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“Please rescue patients in nursing hospitals who are quarantined in a cohort and dying from being trapped like a Japanese cruise ship.” This is a desperate appeal that came up on the website of the Blue House National Petition on December 28, 2020. The author, who said that he was a medical staff at the Smile Medical Center in Guro-gu, Seoul, said, “One week before, a person who posted on the waiting list for emergency (Corona 19 treatment critically ill bed) and contacted him frequently, but did not receive a bed assignment, died again today.” At the Smile Nursing Hospital and nursing home, where the first confirmed case occurred on December 15, 175 people, including 94 patients, 53 carers, and 9 nurses, were infected by the 29th. Four of them closed their eyes in a nursing hospital while waiting for a bed. Yoon Young-bok, director of the Smiles Medical Center, said in a call that the contents of the national petition were true. “I have to separate the confirmed person out of the hospital, but that is not possible, so the infection of the patient and staff that was negative in the previous test continues. Even if the confirmed person becomes serious, we are helpless because we are not prepared for treatment of critically ill patients with infectious diseases.” About 30% (about 40 people) of the usual nursing staff and about 30 people in administrative positions remain, taking care of accommodation in the hospital and seeing 146 elderly patients, including confirmed patients (about 50 at the time), Yoon added. “Everyone is burned out and is on the verge of raising their hand.” In the past two weeks, there have been no medical staff or caring/administrative personnel that the Seoul Metropolitan Government or the Central Accident Control Center (heavy copy) has used to save patients in this hospital.

Elderly people who die while trapped in a nursing hospital

This is not the only site where Abi Gyu-hwan takes place in isolation from the world. As of December 29, 38 out of 175 confirmed patients died, including Hyoplus Nursing Hospital in Bucheon-si, Gyeonggi-do, Yangjiyoyang Hospital in Ulsan (243 confirmed, 24 died), and True Love Elderly Nursing Home in Cheongju, Chungcheong Province (108 confirmed, 8 died). There are a number of places where medical staff and caring personnel are struggling, such as the Smile Morning Care Hospital in Goyang, Gyeonggi Province (87 confirmed, 4 died). There were 55 confirmed patients who died in nursing homes or nursing homes for about 20 days from December 8th to 29th 0:00. It accounts for 16.5% of the 333 deaths of Corona 19 in December. The start of the tragedy lies in not preparing for the winter pandemic, even though it was predicted. The government neglected to secure hospital beds and did not establish a large-scale infection response system in nursing hospitals and nursing homes (senior care facilities). Patients in nursing hospitals and nursing homes are high-risk groups with underlying diseases in the elderly who can die from Corona 19. The lack of beds to accommodate them causes a surge in hospital infections, which in turn leads to a vicious cycle of exhaustion of bed resources and medical staff, and a surge in deaths. The structural issues were reviewed by comprehensive interviews with medical staff, nurses, and nursing care workers who experienced group infection in nursing hospitals and nursing homes directly or indirectly.

① Not’cohort (same group) isolation’, but simply neglect

In nursing hospitals and nursing homes where there are one after another, cohort (same group) quarantine is implemented. Cohort quarantine refers to quarantine by grouping the same group between confirmed patients and those exposed to the virus when hospitalization is impossible in one room per person. According to the government’s guidelines for responding to Corona 19, it is a’not recommended on a daily basis’ method. In the US Centers for Disease Control and Prevention (CDC) guidelines, “a cohort of confirmed patients is allowed, but suspects (contactors) are not recommended.” This is because some of the contacts may be incubated with no symptoms. Usually, when a confirmed person comes out of a group facility, access is blocked and a risk assessment is conducted to determine how much exposure to the virus has been made. People who are not likely to be exposed to the virus are sent outside, and contacts with potential infection are quarantined in a single room. If the number of wards compared to the number of contacts is insufficient and there is no choice but to keep several people in one space, measures such as placing the beds at least 2m apart can minimize further infection.

All confirmed patients, contacts, and general patients were left behind.

In nursing hospitals and nursing homes under cohort quarantine, there are two or three types of groups, such as confirmed patients, contacts, and general patients with no possibility of infection. This is because many of the confirmed cases were not transferred to a hospital dedicated to infectious diseases. Even if there is an extra bed, there is a limit to all elderly patients who need care as well as treatment in a situation where medical staff fatigue is high. Patients in nursing hospitals and nursing homes often have difficulty returning home because their families cannot afford to take care of them. Even if there is no possibility of infection, few hospitals or nursing homes try to receive patients where the outbreak has occurred. In this way, the three groups of confirmed patients, contacts, and general patients remaining in the hospital should be thoroughly separated. However, whether it is a nursing hospital established in accordance with the Medical Act or a nursing home following the Elderly Welfare Act, most of them are operated mainly in shared rooms, and the concentration within the hospital is high. In a situation where the number of patients does not decrease significantly, it is very difficult to adhere to the principles of infection prevention, such as placing a bed at a distance of 2m or more, separate use of toilets and showers, and designating areas for attaching and removing protective equipment. In addition, the risk increases as the ventilation system is insufficient or in a poor place where a small number of medical staff and care workers take care of several patients in a narrow space. The cohort quarantine applied to these facilities is said to be “not cohort quarantine, but simply neglected.” Seung-gwan Lim, co-director of the Gyeonggi Corona 19 Emergency Response Group (Chief Anseong Hospital, Gyeonggi Provincial Medical Center) said, “’Please remove even a few confirmed cases. That way, the confirmed and non-confirmed can be dispersed into different areas.”You need to subtract even a small number of confirmed cases to create a room where doctors and nurses can sleep. “I’ve been sleeping in the corridor for a few days,” he said. It’s not that they don’t know how to minimize infection, but that there are many sites that are difficult to do.

② Even uninfected patients have nowhere to send

In order to reduce the scale of infection and human damage in nursing homes and nursing homes, several infectious disease experts say that one group of both the confirmed patient and the contact person must be separated outside the facility. This is because the government has set out to designate a’nursing hospital dedicated to infectious diseases’ to accommodate minor confirmed cases in need of care. However, measures for dispersal of contacts as well as confirmed patients must be prepared. In the case of group infection at Yangjiyoyang Hospital in Ulsan, we can see the necessity of measures to disperse contacts. In this hospital, 167 patients, 22 nursing care workers, and 21 medical staff were all 243 confirmed (as of December 29th), and 24 died. As of this day, the total number of corona deaths in Ulsan City was 26. Except for only two, the remaining deaths came from one nursing hospital. After 91 confirmed cases occurred for two days from December 5, Ulsan City closed the hospital and implemented cohort quarantine. Ulsan City, which does not have a public hospital, relies on one Ulsan University Hospital for COVID-19 treatment. Compared to the metropolitan area, the outbreak was small and no other group infection occurred, but all of the elderly confirmed patients could not be transferred. It took 20 days for all elderly patients to be transferred out of the nursing hospital on December 24th. Meanwhile, as the confirmed cases continued to come out, Ulsan City tried to move the Eumseong patient to another place. In fact, a plan to evacuate the ward of a private nursing hospital and move the patient to quarantine was not realized. There was great opposition from the hospital’s medical staff and workers. It was necessary to build trust that infection control education and training can be conducted before the crisis hits to ensure their safety. Ahn Jong-jun, head of the Ulsan City Infectious Disease Management Support Division (Professor, Department of Respiratory Medicine, Ulsan University Hospital), said, “In preparation for group infections in nursing hospitals, we need to understand the status of local medical institutions in advance and prepare measures to reduce the density of the hospital, such as evacuating the ward and receiving relatively safe patients in an emergency.” . “With the current nursing hospital infrastructure and manpower structure, it will be difficult to respond appropriately to patients who can transition from negative to positive in another area, taking care of the increasing number of confirmed patients in one area.” “We can think of a way to have the hospital dedicated to quarantine treatment of contact persons.” These measures can be implemented only when a government-level compensation policy for quarantine treatment of non-diagnostics is in place.

The government should compensate for the quarantine treatment of non-diagnostics

③ People who need to take care of patients even if they are infected

A nurse in her 60s at a nursing hospital in the non-capital area has been confined to the hospital since mid-December and has been caring for patients for about 18 hours a day. As a confirmed case occurred among medical staff, the ward he was working for was cohort quarantined. More than 10 people are caring for 80 patients, which were usually treated by 20 nurses and nursing assistants. The number of nursing care workers in the hospital has also decreased. Some were infected and were being treated in hospitals, while others quit in panic. I have no choice but to work long hours. Mr. A and his colleagues disinfect the ward, except for the patient, and deal with room and board. “If I look at the patient for a few hours without being able to close my eyes, it is really scary and difficult that it will take me. But I cannot leave the patients alone.” Nursing hospitals used by patients in need of long-term care have fewer doctors and nurses compared to hospitals and general hospitals. The standard for placement of doctors in hospitals and general hospitals is 1 per 20 inpatients, and 1 per 2.5 inpatients for nurses. However, in the case of nursing hospitals, there is one doctor per 40 inpatients and one nurse per six inpatients. In the nursing home, there is one nurse for every 25 residents, and one nursing care worker for every 2.5 people. The fact that nursing hospitals and nursing homes do not have enough medical staff and caring staff is our bare face that has solved social care with minimal cost. When confirmed cases occur in nursing hospitals and nursing homes, the number of personnel, which was not enough, is greatly reduced. However, the input of manpower to help these sites is very slow. In the case of Bucheon Hyoplus Nursing Hospital, when the number of manpower decreased so that it would be difficult to see the patient any more after about a week after the first patient occurred on December 11, the heavy-duty manpower was used. On December 28th, 10 doctors, nurses, and nursing assistants who had remained in the hospital, and 21 patients who had been negative so far, all became infected. Earlier, the hospital’s medical staff declined the interview request and left this message. “No matter how well the article comes out, it will be difficult to find a way to solve the problem of being unable to remove patients from our hospital because there are no beds.”

Nursing hospital where patients take care of patients

④ Use of untrained personnel to increase the risk of infection

There are also unfortunate situations in which human resources cannot be helped even if personnel are put into the quarantine site. Due to the poor environment of nursing hospitals and nursing homes, where there is a double problem of’treatment and care’, they quit after a day or two, or are exposed to the risk of infection due to insufficient training. On December 21st, one nursing care worker in her 50s who was dispatched from Jungsubon to the Ulsan Yangjiyoyang Hospital was confirmed. To respond to these problems, Gyeonggi-do recently recruited 40 incumbent firefighters and reserve firefighters who are qualified as nurses or emergency rescuers. The manpower gathered in this way was organized into four groups of 10 people each and put them into group infection sites. Professor Ok Min-soo of Ulsan University Hospital (Department of Preventive Medicine) said, “In the long term, we regularly educate local general hospitals or public nursing hospitals to put them into the field when a group infection occurs, and to place personnel supported by the government in vacancies due to dispatch. We have to create a system to ensure safety.” ⑤ Patients missing from waiting for the government to reduce Corona 19 Christmas (as of 0:00 on the 25th), when the number of new confirmed patients a day reached the highest level (1241), Tae-ho Yoon, head of the Central Disaster and Safety Countermeasure Headquarters, at a regular briefing, “ We will do our best with the goal of reducing the number of waiting beds for more than one day to within two digits.” However, patients in nursing hospitals and nursing homes were omitted from the’waiting for beds’ that the government professed to reduce. This is because the’persons on standby for more than one day’ mentioned in the briefing refer to only those on standby at home. Those who die while waiting for bed placement in a nursing hospital are not included in the deaths while waiting for a bed. This is because only cases of death at home or in the emergency room are reflected in statistics. On December 20, the Central Defense Response Headquarters explained, “It is difficult to count (dead in the air) because patients who are admitted to medical institutions such as nursing hospitals receive medical treatment even when they are not in quarantine.”

You have to start with a detailed understanding of the situation

Information on changes in the situation of nursing hospitals, nursing homes, and welfare facilities for the disabled are not systematically collected due to the outbreak of group infection. In addition to the cumulative confirmed cases, it is necessary to know how many confirmed cases remain untransferred, how many non-confirmed cases, and how many internal and external personnel to treat and care for them to determine the actual risk of the site, but there is no such information. Director Lim Seung-gwan confessed, “In Gyeonggi Province, information was not properly collected.” “The reason the city, county and district data are not uploaded to the city and district is because the city did not request it, and if it goes back, the government did not ask for it,” he said. “We do not even have a status board on where and what damage occurs in a disaster situation.” According to data from the Ministry of Health and Welfare and the Health Insurance Review and Assessment Service, there are 1585 nursing hospitals in Korea (approximately 300,000 beds) and 3595 nursing homes (approximately 170,000 people). If you don’t do anything right now, the tragedy will go on endlessly.By Park Hyun-jung, staff reporter [email protected]