What should we prepare for the next coronavirus disease 2019 outbreak? A survey on the opinions of infectious diseases specialists in South Korea

Article information

Korean J Intern Med. 2020;35(6):1270-1278
Publication date (electronic) : 2020 September 23
doi : https://doi.org/10.3904/kjim.2020.222
1Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
2Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
3Division of Infectious Diseases, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
4Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
5Division of Infectious Diseases, Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
6Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
7Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Correspondence to Hyun-Ha Chang, M.D. Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea Tel: +82-53-200-6553 Fax: +82-53-426-2046 E-mail: changhha@knu.ac.kr
*

These authors contributed equally to this work.

Received 2020 May 13; Revised 2020 June 6; Accepted 2020 June 12.

Abstract

Background/Aims

This study aimed to collect information on the opinions of Korean infectious disease (ID) experts on coronavirus disease 2019 (COVID-19) and related issues in preparation for a future outbreak.

Methods

A survey was conducted over the course of 5 days (from April 21 to 25, 2020), targeting all adult ID specialists currently in the medical field in South Korea (n = 265). An online-based survey was forwarded via text message and e-mail. Only one response was accepted from each participant.

Results

Of these 265 ID specialists gotten to, 132 (49.8%) responded. The highest proportion of the respondents envisaged the current COVID-19 outbreak to end after December 2020 (47.7% for the domestic Korean outbreak and 70.5% for the global pandemic); moreover, 60.7% of them stated that a second nationwide wave is likely to occur between September and December 2020 in South Korea. N95 respirators were considered to be the most important item in hospitals in preparation for a second wave. The most important policy to be implemented at the national level was securing national hospitals designated for the treatment of ID (67.4%).

Conclusions

ID experts in South Korea believe that the COVID-19 pandemic may not be easily controlled and that a second nationwide wave is likely to occur in South Korea. Our results indicate that Korean ID specialists believe that a high level of preparation is needed in various aspects, including the procurement of personal protective equipment, to respond efficiently to a second outbreak.

INTRODUCTION

The coronavirus disease 2019 (COVID-19) has spread rapidly across the globe since late 2019, resulting in the onset of a pandemic on March 11, 2020. As a result, more than 4 million confirmed cases of COVID-19 have been reported, encompassing more than 210 countries as of the end of April, 2020 [1]. The first confirmed patient, a Chinese national, entered the country from Wuhan, China on January 19, 2020 [2], and South Korea became one of the first countries to be affected by the outbreak, with a total of 10 738 infections as of April 27, 2020 [3]. The highest level of infectious disease (ID) alert was declared after the occurrence of a significant outbreak within a religious group in Daegu and its neighboring areas in mid-February 2020 [4], after which several countermeasures were introduced and reinforced. Consequently, the outbreak was mitigated from mid-April, with only around 10 newly confirmed cases per day [3]. Thus, South Korea is revisiting the measures put in place during the worst period of the outbreak, namely social distancing, and is preparing for a return to normal life.

Despite the positive social atmosphere, many experts have been warning of a possible second wave. Considering the characteristics of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is reported to be shed from infected patients at the early phase of the COVID-19 and can be transmitted from asymptomatic patients or patients with vague symptoms, it is prospected hard to be controlled [5-7]. Therefore, a discussion on the preparation for the next COVID-19 outbreak might be necessary in order to protect the social system from collapse.

This study aimed to collect information on the opinions of ID experts on COVID-19 and related issues in preparation for a potential second wave of infections.

METHODS

A questionnaire was designed by three investigators (B.K., S.Y.P., and H.H.C.) based on the ‘COVID-19 Real-Time Barometer Study’ and modified to reflect the current unsolved issues associated with COVID-19 [8]. The other authors of this study reviewed the draft questionnaire, and it was refined on the SurveyMonkey platform (Supplementary material 1). The questions about the opinions on COVD-19-related issues consisted of four categories: (1) prospects of the COVID-19 outbreak, (2) preparation for a future COVID-19 outbreak, (3) therapeutic options for COVID-19, and (4) miscellaneous. Some questions required the respondent to select multiple answers. The survey was conducted over a period of 5 days (from April 21 to 25) in 2020, and targeted all physicians with a board certificate of adult ID in South Korea (n = 275). At the time of the survey, 10 experts were either retired or had passed away and were excluded accordingly. Eventually, 265 ID specialists were identified as the subjects of the survey. A link to the online-based survey was forwarded to the subjects via text message and e-mail. To encourage participation, reminders were sent on the 3rd, 4th, and 5th day. There was no reward for the completion of the questionnaire. The respondents were anonymized and were requested to enter their own identification number in order to distinguish duplicated answers. Only one response was accepted from each participant.

In addition to the main analysis, we performed a subgroup analysis for the opinions on the preparation for future COVID-19 outbreak as per the attending physician’s experience in treating COVID-19 patients. The confidence interval for differences of binomial proportions was measured using the Agrestic-Caffo method.

All statistical analyses were performed using SPSS version 24.0 for Windows (IBM Corp., Armonk, NY, USA). Categorical variables were analyzed using the chi-square test or Fisher’s exact test, as appropriate. A two-tailed p value of < 0.05 was considered statistically significant.

The Institutional Review Board of the Hanyang University Seoul Hospital approved the study protocol (IRB number: 2020-04-039). Online-written informed consent was obtained from participants.

RESULTS

Demographic characteristics of respondents

Among the 265 ID specialists, 132 (49.8%) responded. The mean age of the respondents was 42.8 ± 6.6 years, with an average of 8.9 ± 6.0 years elapse since they had acquired their ID board certificates and 57.6% were female. Almost all the respondents (99.3%) were working at secondary-care or tertiary-care hospitals; the majority (75.8%) were working at a national or private university-affiliated hospital. The proportion of respondents who had treated COVID-19 patients as an attending physician was 68.2% (Table 1).

Demographic characteristics of respondents (n = 132)

Opinions of ID specialists on COVID-19 related issues

Table 2 shows the results of our survey. Most respondents stated that they envisaged the current COVID-19 outbreak to end after December 2020 (47.7% for the domestic outbreak and 70.5% for the global pandemic), as well as a second nationwide wave in South Korea between September and December 2020 (60.7%). Accordingly, the majority believed that the current preventive strategies being implemented in Korean hospitals need to be maintained even after December 2020 (43.2%).

Opinions of infectious diseases specialists on COVID-19-related issues

N95 respirators were considered to be the most important item for hospitals in preparation for a second wave, followed by isolation units and hooded coveralls. Furthermore, 75.0% of the respondents believed that the reuse of N95 respirators might be necessary in the case of a shortage. In the case of a shortage of ventilators, 47.0% believed that patients should be prioritized based on the likelihood of their recovery. In preparation for another outbreak, the respondents believed that the most important areas of research and development to be fostered were the development of effective vaccines (75.0%), the development of effective therapeutic drugs (56.8%), and the development of rapid and accurate diagnostic testing methods (52.3%). The most important policies to be implemented at the national level included securing national hospitals designated for the treatment of ID (67.4%), strengthening immigration policies or prohibiting the entry of individuals from affected countries (65.9%), and maintaining social distancing (46.2%). Most of the respondents (88.6%), as concerns the screening of asymptomatic individuals for the prevention COVID-19 outbreaks in medical institution, answered that real-time reverse-transcriptase polymerase chain reaction testing would be necessary for patients with a recent history of visits to affected countries or regions, in order to prevent outbreaks occurring within hospitals. The respondents stated that the most important measures to be upheld by the general public after the end of the outbreak were thorough hand hygiene (74.2%), followed by avoiding public spaces if one has symptoms of COVID-19 (70.5%), and the wearing of masks in public (56.8%). The most recommended type of mask for use on a daily basis was the surgical mask (53.8%).

In terms of treatment options, the respondents reported that remdesivir was the most promising (81.8%) therapeutic agent for the treatment of COVID-19, followed by convalescent plasma (65.9%) and hydroxychloroquine or chloroquine (49.2%). The majority of respondents showed a preference towards the use of hydroxychloroquine or chloroquine regimens in the elderly or in severe cases, while prophylactic use was not preferred.

The respondents stated that issues requiring urgent attention and resolution included “determining the actual efficacy of existing or new drugs for the treatment of COVID-19” (63.6%), “the possibility of re-infection or the reactivation of the virus after patient recovery” (59.1%), and “the conditions underlying the infection transmission” (53.8%).

The comparison in opinions on the preparation for another COVID-19 outbreak as per the attending physician’s experience in treating COVID-19 patients

Most ID specialists who had experience in treating COVID-19 patients answered that powered air purifying respirator equipment (44.4% vs. 7.1%) are important items for hospitals in preparation for a second wave compared with those who had no experience in treating COVID-19 patients (Supplementary Table 1).

DISCUSSION

This survey highlights the opinions of Korean ID experts on controversial COVID-19-related issues. The opinions of these experts regarding emerging IDs are especially valuable as: (1) their opinions are based on their direct experience; (2) a relatively long time is needed to obtain scientific evidence on diseases; and (3) their opinions provide a guide for improving public preparedness. Our results provide useful information in preparation for another potential future COVID-19 outbreak.

In contrast to the positive social atmosphere in South Korea, many ID specialists do not envisage the current outbreak to be controlled easily. Considering the high viral load at the initial phase of the disease, even in asymptomatic patients [6], the complete control of viral transmission remains a challenge. Once social interactions between individuals return to normal and international travel is reinstated, the possibility of a COVID-19 second wave in South Korea is likely to increase accordingly.

The N95 respirators were considered as the most important item to be procured in hospitals. Since SARS-CoV-2 is transmitted via the respiratory tract, health workers when caring for patients must use appropriate masks. In particular, the use of N95 respirators is an effective measure to protect healthcare personnel from the transmission of the virus during aerosol-generating procedures [9]. Unfortunately, hospitals experienced a lack of protective equipment in the middle of the outbreak, which is representative of the difficult experience of South Korea in dealing with the pandemic. In addition, experience might lead the majority of respondents to believe that the reuse of N95 respirators would be inevitable in the case of a shortage.

Many ID specialists believe that at the national level, securing hospitals designated specifically for the treatment of IDs is necessary. This may help to provide an effective therapy to COVID-19 patients, as well as protecting non-infectious patients admitted to other hospitals. Indeed, preventive measures against the inflow of COVID-19 into hospitals are fundamentally important since COVID-19 could be fatal when transmitted to in-patients [10]. Policymakers should consider this when establishing policies related to COVID-19.

The most important social measures to be upheld even after the end of the outbreak were hand hygiene and avoiding public places when a person has symptoms of infections. Given that the microorganisms are frequently transmitted via one’s hand to another or themselves, hand hygiene is considered to be the single most important measure in reducing the transmission of microorganisms [11]. Given the fact that the dissemination of SARS-CoV-2 cannot be prevented just by wearing a mask and the virus can remain viable and infectious on surfaces up to days, hand hygiene should be emphasized to prevent infection [12,13]. Furthermore, interestingly, due to the thorough adherence to measures for the prevention of microorganism transmission, we witnessed that the incidence of other notorious transmissible IDs such as chickenpox, influenza, epidemic conjunctivitis, etc., decreased significantly in 2020 compared to other years [14]. People need to understand that not only the individual’s health but also the health of the entire society could be protected with adherence to these measures.

As study results about the effectiveness of drugs tested for the treatment of COVID-19 have been released, opinions about the therapeutic option also have been converging accordingly. Since hydroxychloroquine or chloroquine was still one of the most promising therapeutic agents at the time of the survey period, we surveyed the opinion about the use of hydroxychloroquine or chloroquine in more detail. Unfortunately, the recent studies revealed that the use of hydroxychloroquine or chloroquine in COVID-19 might not be effective [15]. The only drug that showed effectiveness against COVID-19 to the date (June 5, 2020) is remdesivir. It shortened the time of recovery in patients with COVID-19 and evidence of lower respiratory tract infection but it did not lower the mortality [16].

This study had some potential limitations. First, the response rate was approximately 50% and those who were interested in such a study might tend to have responded to the survey. In order to minimize the selection bias, we sent reminders three times as well as offered the online link via both smartphones and computers to ease the access to the survey. Moreover, the demographic data of respondents (age 42.8 ± 6.6; female sex 57.6%) were similar to those of the entire target population (age 44.7 ± 6.7; female sex 50.6%) and the possibility of selection bias would not have been high. Second, some items might be interpreted differently by respondents due to the nature of the survey study.

In conclusion, many Korean ID experts believe that the COVID-19 pandemic will not be easily controlled and that a second nationwide wave is likely to occur in Korea. The country’s preparedness in various aspects, including the provision of personal protective equipment in hospitals, will be necessary in order to deal with a potential future outbreak efficiently.

KEY MESSAGE

1. The highest proportion of the Korean infectious disease specialists envisaged the current coronavirus disease 2019 (COVID-19) outbreak to end after December 2020

2. N95 respirators were considered to be the most important item in hospitals while securing hospitals designated specifically for the treatment of infectious diseases was the most important policy to be implemented at the national level.

3. The respondents stated that the most important measures to be upheld by the public after the end of the outbreak were thorough hand hygiene and avoiding public spaces if one has symptoms of COVID-19.

Notes

No potential conflict of interest relevant to this article was reported.

Acknowledgements

We would like to acknowledge all the respondents for their participation in the survey. The authors are also grateful to the Korean Society of Infectious Disease for identifying the target participants for the survey; Editage (www.editage.co.kr) for English language editing; Han-Pyo Hong (Biostatistics Collaboration Unit, Industry-University Cooperation Foundation, Hanyang University) for statistical analysis.

Supplementary Material

Supplementary material 1.

The questionnaire of the survey

Supplementary Table 1.

The comparison in opinions on preparation for future COVID-19 outbreak according to experience in treating COVID-19 patients as an attending physician

References

1. World Health Organization (WHO). WHO coronavirus disease (COVID-19) dashboard [Internet] Geneva (CH): WHO; 2020. [cited 2020 Sep 8]. Available from: https://covid19.who.int/.
2. Kim JY, Choe PG, Oh Y, et al. The first case of 2019 novel coronavirus pneumonia imported into Korea from Wuhan, China: implication for infection prevention and control measures. J Korean Med Sci 2020;35e61.
3. Korean Center Disaster Management Headquarters. COVID-19 cases in Korea [Internet] Sejong (KR): MOHW; 2020. [cited 2020 Sep 8]. Available from: http://ncov.mohw.go.kr/en/.
4. Korean Society of Infectious Diseases, ; Korean Society of Pediatric Infectious Diseases, ; Korean Society of Epidemiology, ; Korean Society for Antimicrobial Therapy, ; Korean Society for Healthcare-associated Infection Control and Prevention, ; Korea Centers for Disease Control and Prevention. Report on the epidemiological features of coronavirus disease 2019 (COVID-19) outbreak in the Republic of Korea from January 19 to March 2, 2020. J Korean Med Sci 2020;35e112.
5. Luo Y, Trevathan E, Qian Z, et al. Asymptomatic SARS-CoV-2 infection in household contacts of a healthcare provider, Wuhan, China. Emerg Infect Dis 2020;26:1930–1933.
6. Zou L, Ruan F, Huang M, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med 2020;382:1177–1179.
7. Kim ES, Chin BS, Kang CK, et al. Clinical course and outcomes of patients with severe acute respiratory syndrome coronavirus 2 infection: a preliminary report of the first 28 patients from the Korean cohort study on COVID-19. J Korean Med Sci 2020;35e142.
8. Sermo. COVID-19 real-time barometer study [Internet] New York (NY): Sermo; 2020. [cited 2020 Sep 8]. Available from: https://app.sermo.com/covid19-barometer.
9. Center for Disease Control and Prevention. Interim infection prevention and control recommendations for patients with confirmed 2019 novel coronavirus (2019-nCoV) or patients under investigation for 2019-nCoV in healthcare settings [Internet] Atlanta (GA): CDC; 2020. [cited 2020 Sep 8]. Available from: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/infection-control.html.
10. McMichael TM, Currie DW, Clark S, et al. Epidemiology of COVID-19 in a long-term care facility in King County, Washington. N Engl J Med 2020;382:2005–2011.
11. Pittet D, Allegranzi B, Sax H, et al. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006;6:641–652.
12. Bae S, Kim MC, Kim JY, et al. Effectiveness of surgical and cotton masks in blocking SARS-CoV-2: a controlled comparison in 4 patients. Ann Intern Med 2020;173:W22–W23.
13. van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020;382:1564–1567.
14. Korea Centers for Disease Control and Prevention. Infectious disease portal [Internet] Cheongju (KR): KCDC; 2020. [cited 2020 Sep 8]. Available from: http://www.cdc.go.kr/npt/biz/npp/nppMain.do .
15. Boulware DR, Pullen MF, Bangdiwala AS, et al. A randomized trial of hydroxychloroquine as postexposure prophylaxis for Covid-19. N Engl J Med 2020;383:517–525.
16. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the treatment of Covid-19: preliminary report. N Engl J Med 2020;May. 22. [Epub]. https://doi.org/10.1056/NEJMoa2007764.

Article information Continued

Table 1.

Demographic characteristics of respondents (n = 132)

Characteristic Value
Age 42.8 ± 6.6
Length of working experience in infectious diseases 8.9 ± 6.0
Female sex 76 (57.6)
Position in the hospital
 Director of the clinical department 60 (45.4)
 Director of infection control 52 (39.4)
Type of hospital by referral system
 Tertiary-care hospital 74 (56.1)
 Secondary-care hospital 57 (43.2)
 Hospital 1 (0.7)
Type of hospital
 National university-affiliated hospital 24 (18.2)
 Private university-affiliated hospital 76 (57.6)
 Public hospital; not university-affiliated 9 (6.8)
 Private hospital; not university-affiliated 22 (16.7)
Number of hospital beds
 Less than 300 4 (3.0)
 300–600 27 (20.5)
 600–900 52 (39.4)
 900–1,200 24 (18.2)
 More than 1,200 25 (18.9)
Location of the hospital
 Seoul/Incheon/Gyeonggi-do 84 (63.6)
 usan/Ulsan/Gyeongsangnam-do 16 (12.1)
 Daegu/Gyeongsangbuk-do 10 (7.6)
 Daejeon/Sejong/Chungchung-do 9 (6.8)
 Gwang ju/Jeolla-do 9 (6.8)
 Gangwon-do 3 (2.3)
 Jeju-do 1 (0.8)
No. of patients with COVID-19 treated by attending physicians
 0 42 (31.8)
 0–10 52 (39.4)
 10–50 24 (18.2)
 More than 50 14 (10.6)

Values are presented as mean ± SD or number (%).

COVID-19, coronavirus disease 2019.

Table 2.

Opinions of infectious diseases specialists on COVID-19-related issues

Variable % (95% CI)
Prospects of the COVID-19 outbreak 132
Q1. The expected date of the end of the current domestic COVID-19 epidemic
May–June 2020 12.9 (7.6–18.9)
July–August 2020 18.9 (12.9–25.8)
September–December 2020 10.6 (5.3–16.7)
After December 2020 47.7 (38.7–56.8)
Q2. The expected date of the end of the current global COVID-19 pandemic
May–June 2020 0
July–August 2020 6.8 (3.0–11.4)
September–December 2020 9.8 (5.3–15.2)
After December 2020 70.5 (62.9–78.0)
Q3. The expected date of the occurrence of a second wave nationwide in South Korea
Unlikely 6.8 (3.0–11.4)
May–June 2020 25.8 (18.9–33.3)
July–August 2020 3.8 (0.8–7.6)
September–December 2020 60.6 (52.3–68.2)
After December 2020 3.0 (0.8–6.1)
Q4. The expected date of the end of preventive measures to the inflow of COVID-19 into hospitals (e.g., operating COVID-19 screening clinics, safe clinics for respiratory patients, pre-emptive isolation for pneumonia, etc.)
May–June 2020 26.5 (18.9–34.1)
July–August 2020 14.4 (9.1–20.5)
September–December 2020 5.3 (1.5–9.1)
After December 2020 43.2 (34.8–51.5)
Depends on the situation 10.6 (6.1–15.9)
Q5. The date of the termination of social distancing measures
No longer needed 1.5 (0–3.8)
Within 4 weeks from nowa 45.5 (37.1–53.0)
Within 4–8 weeks from nowa 7.6 (3.0–12.1)
More than 8 weeks from nowa 37.1 (28.8–45.5)
Depends on the situation 8.3 (3.8–12.9)
Preparation for a future COVID-19 outbreak 132
Q1b. Crucial items that will be needed in hospitals in preparation for a second wave of COVID-19
N95 respirators 70.5 (62.9–78.0)
Isolation units (including negative-pressure units) 42.4 (33.3–50.8)
Hooded coveralls 41.7 (33.3–50.7))
PAPR equipment (including hoods) 32.6 (25.0–40.2)
Professional COVID-19 physician 25.0 (17.4–31.8)
Professional COVID-19 nursing personnel 25.0 (18.2–33.3)
Infection control personnel 15.2 (9.8–22.0)
Other protective gear (goggles, hair caps, etc.) 14.4 (9.1–20.5)
Equipment for oxygen supplementation (including ventilators, high-flow O2) 13.6 (8.3–19.7)
Drugs for treatment (e.g., chloroquine, remdesivir, etc.) 12.9 (7.6–18.9)
Diagnostic equipment 5.3 (1.5–9.8)
Hand sanitizer 1.5 (0–3.8)
Q2. Necessity and possibility of reuse of N95 respirators within medical institutions in the case of a shortage
Necessary and possible 32.6 (25.0–41.6)
Necessary and impossible 42.4 (34.1–50.8)
Not necessary and possible 3.8 (0.8–7.6)
Not necessary and impossible 17.4 (11.4–24.2)
Q3. Prioritization of patients in the case of a shortage of ventilators
Severity of the disease 21.2 (14.4–28.8)
Probability of recovery 47.0 (38.6–56.0)
Life expectancy 22.0 (15.2–29.5)
Hospital arrival order 2.3 (0–5.3)
Not sure (difficult to answer) 6.1 (2.3–10.6)
Q4b. Key areas of research and development to encourage in preparation for a further spread of the COVID-19 pandemic
Development of an effective vaccine 75.0 (67.4–82.6)
Development of an effective therapeutic agent 56.8 (47.7–65.2)
Development of rapid and accurate diagnostic testing methods 52.3 (43.2–61.4)
Development of an effective epidemiological investigation system 32.6 (24.2–40.2)
Establishing a clinical trial system that can verify reported therapeutic agents or new drugs 28.8 (21.2–37.1)
Development of mass supply methods for convalescent plasma from cured patients 16.7 (10.6–23.5)
Development of an effective self-isolation monitoring tool 12.9 (7.6–18.9)
Establishing a system for virus segregation 10.6 (6.1–16.7)
Development of an effective protective gear 9.8 (4.5–15.9)
Establishing animal experimental models that can verify reported therapeutic agents or new drugs 4.6 (1.5–8.3)
Q5a. Important policies to be implemented at the national level in preparation for another outbreak
Securing national hospitals designated for the treatment of infectious diseases 67.4 (59.1–75.8)
Strengthening immigration or prohibiting entry from countries with an outbreak 65.9 (57.6–73.5)
Maintaining social distancing 46.2 (37.9–55.3)
Establishing a system for participation of private medical institutions/personnel in outbreaks 45.5 (37.1–53.8)
Reorganization of healthcare-related government 22.7 (15.9–30.3)
Securing masks, hand sanitizers 22.0 (15.9–30.3)
Securing community treatment centers 18.9 (12.9–25.8)
Activation of online education/conference systems 8.3 (3.8–12.9)
Full-fledge introduction of telemedicine 3.0 (0.8–6.1)
Q6c. Screening of asymptomatic individuals using RT-PCR tests to prevent hospital outbreaks
Patients with a history of visiting areas with the outbreak 88.6 (82.6–93.9)
All patients who require hospitalization 36.4 (28.8–44.7)
All patients who need surgery 27.3 (19.7–35.6)
All patients who have recently been admitted to other hospitals 29.5 (22.0–37.1)
Medical staff treating COVID-19 patients 31.1 (23.5–38.6)
Screening of asymptomatic individuals is not required 12.1 (6.8–17.4)
Q7a. Measures that should be upheld even after the end of the current outbreak
Thorough hand hygiene 74.2 (65.9–81.8)
Avoiding public spaces if one shows symptoms of infections, such as fever 70.5 (62.9–78.0)
Wearing masks in public 56.8 (47.7–65.2)
Informing hospitals of recent visits to risk areas or recent contact with patients with COVID-19 40.2 (32.6–48.5)
Observe cough etiquette 33.3 (25.0–42.4)
Maintaining a 2-meter distance 25.0 (18.2–32.6)
Use of personal items, such as towels, tableware, mobile phones, etc. 0
Q8. The best type of mask for use by the general public on a daily basis
KF94 (or N95) mask 13.6 (8.3–19.7)
KF80 mask 24.2 (16.7–31.8)
Surgical mask 53.8 (45.5–62.1)
Face mask 3.8 (0.8–6.8)
Not recommended 3.8 (0.8–6.8)
The treatment of COVID-19 127
Q1b. Drugs that may be effective for the treatment of COVID-19
Remdesivir 81.1 (74.0–88.2)
Convalescent plasma 66.9 (59.1–74.8)
Hydroxychloroquine or chloroquine 49.6 (40.2–58.3)
Anti-HIV drugs (e.g., lopinavir/ritonavir) 39.4 (31.5–47.2)
Systemic corticosteroid 22.8 (15.0–30.7)
IL-6 pathway inhibitors (e.g., tocilizumab) 15.7 (9.4–22.0)
Macrolides (e.g., azithromycin) 12.6 (7.1–18.9)
Inhaled corticosteroid (e.g., ciclesonide) 10.2 (5.5–15.7)
Interferon 1.6 (0–3.9)
Oseltamivir 0
Q2. Patients to be treated with hydroxychloroquine or chloroquine
Q2-1. Asymptomatic, age < 60 years, no underlying disease 26.8 (19.7–34.6)
Q2-1. Moderate symptoms without pneumonia, age < 60 years, no underlying disease, SpO2 > 95% 55.9 (47.2–64.6)
Q2-2. Moderate symptoms without pneumonia, age ≥ 60 years, no underlying disease, SpO2 > 95% 70.9 (63.0–79.5)
Q2-3. Existence of pneumonia, SpO2 > 95% 70.1 (61.4–78.0)
Q2-4. Existence of pneumonia requiring oxygen therapy 73.2 (65.4–81.1)
Q2-5. The prevention of COVID-19 in elderly and patients with underlying diseases after exposure 37.8 (29.1–45.7)
Q2-6. The prevention of COVID-19 in medical staff treating COVID-19 patients 22.8 (15.7–29.9)
Q3. The appropriate duration of a hydroxychloroquine or chloroquine treatment regimen
Within 5 days 7.1 (3.1–11.8)
5–7 days 40.9 (32.3–48.8)
8–10 days 24.4 (17.3–32.3)
11–14 days 14.2 (7.9–20.5)
15–21 days 1.6 (0–3.9)
Until negative conversion of virus detection 3.9 (0.8–7.9)
Miscellaneous 132
Q1b. Important issues that require urgent resolution
Determining the actual efficacy of existing or new drugs in the treatment of COVID-19 63.6 (55.3–71.2)
The possibility of re-infection or the reactivation of the virus after patient recovery 59.1 (50.8–67.4)
The conditions underlying infection transmission (e.g., period of infection propagation) 53.8 (44.7–62.9)
The isolation criteria (e.g., inspection before release from isolation) 36.4 (28.0–44.7)
Efficacy of protective gear in preventing infection 30.3 (22.0–38.6)
Accuracy of existing diagnostic testing methods, including RT-PCR testing 25.8 (18.9–32.6)
Selection criteria for individuals to be examined and tested 15.9 (9.8–22.7)
Effectiveness of preventive medicine in the prevention of infection 15.2 (9.1–22.0)

COVID-19, coronavirus disease 2019; CI, confidence interval; PAPR, powered air purifying respirator; RT-PCR, real-time reverse-transcriptase polymerase chain reaction; HIV, human immunodeficiency virus; IL-6, interleukin 6.

a

The time of conducting the survey (from April 21 to 25).

b

This question requested the respondent to select the three most important items.

c

This question requested the respondent to select multiple items.