Can – or should -- infected doctors treat Covid-19 patients without quarantine? ‘Not yet in Korea.’

As an increasing number of medical workers get infected by Covid-19 amid the Omicron variant’s rapid spread, concerns are mounting among some medical residents over whether infected doctors will have to treat patients without quarantine.

The Ministry of Health and Welfare hurriedly put the matter to rest on Friday, saying it is impossible for infected doctors wearing masks to treat patients under the current circumstances.

Despite the government’s denial, concerns are mounting among Korean medical workers that they may have to work wearing masks without quarantine after getting infected by Covid-19.

According to the “Guideline on business continuity plan (BCP) to prepare for medical workers’ infection” sent by the ministry to medical institutions on Wednesday, even in the third and final phase, when daily infections exceed 50,000, hospitals should isolate infected medical workers at least for three days.

Therefore, hospitals should meet this minimal standard in their BCPs.

However, if the situation aggravates with the daily approaching 100,000, the ministry can revise the guideline by listening to opinions from medical fields.

In a telephone interview with Korea Biomedical Review, an official at the Central Disaster Management Headquarters (CDMH) under the health and welfare ministry made these and other points while explaining the guideline.

The guideline, unveiled Wednesday by CDMH and the Central Quarantine Countermeasures Headquarters (CQCH) under the Korea Disease Control and Prevention Agency, comprises three phases according to the number of confirmed cases a day and hospitals’ infection and isolation rates.

The daily infections of 7,000-30,000 belong to the first phase, 30,000-50,000 in the second stage, and over 50,000 in the third – or crisis -- stage.

However, even if the daily infections exceed the criteria, hospitals do not apply the guideline because they can set their BCP stages according to their respective infection and isolation rates.

Under the government’s guideline, fully vaccinated and infected medical workers with no or mild symptoms can resume work if they test negative in rapid antigen tests after seven days of quarantine in the first phase. Hospitals can shorten the quarantine period to five days in the second phase and three days in the third phase.

Also, fully vaccinated medical workers can continue to work even if they are classified as close contact. However, unvaccinated or partially vaccinated workers must undergo the same quarantine period as infected workers in the first and second stages.

In the third phase, hospitals can temporarily shift them to the non-face-to-face treatment of outpatients. If hospitals are short of negative pressure wards, they can also use general wards as the Covid-19 wards.

“Under the current BCP guideline, infected medical workers cannot treat patients wearing masks without quarantine,” the official said, wanting not to be named, citing the ministry’s internal rule. “They also should consider relations between medical workers and patients. Although hospitals can apply the government guideline according to their respective situations, they should keep the minimal criteria of three days of quarantine in the third phase.”

Even if infected workers show no symptoms, the three-day quarantine standard has been decided by CQCH, considering the Omicron’s spread, the official noted, reiterating that the three-day quarantine is the minimum criteria far looser than ordinary people.

However, he also cited the example of the United States, where the Center for Disease Control and Prevention (CDC) allows infected medical workers can treat patients wearing personal protective gear and without quarantine in the final stage, hinting that government may also revise its guideline in the worst-case scenario.

“Some foreign governments allow infected medical workers to continue work without quarantine,” he said. “In the case of the U.S. CDC, infected workers with no symptoms can treat patients wearing protective gear and without quarantine in the worst-case scenario.”

“In Korea, too, if medical institutions don’t follow the government guideline and let infected, asymptomatic medical workers treat patients wearing masks without quarantine, there is no way to punish them,” he said. “However, they should also consider the relationship with patients. No patients would want to be treated by infected medical staff. Under the current situation, hospitals should operate under the guideline. If the situation exacerbates and requires changes in guidelines, the government will improve it after sufficiently listening to opinions from the field.”

Commenting on the hospitals’ request for dispatching an additional workforce, the official said it would be difficult realistically.

“As it takes a long time to train doctors and nurses, it would be more practical for hospitals to reallocate their workforce according to their respective priorities,” the official said. “Calls for sending more workers cannot be accepted realistically.”

The ministry held a closed-door online meeting with hospitals treating Covid-19 to discuss problems concerning BCP later in the day.

‘BCP application by large hospitals imminent’

On Thursday, a renowned expert on infectious disease predicted that large hospitals would apply the BCP guideline in two to three weeks.

“Social distancing system has been aimed mainly at postponing the spread of Covid-19 instead of reducing it. If the government eases restrictions on Friday, there may not be big changes in the total caseload, but the daily infections could increase in a short period,” said Cheung Jae-hun, a professor of preventive medicine at Gachon University College of Medicine. “Now is the time to worry whether the medical system could handle such a situation.”

Profess Cheong also called for the need to prepare for the spread of infections within hospitals, appearing at a live broadcast produced jointly by the Seoul Municipal Government and “I am a doctor,” a podcast of The Korean Doctors’ Weekly, the sister paper of Korea Biomedical Review.

Stressing that hospitals should manage infected medical workers according to BCP and expected level of damages, Cheong warned that otherwise, there would come a “worst-case situation” where infected workers with no or mild symptoms will have to continue to work without quarantine.

“That is not a matter of whether or how many hospitals would experience such a crisis,” Cheong said. “If the current trend continues, one in every three tertiary general hospitals will likely face a situation requiring the application of BCP.”

In emergency rooms or surgeries, hospitals can lose other lives if specific workers do not work due to quarantine. Therefore, they should consider such a worst-case scenario, Cheong went on to say.

The expert also emphasized the need for the government to prepare measures for smaller hospitals and neighborhood clinics that cannot put BCP into practice.

“A bigger problem is smaller hospitals and clinics. We always tend to think about large hospitals first. However, they can secure alternative workforce,” he said. “I don’t know how a midsize hospital with only one doctor would continue to operate a dialysis facility, for instance.”

Pointing out that these hospitals face limitations to solve problems independently, the government should help essential medical facilities in terms of BCP guidelines or others.