I am a nurse working in South Korea's Seoul National University Hospital, AMA

I’m a registered nurse in Australia and I’ve volunteered to start working in the COVID-19 clinic we’ve just opened! I’m a little anxious. Any advice?

Hello fellow nurse! My advice would be to sanitize your hands as much as you can, wear a mask everyday and always keep in mind that your services will never go unnoticed!

Thank you so much for being there for patients who need you!

Thank you!!! And to you too 🙏🏼

Remember to look after yourself too in all this craziness

Thank you, good luck!

How do you get masks? People in Sweden never have any masks at home and the stores don’t sell them. The hardware stores that keep p3 respirators for painting or asbestos removal and similar are all sold out (not many to begin with).

In asia it seems like most people already have a bunch of masks at home. I have masks for a week at most.

Koreans used masks a lot even before the virus struck, so first of there were some stocks. But right now, we are also running very low, so the government is limiting the purchase to 2 masks per day and that is also not guaranteed. Earlier on, masks were mainly mass imported from China. Almost all out of that too.

Isn't it two per week? Since we can only go one day a week dependent on our birth year (Living in Korea too).

Yeah, that’s right. Sorry about that. But you can get non-government supplied masks without a limit.

2 per day is plenty, I could maybe find one per month here unless you would pay more than 50usd for industrial resporators, but those are hard to disinfect between uses anyway.

People wait in line for hours so they have a chance to buy those two, :( those are also not guaranteed stock.

How do you have time to do an AMA?

I finished my Day shift and I'm off tomorrow. We are people too, we do get off days haha

The CDC in the US are telling us to not wear masks unless were sick, because they don't do anything

Masks serve two purposes 1. protect others from you if you have a disease. 2. protect YOU from others that have the disease. If that is true, CDC is giving you wrong info. that is not cool.

I am an American ICU nurse and we are just seeing our covid-19 ruleout patients ramp up. There has been a big delay because of lack of testing, and the tests are slow. I just worked this whole weekend and while my hospital hasn't yet had a confirmed case, I'm sure we will soon.

Our PPE protocols have shifted a ton. I've heard rumors that droplet precautions (basic masks) are good enough for patients with milder symptoms, and that N95/PAPR masks (full hood with blower strapped onto back) for airborne precautions are needed for anything aerosolizing (bronchoscopy, intubation, cpr, swabbing, etc).

We have to use a new N95 every time we enter a pts room and throw it away when we leave our negative pressure rooms. Or use a PAPR and wipe it down with oxyvir every time it's removed and between rooms. What is your protocol for PPE?

Is there a general progression you tend to see? Are you having to prone people/high fiO2/PEEP/Flolan? What kinds of treatments do you tend to see in your ICU patients?

I'm very willing to work and I'm now aggressively self quarantining now that my weekend shifts are over. I've had a dry and scratchy throat and increasing sniffles the past few days. I want to get tested because I don't want to spread anything to my sick patients, but there are so few tests and they're taking 3-5 days right now. I have a few days off, hopefully some big changes happen. I am really expecting the worst and knowing that I'm going to be very, very busy for the next month.

First off, WOW. 3-5days? that is insane. That is far too slow. Please note that I'm answering your questions based on SNUH's regulations only. 1. Surgical(dental) masks are not 100% able to keep the virus from penetrating the mask, so we are advised to only wear them when contacting patients that aren't related to COVID-19. 2. In ICU settings, medical staffs are currently wearing PAPR masks on top of N95 masks. All PAPR must be sanitized each time. N95 is one-time use only too. But I’ve heard since all medical facilities are running low on N95 masks, (not sure but) some are saying they are re-using N95 masks to one per day. 3. General progression is very different from GW settings to ICU settings. GW tends to be very mild symptoms, so I'll write down what I know about ICU settings. ICU settings consists of older gen patients, with high percentage of pneumonic XR findings and high rate of dyspnea. I've heard that many patients do require High flow Airvo (High FiO2), and sometimes PEEP ventilators. The Tx is mostly Avx for Pneumonia, and Lung care (Either ventilator, O2 supply, High flow etc) It would be easier to understand if you imagined yourself working in a Pulmonary ICU.

Now that Korea's infection rate has leveled off, how many days or weeks until most of the existing infections are resolved?

Based from my hospital's routine evaluation system, it normally takes at least 2 weeks for asymptomatic patients to be considered negative, plus on top of that, you have to get tested negative three times consecutively every 3-7 days for the patient to be officially tested back negative.

So from the first day someone shows symptoms, it likely takes about 7-14 days to become asymptomatic, plus two weeks, plus 9-21 days for the three tests to come back negative? For a total of four to seven weeks?

The amount of time required for a symptomatic person to become asymptomatic varies a lot by each patient. So I would say, on average, from the day you become asymptomatic, it would take 9-21 days for you to be de-isolated.

Is SK considering the possibility that continued air travel will bring second round of virus?

Of course. Air travel is the top reason this went global.

plus, we are currently isolating every patient(whether symptomatic or not) that comes from a specific city, Daegu, where there was a massive viral spread inside a Church, for 2 weeks.

but realistically, the government is looking at November for the COVID situation to be resolved.

Assuming Korea won't be in quarantine until November, are there reports of how the quarantine or advisories will be relaxed in some cities? What's the timeline for that?

Right now, Koreans are advised NOT to travel between other countries, or any cities in general unless needed. Koreans are voluntarily keeping back from traveling even domestically.
Currently there is no "quarantine" in any cities in Korea, and I assume there won't be one in the future. People just don't go to cities that involves numerous outbreaks.

Although the infection rate is leveling down, we are still very careful about everything, so everyone is still advised to wear masks all times and schools(elementary, middle, high and unis) are postponing new school terms until further notice. We are looking at April for people to start going back.(New school year starts in March in Korea)

Man I do not trust Americans to keep from traveling - some people are still doing so now :/

You could take what happened in Italy as an example. People tried to flee from that one city and ended up spreading the virus to other neighboring cities like crazy.

Yeah exactly but it seems like people have learned nothing from watching wuhan and South Korea. its a shame. I respect you and your peers in the medical field. Thank you for pushing through this uncertainty.

No problem. Thank you

If you live in an African country with very limited health care system ie zero to chance of getting a place in ICU. What can you do to improve your chances of surving?. Thanks

1. drink boiled water and NO raw foods.
2. avoid crowded places.

would be the top two priorities I would say.

Why no raw food?

because cooking destroys germs.

yes.

How common is it for a person with covid19 to have a mild fever for 8 days, and not progress to a serious condition that requires hospitalization? (Or do you know where I can find this information?)

Many people around the world are about to get sick, and almost no one in their country has even heard many first-hand covid19 accounts. What is worrisome, and what is just normal, stay-in-bed bad? At what point should an moderately-symptomatic person decide that they need to be at the hospital? (This is important for preventing wasting health care resources around the world right now.) Thank you!

If you are a generally young(30's or younger) with no underlying diseases, you have a higher chance of having less severe symptoms. If you have already developed symptoms, mild or severe, it's very important to get tested so you can prevent more severe symptoms.

Worrisome symptoms would be dyspnea(trouble breathing), pneumonia(symptoms are wheezing, pain when coughing etc) and other severe respiratory symptoms.
Stay-in-bed would technically be milder symptoms like cough, mild fever, but it's better to get tested and only stay at home until results come out.

I don't think you should go to a hospital when you develop symptoms. That increases the risk of you infecting other non-infected people. It depends on the country, but you should look for government info on where you should go or call once you think you need to get tested.

When I had walking pneumonia the one thing that triggered me to go get a checkup was my lung capacity being significantly decreased. Specifically I remember trying to sing along with a song and could barely get out a single verse without having to gasp for a deep breath, and even when taking a deep breath it didn’t feel even close to a normal deep breath.

Is this a decent signal to start packing up and heading to urgent care or a hospital? (Edit: assuming you have a fever and other covid symptoms)

Definitely. If you have history of that severe of Pneumonia, you should be extra careful.

Are there cases of getting the virus and completely recovering at home, with just mild symptoms?

Yep. there are. Mostly young generation patients who don't have underlying diseases.

Can you explain why is it " it's very important to get tested so you can prevent more severe symptoms. "?

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What exactly can be done to help prevent more severe symptoms?

If you get tested early and diagnosed earlier, you can start managing those symptoms before it gets severe and cause permanent damage.

Can you be more specific? How does one manage symptoms to prevent permanent damage?

If you are diagnosed, they immediately start treating you with antibiotics. That can protect your lungs, immune system because those meds can help fight the virus. So it leads to less chances of bigger damages like pneumonia because you're already managing it with preventative medicine.

I have not seen any guideline on using antibiotics to treat this. Are you saying everyone diagnosed (even with mild symptoms) gets antibiotics?

It depends on the country, but korea does have a set antibiotic guideline once you are diagnosed.

maybe that could explain relatively few deaths? Thank you.

I'm not entirely sure, but I do think it could play a factor.

Antibiotics are targeted at bacteria and will not be effective against viruses. Is this to prevent secondary bacterial infections?

To correct my mistake, you would use antiviral meds first and then use antibiotics to prevent secondary bacterial infections if needed. My mistake.

How is the staff handling all the work? Did you have enough masks, gloves,... ? How does your family deal with you working at a hospital during times like these?

In general, the staffing for COVID-19 wards are TOTALLY understaffed, although, fortunately in my hospital, there has been more than enough volunteers that work in the COVID-19 wards. Masks, gloves and safety equipment is a whole other conversation though. We are running on such low numbers of equipment that we don't have enough to give out to caregivers and doctors. We only have enough for nurses and patients. Doctors get their daily mask at the doctor's lounge (one per day) On the last matter, I don't see my family often anymore.. I consider myself a "walking ball of viruses" due to the nature of my job. So I stay away from my family as much as I can

That seems incredibly tough, being understaffed, in those conditions and not seeing your family... I know it is the responsible thing to do, but it still is hard.

Thank you for the work you do! I hope the situation returns to normal quickly.

Yeah, but it feels like the right thing to do, so almost all medical staffs are okay with being away from family, because it saves them.

and you're welcome. I hope this whole COVID thing dies so I can see my man. lol

Now that different countries are going different paths (some are closing everything down, some keep some things open), do you think one way is better than the other?

As a followup question, SK seems to be testing as many people as possible (no restrictions on who gets to take the test?), most other countries seem to have given up on this idea instead stating "Stay home if you think you have it and we will test you if you need hospital-care". Do you see any up or downside by mass-testing as SK is doing?

It feels weird as a citizen to be told "Well you might be infected but we will never know, just go home and get well !".

1. I think some countries closing everything down is not a bad idea, but I'm sure politics are playing a strong factor in that matter. Korea couldn't shut down people from China coming in because of the whole trade issue. And I think it was a smart move for USA to not block Koreans from coming in the States, because Korea holds the technology to mass-test.
2. A middle-sized company in Korean developed a fast, cost-effective test kit for mass testing. That is why Korea is able to test so many people so fast. The government is advising people who either, ;has been to countries that involved 'viral outbreaks' in the past 2 weeks, ;has a fever higher than 37.5 celcius ;has symptoms (cough, dyspnea, etc) ;has been contacted by authorities due to crossing paths w/ another diagnosed person. Those people are advised to go to a public health center located in every city, or call a specific number to get directions. I think in short-term it's not good for Korea to test on so many people, because it shows that much people are getting diagnosed, but in the long-term, we will be able to control the virus better because we know exactly how much people we're dealing with.

Are you ok??

Yep. I'm fine.

I am a neonatal intensive care RN in the USA. I also work in the pediatric ICU. Have you seen many children actually symptomatic or mostly just carriers? our premature babies have such fragile and noncompliant lungs, we are worried what this could do to them.

As you know, it's very easy for neonate-pediatric children to have mild fever. Their temperature tends to shoot up and down, so they get tested as much as adults do. But right now I think I've only heard about one case (15mo/M) of neonatal-pediatric COVID case.

But since you are in a ICU setting. You have to be extra careful. Our hospital's Pediatric and Neonatal ICU have both banned all parental meeting times. No exceptions.

Thank you, stay safe.

you too.

Are there people getting sick again after recovery?

I don't remember seeing cases like that.. but I think there is possibility that can happen.

First - Hero ❤️🙏

What can I say to my sister who thinks this is all being exaggerated?

She's not 100% wrong. It is just another respiratory virus. There are tons of different types of Coronavirus. It's just that this one doesn't have a prevention method and a cure.

What are the first sign of covid-19 ? And how long does it take to go from ok to bad?

First and most common symptoms are: high fever(higher than 37.5 celcius), cough, fatigue

More serious symptoms that need active management are: dyspnea(trouble breathing), pneumonia and other respiratory problems

More serious symptoms usually take 2 weeks (depending on the person's general health), but it also could never happen.

Is that two weeks from exposure or two weeks from symptoms first showing up?

exposure.

Any word on assisting other foreign countries with planning/strategizing over this outbreak and key points where we are deficient in preparedness? Sounds like South Korea is successful in tackling this head on. It would seem like to be honest, a wise thing to do to give assistance in technology to some companies like Apple or google who have the best intentions of getting global societies back to the status quo if that can ever occur....

I think the main reason SK was successful with dealing this is because of the transparent process of testing and revealing all info(including travel routes of every single diagnosed patient) to public. That seems like a smart thing to do and the right thing to do. I hope SK can give out the mass-testing kits and get good credit for it.

Since normal hand sanitzers are sold our here, do you know if iodaphor based sanitizers are effective?

I make my own mead as a hobby, and use it to disinfect my brewing equipment.

although Iodine-based sanitizers are more effective, I think normal hand sanitizers will be enough. Plus, iodine-based sanitizers require more time to set until it becomes 'effective'

1. Is there any evidence that Ibuprofen based pills taken after the symptoms appear makes the condition worse?
2. If masks prove to be ineffective why do people wear them? Does it reduce the risk at all ? If yes, what advice and best practices do you have regarding wearing masks.
3. If heavy symptoms appear, what can patients do at home to alleviate them?
4. Is it better to have a weaken the immune system before catching the virus and then boost it while it's fighting COVID-19 ?
5. Is there any evidence vitamin C helps you recover faster or exhibit mild symptoms?

1. I've never hear whether IBP worsens or betters the condition.
2. Masks are a very effective source of protection. Surgical(dental)masks do protect, but KF80,or 94 masks are more effective. Normal cotton/polyester type masks cannot prevent you from the virus.
3. If heavy symptoms appear, do not try to alleviate them at home. Immediately "call" local health centers and ask them what you should do.
4. No. better to have an already strong immune system.
5. Vitamin C does help with general physical condition if taken regularly, but it hasn't proven directly effective with faster recovery or symptoms.

How many young healthy people are you seeing get infected? What are considered mild symptoms? Are they on the line of a flu? flus can be pretty awful for a young healthy person. Is anything not urgent, considered minor?

Many young gens ARE getting infected, but they have a remarkably low mortality rate (only 1 under the age of 39 so far). Coronavirus is actually a very common cold virus. It is not a flu. CoronaV has been mutating every once in a while, and the new COVID-19 is another version of that mutation that we haven't developed a vaccine/cure to.

Thanks for doing this!

Do you know what the projections are for the epidemic in your country going forward? Are you expecting the numbers of infected to keep decreasing, or will there be a second wave or an increase in the fall?

The government did make a statement that they are looking at briefly November for the virus to die down. Hopefully, the rate does decrease, but there still might be a possibility that when people become relieved, they care less about personal sanitization(wearing masks, avoiding crowded areas), and eventually another peak strikes.

Hi! What do you think is the key to Korea's success in handling COVID-19 and are there precautions being made to stop the virus coming back once you have it under control?

I think the ability and the technologic capability to mass-test and detect people at early stages of the virus made it easier to manage, because more people had less severe symptoms. Precautions that could be taken once you get unisolated is keep your masks on and make sure your immune system is healthy(no extreme diets, eating good healthy food).

Do you know where we can find Korea’s stats? Since they are clearly a head of every other nation in regards to testing, their numbers are probably the most accurate out there in regards to hospitalization and fatality rates.

Edit: found your post of stats below

http://ncov.mohw.go.kr/bdBoardList_Real.do?brdId=1&brdGubun=11&ncvContSeq=&contSeq=&board_id=&gubun= This is the link to Korea's current stats. but they are only in korean. English isn't available yet.

Is the South Korean government worried about the epidemic spreading into North Korea? (Because allegedly the disease has already hit the DPRK.)

I heard it from the news that it did hit DPRK. I heard we supplied masks, but I have no further info on that matter. Sorry.

Masks are good. I'm sure they are getting pointers on dealing with COVID-19 from the Chinese.

Thank you for the fast response and stay safe.

no prob. you too.

Thank you for doing this and hats off to your work.

I am taking all precautions for myself and family life ke avoiding crowded places as much as possible and wearing N95 mask when in crowds, washing hands frequently etc. In a densely populated country like India, what else can I do keep me and my family safe?

N95 masks, hand washing and avoiding crowded areas are all wonderful. If you’re willing to take an extra step, storing your outside clothes(jackets) seperately could also be good. But it’s not necessary

Do you feel there will be any more clusters popping up in Seoul (like what just happened in Sindorim)?

I think it could happen anytime.

에이즈 약을 쓴다는 소문이 있던데 사실인가요?

안녕하세요, 에이즈 약이라 함은 가장 많이 쓰는 '지도부딘(zidovudine)'말씀하시는 것 같아요. 몇주전 뉴스에서 완치되신 분 에이즈 항생제 쓰셨다고 하더라구요. 에이즈와 직접적인 연관을 지으시면 안되고, 에이즈를 치료할만큼 강력한 항생제를 사용했다고 생각하시면 될 것 같습니다. 에이즈랑 전혀 관련 없어요.

정정합니다. 지도부딘이 아니고 Lopinavir/Ritonavir (LPV/r) 라는 약이라고 하네요. 같은 작용하는 다른 약이라고 생각하시면 됩니다.

그렇군요. 고생하십니다.

넵 항상 건강조심하시고, 마스크 구하기 어려우실텐데 잘 사용하고 다니세요!

Hi, thank you for taking the time to do this. I have 3 questions:

1. Do you think this will become a seasonal disease like the flu?
2. As a relatively healthy 27 old, am I better of isolating myself or going out to get this so called 'herd immunity'?
3. If the virus is contracted and you recover, is there likely to be permanent damage?

Thank you for your bravery and hard work!

First off, thank you for the kind words. 1. I think it will become seasonal once we get the vaccine/cure made. 2. Herd immunity only works if there is a vaccine that prevents that disease, so stay at home if you don't want to contract the virus. 3. Permanent damage is more likely when you develop severe symptoms and need to be hospitalized in an ICU setting.

I’m not the original poster, but regarding 2, you should think verry carefully about whether you can be 100% sure that you won’t spread it to some less healthy neighbor or family member before you get into self-quarantine after contracting it. I would absolutely want to wait until very strong medical advice is in place about it before attempting this kind of discount “vaccination”.

I meant to say to stay at home if poster doesn't want to contract the virus. Edited.

What is the situation in the labor and delivery wards? In America and due in 3 weeks with our first. I'm just concerned about how delivery will go and having at least my husband there. My mom was supposed to drive down but we've decided against that at this point. I really don't want to do this alone.

Also any recommendations for keeping myself and a new born safe while this is happening?

First, I hope your delivery goes well! and congrats on your firstborn! I think it's better to have less people with you when you go through delivery, I know it is way better to have emotional support, but considering the baby needs to be protected first, your family can wait a little bit until they meet their newest member. Just like general precautions, ALWAYS wear a mask and avoid crowded places! Especially when newborn are susceptive to viruses and have a weak immune system.

Is it possible to get corona without a fever?

there has been many cases diagnosed that were asymptomatic.

I have lupus, immune system compromised. Any special advise?

Oooh. SLE? I think the best thing for you to do is to try to stay at home and try not to have guests at your house..

I know this is such a shitty answer, but it's the best too. If you have to leave the house, wear a protective mask, when you get home please take off all outside clothing once you enter the house, take a shower.

Yes. Sle. Also is it true you're using hidroxicloroquine to treat covid19 patients? Could it run out?

Hidroxychloroquine is one of the treatments. Running out shouldn't be a problem because it is not a definite treatment. It's one of many options.

Has South Korea found the person who initially brought the virus to the country, and if not, do you know if this research is underway? Also, have you heard any updates on what animal the virus came from?

ETA: also, have you seen any cases of patients who went on to recover after being put on a ventilator? Thank you and stay well!

I think we found who the first diagnosed person is, but I think that person isn't definitely the first to bring it to the country. The initial person is less likely to be found, since the virus has already spread so much. Updates on the animal, I thought it was most likely from the bats in Wuhan market?

Right and I thought it jumped to humans from an intermediate host which they thought was a pangolin but isn’t. Or do we know that it went straight from bats to humans? Thank you!!

I heard it could be the consumption of bats or either bat droppings that got inside the foods sold in the market. not sure.

I added a late question sorry - have you seen any patients recover after being put on a ventilator or is the ventilator a bad sign? Thanks again!!

I’m not sure I’ve heard of patients who ultimately tested negative, but I’ve heard of patients who were able to wean out of vent care.

[deleted]

I think that is false news. Current standings for COVID-19 cases in Korea are: Tested: 274,504 Diagnosed: 8,236 Testing: 14,971 Un(de)isolated: 1,137 Deaths: 81 75

EDIT: Mortality count is 75, not 81

Still a very low death rate, compared to basically any other country. Do you have any idea why that is?

Weird saying it myself.. but Korea does have very advanced medical technology.

But did you have a higher amount of beds and ventilators for the serious cases, than for example Italy or Spain? Did you develop some sort of treatment that other countries aren't adopting? Was the age of the infected lower than in other countries?Where I'm trying to get is: how can we avoid what's happening in Italy? They have a 7% death rate and it's probably still climbing.

Korea does have a very dedicated ICU system (ventilators, ECMO, CRRT) and educated staff. Plus, because we can diagnose them at earlier stages of the virus, there tends to be higher rate of patients with less severe symptoms. As far as I know, the highest age generation that are diagnosed in Korea are people in their 40's and up.

So, correct me if i understood it wrong, you managed to keep older people from catching it at all?

Ooop, I was trying to say that the older generations 40, 50, 60, 70's had a higher chance of catching the virus. English is not my mother language, so sorry if I didn't say it correctly the first time.

Your English is fantastic.

thank you :)

I'd imagine it's the high testing rate and the citizen's voluntary adherence to distancing and other policies. SK seems better set up socially and culturally to minimize exposure and provide care than a lot of other places.

I agree. Koreans are strangely extra cooperative when it comes to national crisis lol

Thank you!

No problem!

When you increase the denominator, (pts tested), the overall number is smaller. SK is testing over 500x the # per million than the u.s.

More asymptomatic or mild cases in the denominator equals fewer deaths per positive case.

true.