Post-Omicron response plan: toward a safe, sustainable new normal
포스트 오미크론 대응계획: 안전하고 지속 가능한 새로운 일상으로
April 15, 2022
The Central Disaster and Safety Countermeasures Headquarters of the Ministry of Health and Welfare (headed by Minister Kwon Deok-cheol) and the Central Disease Control Headquarters of Korea Disease Control and Prevention Agency (headed by Commissioner Jeong Eun Kyeong) announced the social distancing adjustment plan and the post-Omicron response plan at a non-face-to-face press briefing held in Sejong today.
Almost all social distancing measures except mask wearing are to be lifted, and COVID-19 is to be reclassified as class 2 notifiable infectious disease (from the previous class 1 notifiable infectious disease), but with a four-week implementation period. With this change, isolation will no longer be mandatory for people who test positive for COVID-19, and the transition will be made so that the disease will largely be managed via the general healthcare system.
The main strategic directions of this response plan, which aims to ensure a safe and sustainable transition to a healthy new normal, are: (1) sustainable and efficient management of infectious diseases, (2) a gradual transition to the general healthcare system, (3) protection of high-risk groups and the vulnerable, and (4) preparation of a system for response in case of a new variant or surge.
Korea has formulated and adapted its pandemic response strategies based on up-to-date scientific evidence and risk assessment. Based on the characteristics of the Omicron variant and a high vaccination rate of the population, on January 14, response strategies were built to counter the Omicron spread (i.e., becoming dominant strain), which included providing COVID-19 testing and treatments via local hospitals and clinics and improving the at-home treatment system.
Government efforts focused on effective utilization of healthcare resources, the prevention of progression into critical or severe illness, and protection of the vulnerable. To ensure timely diagnosis and treatment of high-risk groups such as the elderly aged 60 years and older, efforts were made to increase accessibility of testing and treatments. Oral antiviral treatments were introduced and prescription of oral treatments was made available to those who test positive from rapid antigen tests administered by health workers at local hospitals and clinics, based on improved accuracy of rapid antigen tests.
The Omicron wave is observed to have reached its peak in mid-March (621,000 cases on March 17) and entered a downward trend. The number of deaths is also in gradual decline.
As of April 15, the cumulative number of deaths per 0.1 million population is at 38.1, and the case fatality rate is 0.13%.
It appears that the Omicron wave has passed its peak and is approaching a stable state, and with over 30% of the nation’s population having experienced COVID-19 infection and acquired natural immunity as well as an understanding of the level of risk, there is a greater need to establish a sustainable COVID-19 response system by implementing more effective and efficient measures, including greater utilization of the general healthcare system for COVID-19 response.
At the same time, preparation against emergence of novel variants of concern, another surge, or a novel infectious disease is also necessary, given several risk factors remaining to considered, such as the possibility of new variants or strains, declining protection of natural and acquired immunity, and seasonal factors.
RESPONSE PLAN FOR THE POST-OMICRON ERA
In consideration of the factors described above, CDSCH (MOHW) and CDCH (KDCA) have jointly prepared the post-Omicron response plan, with the goal of preparing for a safe, sustainable new normal.
Based on vaccination, availability of vaccines and antiviral treatment, and the two-year experience of COVID-19 response, the post-Omicron response strategy focuses on ▴ transition to a sustainable and effective response system, ▴ protection of the highly vulnerable and minimization of negative health outcomes, and ▴ preemptive preparation against emergence of novel variants or surge.
The main directions of the strategy are: (1) a gradual recovery to a new normal in the post-Omicron era, (2) efficient, sustainable infectious disease response, (3) gradual transition to the general healthcare system, (4) protection of the vulnerable, (5) preparation of a response system against emergence of novel variants or waves.
1. Gradual recovery to a new normal in the post-Omicron era
<1> Transition from social distancing policy to voluntary public health practices
In light of the the visible waning of the Omicron wave and stabilization of the healthcare system, most social distancing measures will be lifted and a transition to voluntary public health practices will be initiated.
Notwithstanding the removal of social distancing policy, individual practice of personal hygiene measures such as hand washing, ventilation, and disinfection will continue to be important. As such, the daily hygiene recommendations for infection prevention will be maintained.
Extra measures in place for facilities considered vulnerable such as nursing homes and convalescent hospitals, such as preemptive COVID-19 tests for staff and patients, prohibition of patient visits and physical contact, and restriction on going out and staying out, will be maintained until further assessment.
2. Sustainable and efficient disease control
<1> Transition to testing for early diagnosis and treatment
The testing strategy will be refocused, from large-scale testing for transmission prevention toward making timely treatment of those who are diagnosed with infection.
Positive results from rapid antigen tests (RAT) administered at clinics and hospitals will be accepted as equivalent to COVID-19 diagnosis for another month, in order to ensure timely provision of appropriate medical care and prescription of antiviral treatments. Testing at public health centers will focus on protection of those who are at high risk of developing more serious illness, including those aged 60 or above, and those who are vulnerable to infection.
Testing support will be provided to enable adults aged 60 or above to check their COVID-19 status and receive appropriate care and help vulnerable facilities (such as nursing homes) to identify cases early to prevent further transmission.
<2> Ensuring evidence-based public health policy and strengthening of management of vulnerable facilities
Contact investigation for the purpose of curbing transmission will be reduced, and epidemiologic investigation will focus on supporting preemptive discovery of risks and signs and scientific evidence-based disease control.
Planned inspections will be conducted at vulnerable facilities such as convalescent hospitals and long-term care facilities. Based on the inspections, risk assessment will be made which will inform implementation of effective management of such facilities.
Antibody survey and population immunity evaluation will be conducted, and public-private partnership investigation and analysis of risk factors for development of severe illness or death, and adverse events following vaccination will be conducted to inform formulation of vaccination strategies based on scientific evidence.
In relation to the long-term effects of COVID-19 infection, systematic investigations such as cohort studies and follow-up studies based on big data analytics will be conducted, and the findings will be used to inform preparation for future disease burden.
System advancement will be pursued for vigilant epidemiologic response for evolving situation.
To this end, epidemiological data scattered across various institutions and systems will be linked to Epidemiological Investigation Support System, which is expected to greatly reduce the time required for data collection.
The resource capacity allocated for patient screening and classification will be re-focused on investigation and response for vulnerable facilities. In the event of mass infections at a facility, a prompt site investigation and risk assessment will be conducted.
<3> Border control
With many countries easing and lifting travel restrictions, exemption of quarantine requirement for incoming travelers will be gradually introduced. Arrival testing will also be reduced.
From June 1, all fully-vaccinated incoming travelers will be exempt from mandatory quarantine, and those who are not fully vaccinated will be subject to quarantine, regardless of the country of departure.
Currently, all in-bound travelers are required to take COVID-19 tests 3 times (before arrival, on the 1st day of arrival, and on the 6th-7th day of arrival). From June, travelers will be required to take tests 2 times (before arrival and on the 1st day of arrival).
For early access to traveler information and strengthened information management, the Q-Code system will be made available to all regional and local airports (in the second half of 2022) as well as seaports (in 2023).
3. Gradual transition to the general healthcare system for COVID-19 treatment
<1> Change to classification of COVID-19 as notifiable infectious disease (and isolation requirement for confirmed patients)
Based on risk assessment in consideration of the current epidemic situation, a high vaccination rate, availability of oral antiviral treatments, and accessibility of prompt testing and treatment for the vulnerable population, COVID-19 will be re-classified as Class 2 Notifiable Infectious Disease on April 25, although the 7-day isolation requirement for confirmed cases will be maintained for a four-week transition period, after which isolation will be a recommendation.
The second-dose vaccination rate is 86.8% and third-dose (first booster) vaccination rate is 64.3%. The third-dose vaccination rate among people aged 60 and above is 89.3%.
As of April 14, oral COVID-19 treatments have been secured for around 1.06 million patients. Enough doses for 724,000 patients have been imported to Korea, and about 220,000 patients have been administered with the medication.
For people considered high-risk groups including people aged 60 and above, prescription of oral antiviral medication was made available immediately upon positive result of rapid antigen tests administered by health professionals at local neighborhood clinics and hospitals, to ensure early diagnosis and treatment and to prevent progression to severe or critical illness for the infected.
The transition period will allow time for gradual rearranging of the healthcare system, and the isolation requirement may be replaced with recommendation upon risk assessment of the epidemic situation.
With COVID-19 as Class 2 notifiable infectious disease, health workers will be required to report a confirmed case within 24 hours, compared to the current requirement to report a confirmed case immediately as Class 1 notifiable infectious disease.
Unlike Class 1 infectious diseases, Class 2 infectious diseases require isolation of patients only if designated by the Commissioner of Korea Disease Control and Prevention Agency. During the transition period, COVID-19 will be classified as a “Class 2 notifiable infectious disease with 7-day isolation requirement”.
During the transition period, the government will gradually review and reorganize the medical system. Once the transition period is over, the isolation requirement may become a recommendation, depending on the findings of the assessment of trends in daily new infections and risks for severity.
Infectious disease classification and changes affected
Class 1 infectious diseases
Class 2 infectious diseases
(4-week transition period (starting from Apr.25))
Full monitoring, immediate reporting
Full monitoring, reporting within 24 hours
• Isolation required by law
• All confirmed patients are to be admitted for isolation treatment in principle
* E.g. single-patient negative-pressure rooms and anterooms
• At-home treatment and treatment at non-hospital facilities allowed
• No legal isolation requirement
• Focus on preventing in-hospital transmission
• Voluntary management of disease such as self-isolation
Notice of isolation
• Isolation notified by Commissioner of KDCA, mayors, provincial governors, heads of city/county/district
• UP to 1 year of imprisonment or KRW 10 million fine in case of violation
• Isolation notice at the discretion of the hospital/clinic
• Not mandated by law
• All medical cost supported by the government, including treatment costs incurred at hospital, medical facility, or home
* Through National Health Insurance or government budget compensation
• National Health Insurance
• Patient co-payment
* COVID-19 treatment cost support will be gradually reduced
Living cost support
• Daily living cost support (KRW 20,000 per day)
• Paid leave for employees (Up to KRW 45,000 per day for SMES), etc.
• No support, as isolation is not mandated by law
* Class 1 notifiable infectious diseases are 17 diseases including Ebola, SARS, MERS, and plague
* Class 2 notifiable infectious diseases are 21 diseases including tuberculosis, measles, cholera, and chickenpox
<2> Transition to at-home treatment and face-to-face medical care
Since the current mandatory isolation requirement is maintained during the transition period, at-home treatment will remain in place, while the health infrastructure for face-to-face medical care for COVID-19 patients will continue to be expanded.
Currently, about 99% of all confirmed patients are classified as patients subject to at-home treatment. Depending on risk assessment, patients are classified into either an intensive care group or a general care group. Patients in intensive care group are provided with health monitoring twice a day.
Intensive care group (i.e. patients aged 60 or above and patients and the immunocompromised) receives health monitoring twice a day from a medical institution, and general care group can use phone consultations and prescriptions at local hospitals and clinics or 24-hour medical consultation centers.
During the 4-week transition period, the at-home treatment system will remain in place. Monitoring of trends in daily new infections will be continued and need for any revision to criteria or reorganization of health infrastructure may be considered if needed.
Efforts will be continued to make more COVID-19 outpatient centers available, with the goal of local hospitals and clinics providing most of face-to-face medical care for COVID-19 patients. Government efforts will be continued for preemptive securing of respiratory care resources in preparation for possible future waves and outbreaks.
At-home treatment system will be suspended if the 7-day quarantine becomes a recommendation after the settlement period, though temporary non-face-to-face medical consultation and care will be maintained to help patients advised to stay home for recovery.
<3> Reorganization the treatment system with focus on hospitalization for patients with severe symptoms
The number of hospital beds designated for COVID-19 patients will be gradually adjusted in line with the changes in health system. The number of infectious disease hospital beds for moderately ill patients, which have seen lower demand recently, will be gradually reduced.
Local governments will continue to be in charge of assigning hospital beds for patients classified as severe or semi-severe. Hospital beds for patients with moderate symptoms can be freely assigned at the hospital level (e.g. hospital beds can be requested between hospitals), depending on the bed’s designation status.
During the 4-week transition period, hospital beds for moderately ill patients will be released from designation, except for those at COVID-19 dedicated hospitals, considering the trends in daily new infections and overall hospital bed utilization. The number of hospital beds for severe and semi-severe patients will be adjusted as well. From the settlement period, government designated hospital beds, hospital beds for emergency care, and hospital beds at COVID-19 dedicated hospitals will be available for patients.
<4> Reduce the operation of community treatment centers in a gradual manner
In consideration of the transition to the general medical system and changes in hospital bed utilization, the operation of residential treatment centers will be gradually reduced, while hospital beds for certain social groups with higher risk (i.e. persons at higher risk of infection, living in vulnerable housing conditions, or with special medical needs) will be maintained until the end of the transition period.
If the isolation requirement becomes a recommendation from the settlement period, residential treatment centers will no longer be in operation, and the human and administrative resources allocated to the operation of residential treatment centers will be reassigned for other purposes.
<5> Restoration of medical capacity to provide care for patients requiring emergency care, in labor and delivery, or dialysis treatment
For COVID-19 patients requiring emergency care, hospitals will provide a designated space such as cohort isolation rooms and gradually restore the supply of medical resources that have been suspended during the pandemic.
For COVID-19 patients in labor and delivery, dialysis, or otherwise requiring special medical care, hospitals will continue to provide special treatment beds. After some time, hospital beds for general purpose will be used together with special beds before utilizing general-purpose beds only.
4. Protection of high-risk groups and people vulnerable to COVID-19 infection
<1> Preventing mass infection at vulnerable facilities (e.g. nursing homes)
It is necessary to pay special attention to preventing an outbreak of infectious disease at certain facilities vulnerable to infection, such as nursing homes, where mass infections can lead to significant health harm of those who live in such facilities (e.g. higher risk of severity and fatality).
To this end, fourth dose (second booster) of COVID-19 vaccine will be available for individuals who live in facilities vulnerable to infection and people aged 60 or above, along with first-dose vaccination for those who are not yet vaccinated.
Also, the government will review plans to provide Ibushield for people with a weakened immune system who cannot build immunity with the existing vaccines.
<2> Preparing rapid response plans
For care facilities, medical support will be strengthened to minimize damage in case of COVID-19 transmission.
In addition, hotlines will be established between nursing homes and public health centers and local rapid response teams will be formed jointly by regional KDCA centers and local public health centers to perform risk assessment, contact tracing, and in-depth inspection.
Also, the current medical system will be reorganized to ensure timely provision of medical supplies (e.g. personal protective equipment, test kits, and disinfectants) and to secure more care assistance personnel.
The government is considering a plan to introduce a fast-track procedure for patients at higher risk, under which testing, prescription of oral medications, and treatment are provided timely and the patients have the priority for hospital beds in the event of emergency.
<3> Improving infection control at facilities vulnerable to infection
Efforts will be made to improve health care environment at facilities vulnerable to infection, such as nursing homes and mental health centers, to strengthen infection control capacity since such facilities are at higher risk of mass infection and of severity and fatality caused by COVID-19 infection.
To this end, a status inspection will be conducted at nursing homes and facilities by August, and based on the results of the inspection, plans will be prepared to support the facilities’ health care environment. Also, plans are underway for projects to improve the 3Cs (closed spaces, crowded places, close contact) at mental health care facilities.
<4> Resuming operation of senior welfare facilities
Senior welfare facilities, such as community senior centers, will open their doors again for fully vaccinated people, with details to be decided at the discretion by the local government.
Senior welfare facilities will be advised to provide programs that have a low risk of COVID-transmission, and eating will be allowed only when users are physically distanced or partition screens are installed.
5. Preparation of system for response to novel variants and new waves
<1> Strengthening the monitoring of novel variants and new waves
Disease surveillance system will be strengthened in consideration of possibility of novel variants of concern with different transmissibility or fatality characteristics or new waves.
The government will investigate and analyze the variants, strengthen next-generation sequencing techniques, and perform risk assessment when a novel variant is detected.
Variants are analyzed in terms of 1) epidemiological characteristics, 2) clinical characteristics, 3) effectiveness of diagnostic test, vaccines, and treatments, and 4) viral characteristics
COVID-19 is added to the list of sentinel surveillance of respiratory infectious diseases in order to prevent simultaneous circulation of COVID-Flu or COVID-RSV in winter seasons. Also, to monitor the trends in new infections more effectively, the government will promote the participation of medical centers in the surveillance of acute respiratory infectious diseases.
To help ensure early detection of novel variants and new waves, plans are underway for expansion of the projects for surveillance of influenza and respiratory viruses.
Currently, the purpose of the surveillance projects is to monitor 8 types of influenza and respiratory viruses, focusing on domestic outbreaks, participated by primary medical centers. The government plans to add COVID-19 virus and genome sequences to the surveillance list and focus on both domestic outbreaks and inflows from abroad, with participation from primary, secondary, and tertiary medical centers and contract-based medical institutes.
In addition, in the short term, the government plans to introduce a wastewater-based surveillance system for early detection of outbreaks in the local community and gradually expand the system for nationwide application.
(Short-term plans) 1) Research on how to introduce a wastewater-based surveillance system, 2) A pilot test in Sejong city, and 3) Lay the foundation for local governance
(Mid- to long-term plans) 1) Establish a wastewater-based surveillance system at the local level and 2) expand the system nationwide
<2> Preparation of timely transition to response system in case of new variants
Preparedness efforts will be made so that in the event of a new variant emerging abroad, importation will be delayed as much as possible while the country quickly transitions to a system that would allow preparation for a local or community transmission.
At the same time, the government will transition to a strategy focused on the 3Ts (testing, tracing, and treatment) to curb transmission. If not effective enough, reintroduction of social distancing rules will be considered based on the assessment of variant characteristics and effectiveness of social distancing.
Reintroduction of social distancing will be decided upon sufficient discussion at the New Normal Recovery Support Committee and the Central Disaster and Safety Countermeasure Headquarters based on analysis of the effectiveness and implications of such measures.
The government will make efforts to secure the COVID-19 vaccines preemptively, based on the assessment of vaccine efficacy and the trends in new vaccine development, and prepare strategies to implement large-scale vaccination campaigns and reorganize the relevant infrastructure.
Reintroduction of at-home treatment and self-isolation will be considered based on analysis of the new variant’s transmissibility and fatality as well as the country’s medical capacity, and if necessary, smooth transition will be made.
<3> Solidifying response capacity for preparedness
In preparation for possible new waves, vaccination plans will be prepared in advance, and sufficient stocks of COVID-19 treatments will be secured. More hospitals and clinics will be eligible to prescribe COVID-19 treatments.
Given that immunity from vaccination diminishes with the lapse of time, a booster vaccination strategy and implementation plans will be prepared.
Booster vaccination strategy will be prepared based on the results of preliminary research (i.e. vaccination timing, subject groups, and whether simultaneous administration of vaccines) will be determined based on the immunity formation by age groups and key indicators (fatality, positive rate of antibody, etc.) and expert consultation.
The government will increase compensation for vaccine-related injuries and the scope of eligible injuries and streamline the application procedures to claim compensation in order to encourage citizens to get vaccinated without health concerns.
Sufficient stocks of oral treatments will be secured and more local hospitals and clinics will be allowed to prescribe the treatments to patients, and patients eligible for COVID-19 antivirals will also be expanded.
To improve vaccine and treatment self-sufficiency, all-out support will be continued for research and development of domestic vaccines and antiviral treatment products.
<4> Strengthening local public health infrastructure
The government will strengthen and reorganize local public health infrastructure to enable the country’s local communities to respond to new waves in a timely and flexible manner.
Local governments will play a more central role in the country’s COVID-19 response, with increased capacity provided to local public health centers and public community centers in each city, province, county, and district. Relevant personnel in charge of public health care will be provided with education and training.
The government will establish a permanent system that responds to an outbreak of infectious diseases through the cooperation of regional KDCA centers and local governments. This system will monitor an outbreak of infectious diseases at the local community level, conduct epidemiological investigations, test viral pathogens, etc.
The government will reorganize the existing public health management system for relevant facilities, and will provide guidelines for indoor ventilation based on the results of risk assessment in order to prevent COVID-19 transmission through indoor air.
To meet the on-the-ground health personnel demand more effectively, the government will review the size of nursing professionals who completed the courses for critical care nursing, diversify educational programs for pediatric, labor and delivery, and dialysis nursing, and separately manage capable nurses on secondment.
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Adjusted social distancing policy for two weeks (4.4.~4.17.)
Social distancing restrictions to be lifted starting April 18
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