South Korea may soon be forced to choose which seriously sick patients get priority for care, as intensive care units at hospitals across the country are filling up in the third wave of COVID-19, experts warn.

As of the weekend, only 13 beds were available at ICUs in hospitals in Seoul, Incheon and Gyeonggi Province combined, the Ministry of Health and Welfare’s latest data shows. All such beds in Daejeon, South Chungcheong Province and North Jeolla Province had run out.

Addressing the bed scarcity, Prime Minister Chung Sye-kyun told a government meeting Sunday that “lives being lost from full hospitals must be avoided at all costs.”

In the last 11 months of the pandemic, not enough has been done to increase critical care capacity and prevent the forewarned disaster, experts complain.

The Korean Society of Critical Care Medicine said in a Nov. 27 statement that the country’s critical care augmentation strategies have been “at a standstill” since spring, despite repeated calls from doctors’ groups and health care workers in the field.

“The government’s approach to managing the ICU surge during the pandemic has been to stretch out the existing resources rather than build more,” said Dr. Hong Sung-jin of Yeouido St. Mary’s Hospital at a Nov. 28 roundtable talk organized by the National Academy of Medicine of Korea.

Among such proposals was relocating patients who are less severely afflicted out of the ICU early to make room for other patients, she said. “This is how we managed, barely, to get through the earlier waves -- by using the beds we had more resourcefully.”

In October, the government changed the clinical management guidance so that patients on oxygen masks or other low-flow oxygen therapies are no longer sorted as severe cases.

But without actually upscaling critical care capacity, this strategy of being economical was not going to be sustainable, she warned.

Hong, who was the Critical Care Medicine Society’s former president, said the current resurgence was “nothing like the first two.” “The curve is much steeper than it’s been in the past. At this rate of incidence, what’s left of the beds could be rapidly filled to capacity.”

Relying on individual hospitals to secure ICU beds for COVID-19 patients could affect care for non-COVID-19 patients, she said, urging more support from the government. “To mobilize enough health care workforce and equipment necessary to operate 10 ICU beds for COVID patients, a ward of some 40 non-COVID patients will have to be emptied.”

Trauma surgeon and critical care specialist Dr. Hong Suk-kyung of Asan Medical Center in Songpa, southeastern Seoul, said in a phone interview that Korea will need to have “surge capacity plans in place and be ready for an avalanche of patients.”

The Health Ministry, in response to a press inquiry, said Monday the government did not have plans for rationing medical care in the event of an emergency.

Still, hospitals are bracing for the possibility, according to Hong, and preparing guidelines that will determine which patients get priority for potentially lifesaving treatment if there is a massive influx of patients and resources are exhausted.

“This is the kind of conversation that no one wants to have. But one that we need to have, just in case, so that when crises occur we can respond effectively,” she said.

A system of sorting patients known as triage, may involve factors such as pregnancy, co-morbidities and age to screen patients for admission.

Likelihood of survival is among the considerations. “Earlier in Italy and New York, doctors have had to make decisions about which patients got advanced care based on their prognosis for recovery,” she said.

“But these are measures of last resort that are being mapped out in anticipation of the worst, when health care systems are pushed to their breaking point,” she said, adding a consensus at a broader level might be required. She said the guidelines were being consulted with medical ethicists.

Dr. Benhur Lee, a professor of microbiology at the Icahn School of Medicine in New York, said in a March phone call with The Korea Herald that these were “heartbreaking choices” being made in the pandemic.

“It’s heartbreaking. And this is what happens when the surge is beyond the health care capacity. Decisions have to be made. It’s wartime. You can’t save everyone,” he said.

“This is why anything we do to delay and contain the spread is important. Because that could save lives.”

By Kim Arin (arin@heraldcorp.com)