Korea to expand at-home COVID-19 care in ‘phased return to normal’

South Korea is seeking to have more patients with less severe COVID-19 symptoms stay home from now on in a push to shift toward a more relaxed pandemic response, buoyed by progress in vaccinations.

The Ministry of Health and Welfare said Friday that as vaccination rates rise and Korea prepares to open up again, patients with mild or asymptomatic COVID-19 will be put in home isolation to protect the health care system from being overloaded beyond its capacity.

“In our path to a return to more normal, instituting at-home COVID-19 care is indispensable,” said Lee Ki-il, a senior official at the ministry, during a televised news briefing.

In a trial run, Gyeonggi and Gangwon provinces have been placing some of their patients under home care since late August, according to Lee. Some 60 patients are currently undergoing home care in the two provinces. Previously, home care was prescribed only for minors too young to be separated from their guardians.

So far Korea has isolated and treated all patients with confirmed COVID-19 either at hospitals or at nonhospital facilities called “community treatment centers” for those with mild or no symptoms. Explaining the departure from this protocol, Lee said, “The government is preparing for various situations that may emerge as normal life returns in phases.”

The ministry’s survey shows that the majority of Koreans favor the idea of having more normal and less restrictions. In the survey, which ran Aug. 30 through Sept. 1, 73 percent of respondents said they approved of a less restrictive strategy known as “living with COVID-19” that focuses on managing more serious cases needing hospitalization, rather than all cases.

While 41 percent said a “complete return” to life before COVID-19 would not be possible unless the number of new cases diagnosed each day dropped below 100, 52 percent agreed to a “gradual return” once 70 percent of people in the country are fully vaccinated -- meaning they have received all doses in a vaccine regimen.

Dr. Eom Joong-sik, an infectious disease specialist at Gachon University Medical Center, a designated COVID-19 hospital in Incheon, at-home care was a “necessary compromise.”

“Once the rules are eased, a further rise in cases will inevitably follow,” he said. “It will be hard to provide hospital care for all patients.”

For the home care system to be safe and successful, he called for a “triage process for carefully screening which patients are more in need of in-hospital care.”

Last month, at community treatment centers in Incheon and Asan, some patients died while waiting to be moved to hospitals. According to the ministry data, on average, about 16 percent of patients admitted to such isolation facilities have to be transferred to hospitals after developing more severe symptoms.

“This is why even if patients are mildly or minimally sick at the time of diagnosis, close monitoring is key. Symptoms can worsen rapidly overnight,” Eom said. “When at-home care becomes more common nationwide, patient monitoring will be a challenge.”

Home care should be a “last-resort measure,” according to Dr. Jung Ki-suck, former director of the Korea Centers for Disease Control and Prevention.

“Not all patients that initially show only mild symptoms remain so,” he said. 

“Home care means patients who would have been accommodated at community treatment centers will now be isolated at home. At the center, there are medical staff that are capable of running tests and responding to emergencies -- something that patients staying home will not have access to.”

He went on, “Until easily administered, oral drugs against COVID-19 become available, I don’t think home care is advisable.”

He added that isolating at home will not be plausible for people in multi-person households, pointing out that people had unknowingly spread the virus to others while in quarantine.

Meanwhile, the ministry’s spokesperson Son Young-rae said ahead of the weekend that Korea would be over the peak of the current, fourth wave of the COVID-19 pandemic later this month when the first-dose vaccination rate crosses 70 percent.

“The multiple simulations that have been run all led to the conclusion that transmission and hospitalizations will begin to fall in mid- to late September,” he said. Earlier this month, the ministry had said the ongoing wave was expected to peak “in a few weeks’ time” at about 2,000 to 2,300 cases a day.

In the latest 24-hour period, Korea found 1,755 positive cases out of 107,983 tests conducted, translating to a positivity rate of 1.6 percent.

So far, some 111,400 cases logged over the course of the fourth wave, which took off in early July, account for roughly 40 percent of all 272,982 cases documented here since the beginning of the pandemic.

Korea is on pace to hit the much-anticipated milestone of vaccinating 70 percent of the population with a first dose of a vaccine by next weekend, when the annual Chuseok holiday comes around. The deadline for the vaccination goal was set before the major national holiday to permit more freedoms at family get-togethers and celebrations.

Up to eight members in a family can gather this Chuseok if at least three are fully vaccinated. But gatherings solely among people who have had only a first dose, or none at all, cannot be larger than four.

The upcoming holiday will prove to be a “big test” before the surge can finally recede and Korea can move on to softened social distancing, the ministry said in unveiling the safety rules attuned to the season last week.

Eom of Gachon University Medical Center says only fully vaccinated people should be allowed to travel over Chuseok. “People who are unvaccinated or only partly vaccinated must stay put,” he said.

“Nearly 7 in 10 recently diagnosed cases are traced to Seoul and the surrounding cities. Travel can accelerate the spread to the rest of the country.”

By Saturday’s end, Korea had fully vaccinated 45 percent of its adults aged 18 and above, far below the minimum threshold of 80 percent outlined by the national disease control agency chief Jeong Eun-kyeong.

By Kim Arin (arin@heraldcorp.com)