COVID-19 Medical Staff "End Impossible... Hospital Beds Must Be Secured by Changing Admission and Discharge Criteria" (Update)

Proposal at the Press Conference of the Central Clinical Committee on Emerging Infectious Diseases
Analysis of Clinical Data from 1,309 COVID-19 Patients
"Change Admission and Discharge Criteria to Secure Spare Hospital Beds"

On the afternoon of the 21st, Oh Myung-don, the Central Standing Committee Chairman, is presenting data at a press conference of the Central Clinical Committee on Emerging Infectious Diseases held at the National Medical Center in Jung-gu, Seoul.

[Asia Economy Reporter Choi Dae-yeol] Medical staff who treated domestic patients with the novel coronavirus infection (COVID-19) proposed changing the admission and discharge criteria to use hospital beds more efficiently. They believed that patients who have fully recovered and are no longer infectious do not need to be isolated and hospitalized. Concerns also arose due to accumulated fatigue among medical staff and the recent spread of the epidemic in the metropolitan area, fearing that a shortage of hospital beds, like the one in early March in Daegu, could occur at any time.

The Central Clinical Committee on Emerging Infectious Diseases at the National Medical Center announced on the 21st the results of analyzing clinical data from 3,060 domestic patients. This committee is a consultative body composed of medical staff and institutions responsible for treating COVID-19 patients in Korea. They analyzed clinical records of 1,309 adult patients aged 18 and over, whose clinical progress was confirmed over four weeks, and reached this conclusion. This is the first time that Korean medical staff have recommended medical guidelines tailored to Korea’s circumstances based on clinical data from a large number of patients.

The committee considered that high-risk groups should be prioritized for hospitalization based on age and degree of obesity. This includes patients with a body mass index (BMI) of 30 or higher (severe obesity), respiratory rate of 22 breaths per minute or more, systolic blood pressure of 100 mmHg or less (qSOFA score of 1 or higher), and those with underlying conditions such as diabetes, chronic kidney disease, dementia, or elderly patients aged 65 or older.

Patients with a low likelihood of worsening to severe disease were judged to be suitable for isolation at home or transfer to dedicated facilities for mild cases, such as residential treatment centers. These patients should be adults under 50 years old within 7 days of symptom onset, without dyspnea at diagnosis, and without underlying conditions such as hypertension, diabetes, chronic pulmonary disease, kidney disease, or dementia.

They also proposed using hospital beds more flexibly by assessing consciousness, respiratory status, and vital signs to determine hospitalization necessity. Applying these criteria, 777 out of the 1,309 analyzed patients would not require hospitalization, accounting for 59.3%. This means that hospital bed availability would increase accordingly.

On the afternoon of the 21st, at the press conference of the Central Clinical Committee on Emerging Infectious Diseases held at the National Medical Center in Jung-gu, Seoul, Bang Ji-hwan, head of the Central Infectious Disease Hospital Operations Center, is announcing the revised guidelines and recommendations in response to the resurgence of COVID-19.

Mild Patients Rarely Experience Symptom Worsening After Ten Days
Changing Criteria Could Make Over Half of Hospitalizations Unnecessary
Relaxing Isolation Release Criteria Could Shorten Hospital Stay by One Third

Bang Ji-hwan, Director of the Central Infectious Disease Hospital Center (Professor of Infectious Diseases at Seoul National University College of Medicine), said at the press conference, "Only 0.12% of patients with respiratory rates below 22 breaths per minute and systolic blood pressure above 100 mmHg, as diagnosed by medical personnel, progressed to severe disease requiring oxygen therapy." He added, "For low-risk patients, if there is a caregiver to report symptom worsening, hospitalization is not necessarily required, and home isolation is possible; if no caregiver is available, transfer to a residential treatment center should be considered."

The committee also judged that discharge criteria after hospitalization should be relaxed. They considered that patients under 50 years old who have not required oxygen therapy within ten days of symptom onset and have a caregiver could be considered for discharge. This is because only 0.2% of patients under 50 who remained in a mild state for ten days after symptom onset worsened to require oxygen therapy. No patients who had stopped oxygen therapy for more than three days worsened to the point of needing oxygen therapy again.

They also saw the need to relax isolation release criteria aimed at infection control rather than treatment. Since COVID-19 infectivity decreases around 5 to 8 days after onset, there is no need to isolate patients for a prolonged period. According to current guidelines, isolation release requires two consecutive negative results from PCR tests conducted one day apart, which can result in asymptomatic patients remaining hospitalized and preventing timely treatment for severe patients. Relaxing these criteria could reduce hospital stays by about one third.

Oh Myung-don, Chair of the Central Clinical Committee (Professor of Infectious Diseases at Seoul National University Hospital), referenced the delayed treatment of severe patients during the surge in Daegu, emphasizing, "Considering the characteristics of the coronavirus, the ultimate goal of infection control should be to reduce fatalities rather than complete eradication." He added, "There can be conflicting situations where infection control requires isolation because PCR tests are positive, but clinical judgment allows discharge because the patient has improved. I believe that clinical decisions should be made by medical institutions and physicians."

This content was produced with the assistance of AI translation services.