Korean hospitals went on heightened alert for local transmissions of the new coronavirus after the health authorities confirmed the new case with an unknown infection route on Sunday. Clinicians have to deal with increased uncertainties over when and from where a patient with the deadly virus would visit them.

The 29th confirmed patient with an unknown transmission route and with no overseas trip records, reminded some doctors of the MERS (Middle East Respiratory Syndrome) outbreak in 2015, which hit the nation with local transmissions.

The patient was an 82-year-old man who visited an emergency room of Korea University Anam Hospital on Saturday due to chest pain. Although the patient did not have any record of travel overseas, the emergency medicine specialist suspected him of viral pneumonia after checking the X-ray on the chest. As the doctor confirmed pneumonia symptoms through CT scanning, the hospital immediately quarantined the patient in the negative pressure room.

On Sunday, the patient, confirmed with the COVID-19 infection, was transferred to the Seoul National University Hospital. The Korea University Anam Hospital shut down the emergency room and minimized other people’s contact with the 29th confirmed patient, particularly with the quick and accurate judgment of the attending physician.

Ten patients contacted the 29th patient, and 36 healthcare workers are suspected of contacting him at the emergency room of the Korea University Anam Hospital.

The medical community regards the latest case as a signal that local transmissions have already begun. The health authorities decided to conduct a real-time polymerase chain reaction (RT-PCR) test on patients with pneumonia symptoms with unknown causes for the new coronavirus.

Small hospitals fret over suspected patient’s visit

Experts said hospitals should have a transparent medical delivery system to minimize confusion.

Physicians are already at a loss whether to see a suspected patient or not. Smaller hospitals and clinics, which have no authority to collect samples or quarantine a patient, hesitate to receive suspected patients. Even if a clinician finds a suspected patient and reports to a near public health center, the public health center asks the doctor to “care for the patient anyway,” a physician said. This means that small hospitals and clinics were already exposed to the risk of local transmissions, he added.

“Although we do not have an isolated screening room, we are strictly blocking the hospital entry due to concerns that a patient with the new coronavirus unaware of the infection may come,” a small hospital director said. “Because of the stricter entry control, the number of patient visits shrank by about 30 percent. But we have to keep tight management to prevent any visit from a suspected patient because that would damage us much more.”

Severance Hospital’s isolated examination room screens patients suspected of the new coronavirus infection.

‘Rearrangement of delivery system needed to prevent avoiding patient care’

To minimize confusion among physicians and accurately separate suspected patients, local hospitals should reestablish the medical delivery system, an expert said.

“Emergency medicine centers under tertiary hospitals in each city and province should divide 550 isolated examination rooms into two groups – one with hospitals able to collect samples for the RT-PCR coronavirus test and the other with those who cannot,” said Lee Wang-jun, the leader of the Working Group of the Korean Hospital Association’s New Coronavirus Emergency Response Headquarters, and chairman of Myongji Hospital.

If not, hospitals will pass patients on to each other, and the confusion could undermine the disease control.

Lee also said that public health centers should collect samples of a suspected patient if requested by a clinic or a small hospital.

During the 2009 flu pandemic, physicians could just put on a face mask and gloves to collect samples. However, they must wear full protective gear at a separate room to collect a sample of the new coronavirus, he said. This was why the bottleneck occurs in the collection of samples, he added.

“As hospitals have secured sufficient diagnostic reagents for the new coronavirus, private testing agencies and large hospitals can operate the RT-OCR test,” Lee noted.

The Korean Hospital Association said it would hold an urgent symposium with the Korean Society of Infectious Diseases on Wednesday to discuss the response system to fight the new coronavirus.

Patients should be divided depending on level of symptoms

Another expert said hospitals should have a system that divides infected patients into those with mild symptoms and others with severe ones.

Kim Hong-bin, a professor at the Infectious Disease Department of Seoul National University Bundang Hospital, said it was important to quickly find patients with local transmissions and stop them from spreading the virus to others. “What’s more important is to find and treat serious patients actively," he added.

Doctors should aggressively treat patients with severe pneumonia symptoms to lower the fatality rate, he emphasized.

The Korean Society of Infectious Diseases, the Korean Society for Healthcare-associated Infection Control and Prevention, and the Korean Society for Antimicrobial Therapy recommended that public health centers should screen patients suspected of the COVID-19 infection and state-run hospitals should treat those with mild symptoms. They also said university hospitals operating a state-designated quarantine room should focus on treating patients with severe symptoms.

“As suspected patients with mild symptoms got admitted to a state-designated quarantine room for a test and are discharged repeatedly, physicians treating confirmed patients are suffering a work overload,” the three societies said in a statement.

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