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COVID-19 Crisis: Korean Helathcare Workers Speak Out (Roundtable Report and video)


Korean Healthcare Workers' Speak Out about the COVID-19 Response
Roundtable Report

*An edited video of the event can be seen here:

On May 13, the Korean Public Service and Transport Workers' Union (KPTU) Healthcare Workers' Solidarity Division held a roundtable to discuss the firsthand experience of healthcare workers' in confronting COVID-19. The goal of this event was to provide a more nuanced picture of Korea's COVID-19 response, which has been portrayed in the domestic and international media as a total success.

The roundtable was also an avenue to share the experiences and analysis of healthcare workers in other countries and draw out lessons on what is needed for healthcare systems and workers around the world to be truly able to overcome the COVID-19 crisis. In preparation for the event, s and members in Italy, the United States and Indonesia sent us their experiences and questions they had for their Korean colleagues. These stories were shared through video, pictures and a presentation made during the roundtable. The answers to (almost all of) the questions, which were provided during the event are summarized below and in the accompanying video. While it has taken MUCH LONGER to produce these materials than we had expected, we hope that this dialogue will help build solidarity among healthcare workers globally.

1. What was it like when you first started admitting COVID-19 patients?
- Where dormitories provided for healthcare workers?
- Did you have enough PPE and training?

One nurse from Daegu, the city hit hardest by COVID-19, put it this way:

"When we first started admitting coronavirus patients our hospital was complete chaos. Staffing arrangements, the facilities, clean zones  nothing was in place."

Due to early infections, all emergency rooms in Daegu were eventually closed down and many hospitals went into cohort quarantine. Healthcare workers said this was like walking through a 'minefield' as workers never knew when an infected person might come through an emergency room or outpatient treatment.

Despite Korea supposedly being more prepared for the pandemic because of its experience with the MERS outbreak in 2015, healthcare workers didn't really feel much of a difference on the frontline. There were no clear guidelines on how to care for COVID-19 patients. At many designated treatment hospitals, nurses didn't receive adequate training on the use of PPE and had to make due with watching a video and helping each other out. At some hospitals, it took several weeks of the making demands before workers were provided dormitories, forcing them to use their own money to secure accommodations or sleep somewhere in the hospital in order to avoid going home and potentially infecting family members.

2. Which professionals provided direct care to COVID-19 patients?

It is important to note that the vast majority of patients were treated in public hospitals by public hospital workers. In the Daegu-Gyeongbuk region there are 40,000 hospital beds. 90 percent of these are in private hospitals, but the private hospitals cared for only one fourth of the total COVID-19 patients. The other three fourths of the patients were cared for in the public hospitals, which were designated as COVID-19 treatment facilities, and which have only 10 percent of the hospital beds.

Nurses and doctors at designated COVID-19 treatment hospitals provided direct care. By given the low staffing ratios in Korea (there are 6.8 employed nurses to every 1000 Koreans, which is much lower than the OECD average of 9.5), and in particular the lack of nurses with ICU training, nurses and other medical staff had to be brought in to Daegu from other regions. This created inefficiencies, which can only be overcome by training adequate number of nurses to be able to deal with future outbreaks and providing conditions decent enough to keep them in the field.

Because other workers were not brought into COVID-19 wards, nurses had to do non-nursing tasks as well, increasing their workload significantly. The CDC guidelines call for nurses in ICUs to work in teams of 2 for 2 hours each, 5 teams working in 3 shifts. However, it was not possible to maintain these levels in many cases meaning that nurses could not take breaks leading to exhaustion and more health risks.

3. How did you manage to find suitable PPE?

In the beginning, some hospitals in Daegu were designated as COVID-19 treatment facilities and begin admitting patients before PPE arrived. This was due to confusion from the government's Central Disease and Safety Countermeasures Headquarters' (CDSCH, the government's main respond instrument) in their management of PPE. They don't know what it was like on the ground so, for example, they distributed on set of PPE for each patient, when in fact 10 times more PPE is needed in intensive. The worked to located which hospitals had an excess of PPE and demand it was redistributed. We also continued to demand of the central government that it provide more PPE. But after several weeks many hospitals faced shortages and ended up disinfecting and reusing PPE. Still, the situation has not been as bad as in other countries where healthcare systems have been overwhelmed by the number of patients.

4. How did health workers manage to overcome the difficulties of wearing PPE while working?

As one nurse explained, when she put on the PPE for the first time she felt like:

"I was trapped under water. Suddenly I couldn't breathe and I felt like it was engulfing me. I was hit with this rush of fear."

This was the experience of most nurses using PPE for the first time, especially without proper training. Since all were feeling the same thing, sharing their experiences with one another, encouraging each other to put on the PPE slowly and get used to it helped getting over the fear.

5. How many infections occurred among healthcare workers?

About 250 healthcare workers have been infected. Most of these were community infections or secondary infections from inside hospitals. About 70 of these were healthcare workers who were caring for non-COVID-19 patients without protection and were exposed. There was one sixty-year-old doctor who was infected while treating patients and eventually died. At the time of the roundtable, 9 nurses had been infected while treating COVID-19 patients. Following the roundtable 4 more nurses were infected in non-COVID-19 units at one of the main private hospitals in Seoul.

6. What has worked best in preventing COVID-19 infection among healthcare workers in South Korea?

Better access to PPE and information on infections, and the fact that hospitals were truly overwhelmed by COVID-19 patients in a relatively contained area for a relatively short period of time has helped keep the level of infections among healthcare workers down. The fact that s demanded that hospitals share information on infections and the movements of infected people within hospitals from early on helped. Where administrations listened to s' demands and proposals on PPE and other safety measures it was easier to prevent infection. Still the proportion of healthcare workers infected among all cases of infection &ndash 2.4 percent &ndash is not insignificant, and could have been further reduced with better staffing levels and working conditions.

7. How did you work with management? Were workers able to get what they needed in the crisis or were there roadblocks?

The situation has been different in different hospitals. In cases where a decent relationship already existed between the the hospital management, representatives were included in hospital emergency response structures were the could make proposals about how best to distribute information to workers (through an cell phone app, for instance), what PPE was needed, the construction of negative pressure rooms and other issues. In these cases the chaotic situation that existed at the beginning of the pandemic was stabilised fairly quickly. Where administrations didn't communicate with the , the response was much less well organised and more difficult and dangerous for workers and patients.

When the administrations didn't make information available or were not providing adequate PPE (for example to patient-care workers who are informally employed in Korea and not part of the directly-employed hospital workforce), the issued statements and carried out press conferences in front of City Hall to pressure the administration. This was effective in most cases.

8. What kind of compensation have you succeeded in receiving?

One of the main issues now is adequate compensation for nurses in the Daegu area. The nurses who were brought in from other areas were granted hazard bonuses (150 thousand won on the first day and 50 thousand won a day after that) and 14-days off for self-quarantine after their COVID-19 duty was over before returning to their regular work. For nurses in Daegu whose hospitals became designated treatment centers, this compensation has not been provided. These nurses have had to go back to treating non-COVID-19 patients directly after the COVID-19 wards are closed, and they have received no extra compensation. We are demanding this right now, but payment for these nurses was left out of the government's 3rd supplementary budget announced on June 3rd.

9. Are there are separate care pathways for the elderly, adults and children?

In Korea, treatment pathways have been distinguished not by age, but by the severity of symptoms the patient is experiencing. Those with mild or no symptoms have been cared for in community treatment centers, which were set up quickly after the outbreak began. This has helped to relieve the burden on hospitals.

10. What preventive investigations have been put in place? What was done differently in Korea that helped in achieving a successful outcome?

The case fatality rate in Korea, - the percent of deaths among confirmed cases is 2.4 percent. This is why the Korean government has bragged about 'K-quarantine' - like 'K-pop' - to the rest of the world. In fact, the South Korean government achieved this with a high-level of containment and social distancing in non-productive areas, but a low level of social distancing in production and distribution, which were kept open. This form of containment allows for the continued pursuit of private profits, which is why it has received so much attention from businesses and governments around the world. But it is important to look at what made 'K-quarantine' possible.

The first element is a high level of technical monitoring and social control. In South Korea all citizens have singular resident registration numbers, which are computerized. The government is in possession of everyone's picture and fingerprints coordinated with these numbers. This allowed for quick contact tracing, done using people's credit card records, records from the GPS in their cell phones, and security camera footage from the CCTV cameras that are widely used. Rapid PCR testing means that COVID-19 test results come back in 6 hours. Once a patient has been diagnosed, then contact tracing occurs using the data mentioned above. This has happened without individuals' consent.

The second part is grinding healthcare and public sector workers to the bone as described above. And the third element is a heightened concern for safety among the Korean people. Koreans experienced the mass candlelight protest in relation to mad cow disease and beef imports in 2008, the sinking of the Sewol Ferry in 2014, and then the MERS outbreak in 2015.

This has made people cautious and more or less cooperative with social distancing. However, we would say that Korea is only a relative success. As one roundtable participant put it, "if other countries scored a 30, maybe we get a 50." For example, by March 16 there had been 75 deaths. Of these, 17 people or 23% died without being able to get admitted to a hospital. A very high rate of death occurred among the elderly, many of whom live in private nursing homes. The case fatality rate among people in their 70s is 10 percent. It is 25 percent among people in their 80s.

There is also an element of luck in the Korean story. Korea is a small country with a highly centralised government, which made a rapid and coordinated response somewhat easier than in countries where government is more decentralized like the United States, Italy and Indonesia. Further, the main cluster of infections early on occurred among Sincheonji Church-goers, many of whom were young leading to a lower fatality rate.

11. Looking toward future outbreaks of infectious disease, what are the most important ways to ensure a prepared healthcare system and workforce? What lessons have you learned in order to be prepared for the next global health crisis?

It is important to look at the context of the Korean healthcare system. South Korea has a universal public health insurance system, but the coverage rate is only 67% percent, at the bottom end for OECD countries. As mentioned above, only 10% of the total 720 thousand hospital beds in Korea are at public healthcare facilities. The number of hospital beds per 1000 people is very high, but the number of public hospital beds is again on the bottom end for OECD countries. But it is public hospitals that cared for the majority of COVID-19 patients.

Strengthening of the public healthcare system is essential for being prepared for future crises. That is why s and civil society organizations are calling for increased funding for public healthcare, increase in the number of public healthcare beds to 30% of the total, and in particular an increase in ICU beds and the establishment of public hospitals specializing in infectious disease. We are also calling on the government to take over private hospitals and turn them into basic healthcare facilities that serve local communities.

The staffing issue also has to be overcome, in order to make it possible to meet CDC guidelines. Staffing levels have to be increased not only for nurses, but for all occupations. Workers have to be able to receive the training they need ahead of time. For this reason we are calling for the establishment of a public medical school as essential for increasing staffing levels and ensuring an adequately trained healthcare workforce. The principles of universality, equality and solidarity that apply to the Italian healthcare system have to be implemented in South Korea to ensure that everyone can get the treatment they need, when they need it, inexpensively. This requires increasing healthcare insurance coverage and lowering treatment costs. Given the rate of poverty among the elderly and the number of COVID-19 deaths in nursing homes it is important to expand public social services and strengthen the workforce and level of care in this sector as well.

The situation may be a bit different in each country, but we think that our demands for safe, adequately-trained and equally and adequately-compensated healthcare workforce and protection and strengthening of the public healthcare system are universal and global demands. We hope to continue sharing experiences and solidarity with healthcare workers in other countries and to work to build a collective movement for universal public healthcare once and for all.