Protecting Front line American Healthcare Workers Fighting COVID19: Lessons from South Korea

Hello, everyone. Thank you all so much for joining this conversation with us during this time of crisis. I know that there are those of you coming from all over the world, from California to New York, from the UK all the way down to New Zealand. And it is just absolutely inspiring to be able to reach out to all of you here today. And I only wish that it was just under different circumstances. My name is Ron Lee. I am an inpatient medicine physician at Stanford. Like many of you joining us here today, my colleagues and I in the San Francisco Bay area have been fighting COVID 19, and we are all just bracing for what is to come. I hope that you are all staying safe. We're going to get through this, and we're going to do it together. The idea for this webinar was born out of a scramble among several of us to just learn as much as we can about how to best protect ourselves while we take care of patients with COVID 19. And then we quickly realized that there is just so much that we still don't know, so much we could learn. Especially from the countries that have most successfully fought this pandemic. We know that as healthcare workers, especially those in the front lines, we are just at higher risk of getting infected. The data from China, from Italy, and from now from the rest of Europe and the US all show this. We have all heard of colleagues now falling ill, and some of them severely ill from COVID 19 while the rest just push on. And the thing is, if we get sick, we risk spreading the virus to our families, our friends, our communities, and we can also just no longer take care of our patients if we're sick. So that's why we want to learn everything, everything possible that could help us protect ourselves so that we could best serve those around us. We have all looked to South Korea as one of the success stories in controlling this pandemic within their country, but also in how they have successfully protected their healthcare workers. I was lucky enough to connect with Dr. Chung from Seoul, South Korea, who has graciously offered to share his experiences as the director for the center for Infection Prevention and Control for Samsung Medical Center, a tertiary care hospital. And they just have had extraordinary success in not only building workflows at work, but also just making sure that no one at their hospital gets sick. Not no one, no staff member from their hospital gets sick. From COVID 19. So we'll start with a presentation by Dr. Chung, followed by a question and answer session that I will moderate. Fortunately, we won't be able to get through all the questions, so I will do my best to highlight the most pressing and highest yield ones during this hour. I'd like to give special thanks to the DeepLearning AI team for making this possible, both by helping us reach out across the Pacific and also by providing this platform for this conversation. Now I have the pleasure to introduce Dr. Chung as the Director of Infection Prevention and Control for Samsung Medical Center. He is one of the top experts in South Korea on hospital infection control for COVID 19. He is also the Chief of the Division of Infectious Diseases and Professor of Medicine at Sung Kyung Wong University School of Medicine. He is also the Secretary General for the Asia Pacific foundation for Infectious Diseases and also serves as the Chair of the Scientific Committee for the Korean Society for Healthcare Associated Infection control and prevention. Dr. Chung, we are honored to have you here with us. Thanks for your time.

Thank you for your kind introduction. Nice to meet all of you. My name is Julian Jung and I'm very honored to have an opportunity to share our experiences in my hospital and also in South Korea. So let me share my slides first. Okay, So the outline of my talk today will be the situation of COVID 19 epidemic in South Korea and also overview of national response in South Korea and also I'll cover the response of the Samsung Medical center at the hospital level. Let me start with a brief overview of COVID 19 situations in South Korea. As of yesterday, the number of confirmed cases is over 9,000 and the case fatality rate is 1.4%. As you can see in this map, the instance differs by the location. Daegu is the city showing the highest instance density and the province surrounding daegu shows the second highest density. 72% are from a single city, Daegu, where big outbreaks occurred associated with worship or meetings of a particular religion and 80% of cases occurred in clusters, mostly in chronic care facilities and healthcare institutions and also some call centers of the company. And Seoul metropolitan area has a high population density with accounting for 44% of total population in South Korea. So we have a very high concern on this area. Although the instance of COVID is still low as the outbreak in Daegu has been controlled thanks to participation of all citizens in social distancing and mask wearing, the number of new cases per day has become lower. However, the number of cases in Seoul metropolitan area has shown an increasing trend. Furthermore, the more the number of people diagnosed with COVID 19 is increasing among the people entering from overseas South Korea, which suffered from the epidemic in several hospitals that started from a single patient from The Middle east five years ago in 2015 has prepared a lot to cope with the crisis due to highly infectious disease. The government and health care institutions have been doing what should be done immediately as soon as the first imported COVID 19 patient was diagnosed on January 20th. And the people have followed these measures very well. In short, our response in Korea was to search all COVID 19 patients and trace all close contacts and quarantine all of them. Since it is expected that this pandemic will last for a long period, we are considering a new strategy to minimize the spread of infection in our daily lives. While maintaining this strategy of search and isolate. Korea has a very heavy reliance on private sector providers of medical services with approximately 90% of hospital beds being private. Therefore, active participation of private healthcare institutions was also essential. South Korea is one of the countries that have performed the most diagnostic tests for COVID 19. Currently we have been implementing so strict policies to prevent the transmission.

Sound like just a culture of seriousness that everyone attributes to this?

Yeah, actually another important thing in prevention of healthcare workers from infected by COVID 19 is occurring. Day of hours because they can be infected in the community. So we are encouraging just following the general principles of social distancing to 9,000 healthcare workers. But I'm not sure the principle can be followed by all healthcare workers 100%. And I'd like to show some ways of preventing transmission between the healthcare workers. So as you can see here in the photo on the right, I mean, sorry, let me find. Yeah, so for the safety of our healthcare workers, we have been finding and doing additional things we can do. So for example, the glass, the acrylic barriers were installed to protect the workers at the reception desk of the administration like here, so it can block the droplet transmission between the healthcare worker and visitors. So that has been installed recently in my hospital. And every hospital has a big call center who deal with the patient's reservation and changing of those schedules. And this call center is at high risk of transmission between each other because for clear conversation, the workers here usually prefer the wearing of their masks. And the distance is so close. So we made a change. So the employees working here should wear a mask at any time. And the seats were rearranged so they were seated one by one, just like here. So to reduce the risk of transmission between these people and also when eating, especially in the step cafeteria cafeteria, they have to take off the mask for eating, which may spread the COVID 19 in the step cafeteria and they, they want to conversate each other. So I think the the cafeteria in the hospital is a place with high risk of transmission between each other. So the hospital have started the campaign silence during the dining and sit side by side without facing each other. So in this cafeteria in one of buildings of my hospital, there is no chair at this side, so nobody can sit facing these people. So we have been doing this campaign.

It must be very quiet in the cafeteria, huh?

Yeah.

Well, this is again very, very helpful. And we only have a couple of minutes left. I'd like to ask one more quick question and then also just have you maybe help us summarize, just give us some advice really that we could take forward. The last question I have is you do make a very important point. I mean, even now as you have thousands of cases in your country, it seems like you are doing everything you can to prevent transmission, which is a different approach than say we already have so many cases. Why don't we just let it spread and then we'll just so called flatten the curve and slow it down. Do you think that's so given that at least the United States we have different states with different levels of infection. So in New York, unfortunately they've been hit very hard. California, we've been hit hard as well, though not as much as New York. And then we also have other states actually that are starting to see cases, but not nearly as the numbers aren't nearly as high. So from your perspective, what would be the best approach to really solving this problem for a place like the US where you have all these pockets of infections, they haven't quite exploded in the way that some areas have. Is there a chance to still contain this infection?

This is a very difficult question actually, because everyone knows that this COVID 19 pandemic will last for a long period, like one year. And at any time many persons will be infected. But the important experience that we shared is the situation in Wuhan, China at the beginning of this pandemic, and also the situation in Daegu City in South Korea. And also we have been seeing very serious situations in Italy and other European countries. That dangerous situation occurred when the transmission was so active without any kinds of efforts to prevent transmission in the community. So those numbers of increasing infected persons surpassed the surgical capacity of the city of the country. And so many fatality has been caused. So although we are facing the pandemic lasting for a long period, and we cannot block this transmission by vaccine, we need to slow down the transmission in every community and in the city and at the country level, that is the way we can reduce the number of the fatality.

And it sounds like these measures of social distancing, of wearing masks in public, that has really played a huge role in your country.

Yeah. And also, although the community starts to loosen the social distancing because we also need to do work and also we need to be involved in economy, the production, like that. But the last place that we have to address social distancing will be healthcare institutions and also the chronic care facility. So we are working at the place where the most strict policies should be applied.

Well, I think that's a good place to end. And what I'm taking from this is that this is very hard. There's no real answer at this point. And it seems like the solutions will have to be adapted, of course, to wherever you are. But at the same time, I think you give us a lot of hope because this is a situation that your country has done a very good job addressing and the measures that you've implemented are doable. I think in many places, I think there is a real equipment shortage. I think there are places where that just will not have enough full body suits, will not have enough N95 masks. And I think we will have to adapt as healthcare workers. At the same time, I think what you're describing here are measures that may not even require as much equipment, but it's more of maybe a mentality, a shared mentality among your people, which is that this is serious, this could get a lot worse. This is nothing like we've ever seen before. We need to come together as a country to do this. And also this maybe concern specifically for the healthcare workforce and the healthcare workers in healthcare facilities is that being such a high risk area that almost everything has to be done to make sure that that area is as safe as possible. And I think that that's something that we will have to work on. And you know, we have our constraints, we have our PPE shortages, but I also think that that's a problem that's solvable. We know how to make masks, we know how to make all this equipment. I think it's part of technology, but also part political will. And I think that's something that hopefully we as healthcare workers can come together and figure out how to solve together. So with that, thank you again, Dr. Chung. We really, really do appreciate it. We look to you as we look to you for guidance also just again for hope as we fight this together. Thank you again for the deep learning AI team for really facilitating this. We really do hope to continue this conversation. So for those of you listening? If you have any ideas for suggestions, please email us. And with that, we will end this session. Good luck out there. Stay safe. Take care.

Okay. Thank you very much. I hope we can overcome this pandemic. Where? We will. Bye. Bye.

Bye.