Quarantine Facility for Patients with COVID-19 with Mild Symptoms in Korea: Experience from Eighteen Residential Treatment Centers

Abstract

With the rapid spread of coronavirus disease 2019 (COVID-19), a particularly sharp increase in the number of confirmed cases in Daegu and Gyeongbuk regions at the end of February, Korea faced an unprecedented shortage of medical resources, including hospital beds. To cope with this shortage, the government introduced a severity scoring system for patients with COVID-19 and designed a new type of quarantine facility for treating and isolating patients with mild symptoms out of the hospital, namely, the Residential Treatment Center (RTC). A patient with mild symptoms was immediately isolated in the RTC and continuously monitored to detect changes in symptoms. If the symptoms aggravate, the patient was transferred to a hospital. RTCs were designed by creating a quarantine environment in existing lodging facilities capable of accommodating > 100 individuals. The facilities were entirely divided into a clean zone (working area) and contaminated zone (patient zone), separating the space, air, and movement routes, and the staff wore level D personal protective equipment (PPE) in the contaminated zone. The staffs consisted of medical personnel, police officers, soldiers, and operation personnel, and worked in two or three shifts per day. Their duty was mainly to monitor the health conditions of quarantined patients, provide accommodations, and regularly collect specimens to determine if they can be released. For the past two months, RTCs secured approximately 4,000 isolation rooms and treated approximately 3,000 patients with mild symptoms and operated stably without additional spread of the disease in and out of the centers. Based on these experience, we would like to suggest the utilization of RTCs as strategic quarantine facilities in pandemic situations.

Keywords: COVID-19; Coronavirus; Isolation; Korea; Residential Treatment Center.

Fig. 1. Establishment and operation flow of RTC.

Blue Box (establishment, operation, and close of RTC): The Ministry of Health & Welfare and local governments may decide to establish the RTC. They secure facilities for RTCs and carry out planning, staffing, and resources management. Orange Box (admission, isolation, and discharge of patients): when a COVID-19 patient is confirmed through screening treatment, the patient management team immediately assesses the severity and assigns a bed. Patients with mild symptoms are admitted immediately after being assigned to RTC, undergoing a basic medical examination, and quarantined until criteria for lifting isolation is satisfied. RTC = residential treatment center, COVID-19, coronavirus disease 2019.

Fig. 2. Separating zones of the one-building center.

• Designating contaminated/clean zone by floor. • Blocking indoor air circulation and natural ventilation in all zones. • Preparing a neutral zone between contaminated zone and clean zone. • Restriction on patients' movement between floors (permit only when admission, waste disposal, etc.).

Fig. 3. Staff distribution by the number of patients. Group 1 implies less than 100 patients, Group 2 implies 100 to less than 200 patients, Group3 implies 200 to less than 300 patients, and Group 4 implies more than 300 patients.