped ones, with 11 negative pressure rooms. But once those get occupied, we have to ask the patients to wait. Otherwise we risk exposing other patients, who are among most vulnerable to the virus, to the infection, as well as the staff who can’t be easily replaced if they fall sick,” he said.

Another ER physician, Dr. Kim Ho-jung of Soonchunhyang University Hospital in Bucheon, said the volume of total emergency patients has decreased since the coronavirus started spreading here. “Now we are seeing a gradual rebound in patient numbers, save for pediatric patients. I think there may be patients who are choosing to skip or delay visits due to infection worries,” he said.

According to the National Emergency Medical Center’s data, 266 more people died in the emergency room in February and March than did so during the same period last year. The average time taken before an emergency patient is admitted was 110 minutes longer in April than the same month in 2019.

Experts say the increase in reported deaths at the ER may be attributable to the protraction in the average emergency response time. Seoul Metropolitan Fire and Disaster Headquarters’ data shows transport of patients with respiratory symptoms took about 11 minutes longer during first half of this year -- 36 minutes -- than last year’s figure of 25 minutes. The ambulances were also having to travel further to find a hospital that had the capacity to house the suspected COVID-19 patients -- an average of 6.2 kilometers, which is about 1.6 kilometers farther than last year’s 4.6 kilometers.

Addressing the possible oversights in the medical system, Ministry of Health and Welfare’s spokesperson Son Young-rae said based on raw numbers of deaths alone, the year-on-year disparity wasn’t too significant thus far.

“Making sure patients of diseases apart from COVID-19 are not missing out on care is just as an important task, as we brace for the pandemic’s lasting impact,” he said. To help cope with the demand, there will be separate clinics for respiratory patients and an expansion in virtual doctor’s appointments, he said.

Dr. Choi Kyu-jin of Association of Physicians for Humanism said now was time for complementing the loopholes in the health care system so that no one in need of care is neglected. “Concentrating all of our resources on COVID-19 might have been OK, or even the right response, when the cases were surging and containing the outbreak was a top priority,” he said.

“But if this situation is going to persist and a second wave is inevitable, as the health officials makes it out to be, how many more are we going to let become ‘collateral damage’ to the coronavirus battle?”

By Kim Arin (arin@heraldcorp.com)