Photo: Thomas Maresca/UPI
While South Korea has found success in combating the spread of COVID-19 through an aggressive approach of testing and contact tracing, there has been another crucial factor driving the country's response to the deadly disease: its nurses, who have carried some of the heaviest burdens among healthcare professionals here.
At hospitals in areas where the coronavirus outbreak was most severe, such as Daegu, the southeastern city where about two-thirds of the country's more than 10,000 COVID-19 cases are located, nurses have worked around the clock, with many living apart from their families for weeks at a time for fear of spreading the infection.
In addition to their regular duties of monitoring and caring for patients, nurses have also had to take on a wide range of extra tasks while wearing cumbersome protective gear inside airtight negative pressure rooms where COVID-19 patients are kept.
"We have to take care of patients from A to Z," said Oh Nam-hee, a nursing team leader at Daegu Medical Center, a public hospital that was designated as a COVID-19 treatment facility. "Not just anybody can come into the negative pressure rooms, so the nurses have to do all the jobs we used to outsource: feeding the patients, cleaning the rooms, disposing of waste, even removing infected corpses."
The number of patients under a single nurse's care has also roughly doubled at the hospital, to six or seven patients per nurse.
"This has been the hardest time in any nurse's career here," said Oh, who has been sleeping on a bed in her office and was not able to see her family in person for weeks after the outbreak.
"My family would come to the parking lot in their car, and I would just wave to them," she said. "At first, I was too busy to even go outside."
South Korea's first confirmed case of COVID-19 was on Jan. 20, and for the next month, the infection remained relatively subdued.
However, it was the country's 31st patient, a 61-year-old woman in Daegu who was confirmed on Feb. 18, that sparked an epidemic. The woman was a member of a secretive religious sect, the Shincheonji Church of Jesus, and had attended a number of services at its church in Daegu with hundreds of other congregants while infected.
Cases began multiplying exponentially, doubling for several consecutive days and reaching a peak of 909 new cases on Feb. 29.
The massive influx of new patients nearly overwhelmed the hospitals designated to handle coronavirus cases in Daegu, such as Keimyung University Dongsan Hospital, where ambulances would line up some 30 deep at the main entrance, which staff quickly nicknamed "Corona Road." The hospital, which normally has around 200 beds, saw its number increase to 465.
"The patients just kept coming and coming," said Choi Youn-suk, vice head of the nursing department at the hospital. "Things happened so suddenly, and we weren't prepared for this sort of pandemic situation. We were working 16 hours a day at the first stage. Many nurses were too busy to commute to work but there were no facilities ready, so some were sleeping in the funeral parlor next door."
One of the main hardships nurses have faced treating COVID-19 patients is working in the personal protective equipment required to maintain safety, Choi said. For every shift, healthcare workers have to put on gear that includes a full bodysuit, face mask, goggles, gloves and a breathing apparatus.
The heat and weight of the equipment is draining. The goggles cause headaches and leave deep grooves in the skin, causing many nurses to wear bandages as protection. Some nurses avoid drinking water to limit restroom trips, which would require removing and disposing of the gear, leaving them dehydrated.
"It takes a lot of energy and stamina just wearing the protective gear," Choi said. "Some nurses will vomit and most have to take Tylenol. We have to rotate out in two-hour shifts. And to maintain that cycle, we need more manpower, it's too much of a job."
While at first Korean health authorities scrambled to find enough hospital beds and supplies such as face masks ran short among the public, it was the lack of nurses that has lingered as one of the biggest challenges.
"The role of nurses is very important," said Dr. Cho Chi-heum, the director of Keimyung University Dongsan Hospital. "They drive everything. We have enough doctors -- we need more nurses, twice as many nurses as we have."
Volunteers have helped fill the gap. At Dongsan Hospital, an additional 150 volunteer nurses were eventually added to the regular staff of 120. Others, such as 18-year-old first-year nursing student Kim Hyo-ju, have been helping with tasks like assisting healthcare workers with their protective gear.
"I saw a documentary about nurses volunteering here, and even though I'm just a student I called the hospital to see if I can help," she said. "For me, it can be a stepping stone. We don't know when the next virus will be coming, so I will be experienced and ready for the next time."
In the meantime, advocates have raised the alarm about the impact the workload and stress have been having on the nurses.
"We are concerned about the health and safety of nurses," said Dr. Shin Kyung-rim, president of the Korean Nurses Association. "As fatigue accumulates, they are at higher risk of infection."
Shin said the stress of dealing with so many critically ill patients, as well as the separation from their families is taking a heavy emotional toll, so much so that the KNA has set up a psychological counseling hotline.
The association is also advocating for a new set of policy guidelines from the government to regulate nursing on everything from improved working conditions to better hazard pay.
"It is essential to procure proper equipment, secure enough manpower at all times and to provide prior training," she said. "The government knows there needs to be a systematic reform. We don't want to rely on volunteer nursing again in another crisis."
The work of South Korea's nurses during the pandemic hasn't gone unnoticed. Hospitals hallways in Daegu filled with donated supplies ranging from food and water to new clothes for the nurses. Children's art covers lobby walls, with many images thanking nurses.
South Korean President Moon Jae-in also singled out South Korea's nurses last week on World Health Day, part of a yearlong campaign by the World Health Organization that is focused on celebrating nurses and midwives.
"Nurses are warriors in protective clothing fighting on the battlefield against COVID-19," he said in a message on his Facebook page. "Despite the heavy risk of infection, nurses stay with the patients for the longest time. I hope that all of us cheer on nurses as a source of pride that can't be replaced."
As South Korea has seen new COVID-19 cases drop to their lowest levels since February, the country marked a milestone on Friday: the city of Daegu reported its first day of no new cases since the outbreak began there. It is an accomplishment that wouldn't have been possible without the sacrifice of nurses, said KNA's Shin.
"In South Korea, the death rate is low and the cure rate is high," she said. "This is not only due to the medical system, although that is important. It is also due to the nurses, through their knowledge and experience and devotion."