After South Korea’s brief freedom from COVID-19 restrictions, deaths and hospital admissions are all rising, putting Moon Jae-in administration’s goal to bring country back to normal by early next year to a test. The country will decide this week whether to roll back social distancing and other restrictions of the past.


Pandemic of the unvaccinated?

In the past week the number of deaths per day has averaged 57, nearly five times what it was in the last week of October. Eighty deaths were announced Saturday, the highest-ever to be recorded in one day, and the number of patients severely or critically ill also rose to a new high of 894 on Sunday.

Intensive care beds for COVID-19 patients in hospitals across the country are over 80 percent filled. In Seoul, where the outbreak is most severe, the rate was over 90 percent. By Sunday afternoon 1,533 patients in and around Seoul had been waiting for an available hospital bed for longer than a day, of whom 1,019 were clinically vulnerable.

Asked to explain the main factors behind the sudden increase in deaths and hospitalizations, Son Young-rae, spokesperson for the Ministry of Health and Welfare, said in a closed-door briefing Monday that while unvaccinated are a small minority of the overall population, they accounted for the majority of severe cases.

Citing the latest ministry figures, he said that in the past month unvaccinated adults made up 51 percent of intensive care unit admissions and 54 percent of deaths. In people 18 and above, less than 8 percent remained just partly vaccinated or unvaccinated in Korea as of Sunday midnight.

“Minimizing infections in unvaccinated adults, especially among those 60 and older, will be key in reduce the strain on our health care systems. In fact, reducing infections in unvaccinated older adults could cut the hospital burden by half,” he said. “If you aren’t vaccinated, then you are best advised to refrain from leaving the house as much as you can.”

In previous briefings Son had described the current surge a “pandemic of the unvaccinated.”

Against this backdrop, he said a wider implementation of the vaccine pass system -- requiring people to submit a proof of full vaccination or negative PCR test result to enter public places -- would act to “shield the unvaccinated from the risk of infection.”

In addition, as booster doses become more widely available, the rates of people falling sick enough to need hospital care were expected to fall, he said. To date 4.2 million people 16 and above here have gotten a third vaccine dose. 


Should haves, could haves

Contrary to the government assessment, however, Dr. Eom Joong-sik, an infectious disease specialist at Gachon University Medical Center in Incheon, near Seoul, said the rush to lift restrictions was “directly responsible for the recent resurgence.”

“It’s absolutely true that unvaccinated people are at greater risk of becoming hospitalized,” he said. “But that alone would not explain the spike we are seeing now. Much fewer caseloads were reported prior to November, when we had even higher proportions of unvaccinated people.”

By November’s end, about four weeks into return to normal, movements have bounced back to pre-pandemic levels, a government analysis of cellphone data showed.

Eom, who had been in meetings with the government over bed capacities in Seoul area, argued that the Nov. 1 reopening was “pushed through despite the protest from front-line medical workers.”

“We didn’t have more critical care beds secured. We didn’t have the system, infrastructure or staff ready to enable a safe home care for all patients.”

Eom said that the rise in deaths, especially deaths outside hospitals, was a result of the refusal to reimpose the restrictions when bed occupancy rates started hitting over 70 percent in mid-November. According to official statistics, at least 29 people have died at home in the last five weeks while waiting for a bed to open up.

“We waited around a month before things started to really spiral out of control,” he said.

Dr. Kim Woo-joo, another infectious disease expert at Korea University, said waning immunity in older populations did not seem to have been taken into account in the decision to leave as few restrictions as possible.

He said that had left 60- to 74-year-olds who received their two AstraZeneca doses 11 to 12 weeks apart “in an awkward limbo” for over a month as the country was back to normal.

As vaccinations in this age cohort started in late May, most got their second doses sometime in August, preventing them until very recently from getting a booster vaccination. It wasn’t until this week that the wait for a booster was shortened to three months.

“We may have celebrated our vaccine feat too early,” Kim said. “Before abandoning mitigation measures, we should have moved on right away to distributing boosters to older people who got the vaccine earlier, in light of protection wearing off.”


Time to press pause

The worst consequences of the month of freedom have yet to unravel, according to Dr. Jung Jae-hun, a preventive medicine specialist and COVID-19 advisor at the prime minister’s office.

Based on recent trends, Korea was on course to reaching about 10,000 cases occurring per day by late January, he said, citing his estimate from earlier this month. “And that’s without including omicron in the equation,” he said. The new variant, he said, was believed to be even more transmissible than delta.

Less than two weeks since detecting the first cases on Dec. 1, the omicron case count in the country rose to 114 as of the latest available statistics.

On top of the wider use of the vaccine pass and tighter limits on personal gatherings taking effect from Monday, the government said additional measures may be announced.

Jeong Eun-kyeong, the chief of the Korea Disease Control and Prevention Agency, had also earlier hinted that the country may need to put off entering the second of the three-stage plan to completely exit pandemic restrictions, originally slated for mid-December.

In a joint statement Monday, the societies of infectious diseases and health care-associated infection control and prevention called for “a pause in the return to normal life plans.” The societies said that in face of crowding hospitals, it was “absolutely necessary” that Korea tighten restrictions and at the same time solicit compliance from the public through compensations for hard-hit businesses.

The societies stressed that vaccines remained the single most effective weapon against COVID-19, and that their efficacies wearing off over time did not mean they weren’t any less beneficial.

“Intense social distancing is the only way to slow the spread and buy time for hospitals to get back on their feet,” said Eom of Gachon University Medical Center.

By Kim Arin (arin@heraldcorp.com)