[Asia Exclusive] "Unprecedented Critical Juncture in 3rd Wave... Dedicated Hospitals Must Be Established"

Choedaejip, President of the Korean Medical Association

Shift the COVID Paradigm from K-Quarantine to Treatment and Infection Control

Urgent Need for Mid- to Long-Term Critical Care Measures
Government Policies Should Focus on Medical Institutions

[Asia Economy Reporters Seo So-jeong and Jo Hyun-ui] The number of new confirmed cases of the novel coronavirus infection (COVID-19) exceeded 1,000 over the past weekend, marking a major crisis. Unlike the first and second waves, which were limited to specific groups or facilities, the third wave is emerging simultaneously and sporadically throughout everyday life, posing a greater threat. Especially critical is the rapid increase in severe and critical patients as daily new cases surpass 1,000. Medical staff at various healthcare sites are struggling daily against the rising number of new cases while battling COVID-19. Although the government has secured hospital beds since the second wave in the metropolitan area last August, intensive care unit (ICU) beds remain severely insufficient.

As concerns grow that COVID-19 patients may not receive timely treatment, the Korea Medical Association (KMA) has raised its voice, led by Chairman Choi Dae-jip. Chairman Choi diagnosed the third wave as an "unprecedented critical turning point." Nearly 11 months have passed since the first confirmed case in Korea on January 20, but there is an underlying criticism that proactive measures were not properly taken. Chairman Choi asserted that the current "burning out medical staff" approach to quarantine is unsustainable for continuous K-quarantine. He emphasized the need to shift the COVID-19 management paradigm and actively seek mid- to long-term plans for efficient response. We recently met Chairman Choi at the KMA temporary office in Yongsan-gu, Seoul.

-Signs of prolonged third wave are emerging.

▲ Now, one year after the first confirmed COVID-19 case in Korea earlier this year, we face the crisis of the third wave. The KMA has expressed concerns and strongly urged the government to prepare from the early stages of the first wave, based on past experiences with novel infectious diseases such as the novel influenza and Middle East Respiratory Syndrome (MERS). Thanks to voluntary public cooperation and dedicated medical staff, the damage from the first and second waves was minimized. Compared to the unprecedented deaths worldwide, K-quarantine has been effective, but the pattern of the third wave shows the limits of the existing response system. Particularly urgent is the need for measures to treat severe COVID-19 patients. With nearly 1,000 new cases daily, the current medical system cannot cope.

-Is it necessary to raise social distancing to Level 3 in the metropolitan area?

▲ On the 1st of this month, the KMA already requested the government to raise social distancing to Level 3 through a government recommendation letter. Social distancing is the most effective means to prevent infection spread, but Level 2 is insufficient to curb the spread. The KMA’s concerns have recently materialized. Despite warnings in early to mid-month about the possibility of a large-scale outbreak and calls for a short-term, strong Level 3 social distancing for 1-2 weeks to preemptively block the wave, the government hesitated to raise the distancing level, leading to a surge in confirmed cases.

Designating and Operating COVID-19 Dedicated Hospitals
Practical Efforts Needed to Reduce Mortality

-You mentioned the need to shift the K-quarantine paradigm.

▲ The COVID-19 management paradigm should shift from "quarantine" to "treatment and infection control," with government measures and support focused on medical institutions. This means practical efforts to reduce mortality through thorough management of already infected patients. It is crucial to expand negative pressure ICU beds for severe patients and establish management systems for moderate, mild, and asymptomatic patients. More COVID-19 dedicated hospitals must be established. From the perspective of medical institutions and personnel, managing COVID-19 patients alongside general outpatient and inpatient care is a huge burden. Designating hospitals is not enough; these hospitals must be generously supported with personnel and resources. Strategies focusing on securing ICU beds mainly in some tertiary hospitals and rapid bed turnover through central appropriateness evaluations of limited beds are mere theoretical discussions lacking understanding of the ICU treatment field.

-Negotiations with the Ministry of Health and Welfare are delayed.

▲ On the 2nd, we held discussions with Deputy Minister Kang Do-tae of the Ministry of Health and Welfare regarding the operation of the medical-government consultative body and COVID-19 quarantine. We agreed on the need for close public-private cooperation to overcome COVID-19. The KMA’s internal decision-making body, the Pan-Medical Community Struggle Special Committee (Pan-Committee), decided to launch the consultative body to implement the September 4 medical-government agreement through additional meetings. However, discussions on establishing a public medical school and expanding medical school quotas are not part of this discussion, as they were agreed to be addressed after COVID-19 stabilization in the September 4 agreement.

-If you oppose establishing a public medical school and expanding medical school quotas, do you have practical alternatives?

▲ The argument that a public medical school should be established to supply doctors in essential medical fields is unreasonable. The number of doctors needed in essential fields far exceeds the number of students admitted to the government-proposed public medical school. While some students want to enter difficult fields like thoracic surgery and general surgery, the low salaries and high risks deter them. Without legal protection for those performing high-risk medical procedures and with the current situation where poor outcomes lead to prosecution, these fields will inevitably be avoided. A sufficient legal compensation system is necessary. Moreover, establishing a proper medical delivery system is the most urgent task. In Korea, patients flock to the so-called "Big 5" tertiary hospitals nationwide. There must be firm control over referrals from primary clinics to secondary hospitals and tertiary hospitals.

-It is true that there is a shortage of doctors in local areas.

▲ The government plans to select 400 additional doctors annually, support their tuition, and impose a 10-year mandatory service, but this restricts basic rights, namely freedom of occupation. It is preferable to expand the regional talent quota system already implemented in regional medical schools. For example, at Chonnam National University, graduates from Gwangju and Jeonnam are more likely to remain as residents in the region than students from outside. Additionally, a regional fee incentive system is necessary. Doctors avoid local areas for the same reasons as other professions: lack of basic education and cultural infrastructure, leading to concentration in the metropolitan area. To overcome these disadvantages and enable doctors to work in local areas, a drastic regional fee incentive system is needed. Without clear economic benefits, the concentration in the metropolitan area cannot be prevented.

Launching Medical-Government Consultative Body to Strengthen Public-Private Cooperation
Exceptional Allowance of Telemedicine Expected
New Minister Anticipated to Foster New Medical-Government Relations

-COVID-19 demands non-face-to-face medical care. Has your stance on telemedicine changed?

▲ It is true that the demand for telemedicine is increasing due to national infectious disease situations like COVID-19. The medical community also needs to start serious discussions on this. While direct face-to-face care is the principle, in large-scale disasters such as national infectious disease outbreaks where doctors cannot see patients directly, telemedicine should be exceptionally allowed. Given the new situation posed by COVID-19, patients’ perspectives must be considered.

-Kwon Deok-cheol, former deputy minister, has been nominated as Minister of Health and Welfare.

▲ Minister-designate Kwon Deok-cheol is a career bureaucrat with extensive experience in health and medical fields, having worked at the Ministry of Health and Welfare and the Korea Health Industry Development Institute. He has a history of negotiation and communication with the medical community as the Ministry’s representative during the 2014 struggle to block telemedicine. At this time, when the government’s unilateral policy push has caused major conflicts with the medical community, we hope the appointment of the new minister will open a new chapter in medical-government relations.

-Your term ends in April next year, which is not far off.

▲ Our goal is to initiate at least the minimum groundwork to normalize essential medical fees before the term ends. It is estimated that 6 trillion won is needed to raise essential medical fees. We want to prioritize and normalize about 500 billion won worth of essential medical fees before the term concludes.

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