Outside of China, Korea was the first country to face a peak explosion of the COVID-19
global pandemic situation. On January 20, 2020, a Chinese who arrived from Wuhan,
China, was detected for the first case of COVID-19 in Korea [1], and the outbreak
started from the 31st case in Daegu Province in the third week of February. The Korea
Centers for Disease Control and Prevention have tracked all cases [2]. All possible
case contact people were identified, and polymerase chain reaction (PCR) tests for
COVID-19 were performed to confirm cases of infection. The positive cases were admitted
to a special room equipped with negative pressure ventilation. The case contacts who
were shown to be negative for the COVID-19 PCR test were requested to be in isolation
for 14 days; thereafter, they were retested for COVID-19. The Korean prevention strategy
was strengthened when the 31st case was reported and several hundred cases were identified
in an orthodox church located in Daegu, in the south of the Republic of Korea. The
many possible cases were church congregants, who then spread the COVID-19 infection
throughout the country.
As of April 5, 2020, the Korea Centers for Disease Control and Prevention reported
that there were 241 COVID-19 cases (2.4%) in health-care workers (HCWs), among a total
of 10,062 positive COVID-19 cases. Of the 241 cases in HCWs, 101 had been infected
at work. No one was infected during treatment. (Table 1
). There were 11 doctors, 82 nurses, and 8 other HCW categories. The proportions of
HCWs and HCWs who were occupationally infected among all cases of COVID-19 were 2.4
and 1.0%, respectively. This proportion is substantially lower when compared with
the cases reported for the Middle East respiratory syndrome (MERS) outbreak in 2015
[3]. During the MERS outbreak, the percentage of HCWs who were infected at work was
21.0% (39 cases) of all MERS cases (186) in Korea. The HCW categories were physicians
(8), nurses (15), caregivers (8), radiographers (2), and other HCWs (6). They were
infected in outpatient clinics, emergency rooms, intensive care units, wards, radiographic
chambers, and even in ambulances.
Table 1
The status of COVID-19 infection in health-care workers in Korea as of April 5, 2020
Table 1
Cases
Physicians
Nurses
Other HCWs
Occupational infection
Treatment for confirmed cases
0
0.0%
0
0
0
Screening tests
3
1.2%
1
2
0
General treatment
66
27.4%
6
57
3
Outbreak in hospitals
32
13.3%
4
23
5
Subtotal
101
41.9%
11
82
8
Nonoccupational infection
Community infection
101
41.9%
7
76
18
Unknown source
26
10.8%
5
21
Subtotal
127
52.7%
12
97
18
Still under investigation
13
5.4%
2
11
Total
241
100.0%
25
190
26
HCWs, health-care workers.
The basic reproduction number (R0) of COVID-19 ranges 2 to 5.7, which is higher than
that of the severe adult respiratory syndrome (<2) and MERS (<1) [4]. The relatively
lower rate of COVID-19 in HCWs is quite significant in occupational health, in view
of the fact that COVID-19 is known to be more contagious than MERS. This observed
lower rate of infection can be attributed to prevention actions and protocol designed
for HCWs, based on the experience and lessons learned from the MERS outbreak. First,
during the MERS outbreak in 2015, respiratory patients with fever, who possibly had
a highly contagious disease, were treated with other patients at outpatient clinics
and emergency rooms on arrival at hospitals or clinics. At that time, HCWs did not
have any information on the possible infection and they did not know with whom their
patients had had contact. Second, when confirmed cases were found, there was no way
of knowing who the case contacts were unless the patients were honest in their descriptions
of possible contacts and if they did not have a recall bias. At that time, the tracking
of possibly infected contacts was impossible due to the enforcement of the Personal
Information Protection Act. After the MERS outbreak, the act was amended so that the
epidemiological team is now able to track and trace the route of confirmed cases to
let people know whether they may have had contact with a possible source of infection
[5]. Lastly, HCWs were not well versed or trained in good practices and the proper
use of personal protective equipment. HCWs were in direct contact with patients without
wearing the adequate personal protective equipment, such as masks, until well after
the MERS infection was already widely spread. A health mask, KF94, which is equivalent
to the N95 mask in the USA, was used only when seeing patients presenting at the infectious
diseases departments. A national action plan for preventing endemic diseases was established
only after the MERS outbreak. In hospitals, virtual training exercises had been periodically
carried out using a scenario of a highly contagious patient referred or identified
during a diagnostic process.
Although the number of COVID-19 cases has been steadily decreasing, there is no way
of knowing if the pandemic in Korea is nearing the end. However, many prevention actions
and protocols have been established and implemented, based on the experience of COVID-19
since the first case was reported in January, followed by the massive outbreak in
February. We can anticipate that the protection measures implemented for HCWs during
this outbreak situation have been successful, even though there may be other reasons
for the low rate of COVID-19 infections observed in HCWs in Korea.
The important points in terms of the observed low rates of COVID-19 infection in HCWs
are (1) segregation of potentially infected patients by operating a separate screening
area for those patients who present with fever or respiratory symptoms. Patients suspected
of having COVID-19 infection are submitted to PCR testing and sent to a dedicated
room equipped with negative pressure ventilation if they have pneumonia or pneumonia
symptoms, until confirmation can be obtained from the PCR test results. Separating
the infected patients can prevent infection of HCWs and other patients, and it can
reduce the burden of the workload experienced by HCWs. (2) Identification of infected
patients through a massive, proactive case-finding and testing exercise for COVID-19
infection (test, trace, and treat) [6]. Identifying infected persons through a rapid
test is very effective in preventing further transmission to people with whom the
infected patients may have had close contact. (3) The good practice of wearing a mask,
by HCWs and patients alike. The practice of patients wearing a mask may prevent HCWs
from becoming infected by their patients during medical procedures. (4) All hospital
staff and visitors are required to have their body temperature checked every day when
entering the hospital premises. (5) Hand sanitizers have been provided throughout
hospitals and other clinical settings. Other infection prevention actions have been
taken in combination with the aforementioned good practices; these include frequent
hand washing, social distancing in the seating arrangements in canteens and after
work, temporary closure of public rooms such as change rooms and common meeting areas,
postponement or cancellation of face-to-face meetings or conversion of these meetings
to web-based communication events, and so on.
Preventing infection of HCWs is a critical aspect of national response and very important
for the duration of any pandemic [7]. Infection of HCWs will lead to reduced medical
manpower and inadequate medical care of patients. Korea can ensure the efficiency
and sustainability of its health-care system during the COVID-19 pandemic first and
foremost by keeping its HCWs safe and healthy.
Conflicts of interest
The author declares that there is no conflict of interest.