PHWR Public Health Weekly Report

The coronavirus disease 2019 (COVID-19) pandemic highlighted the critical need for a thorough understanding of the current situation to ensure efficient allocation of medical response resources. In the early stages of the COVID-19 pandemic, when clusters of confirmed COVID-19 cases emerged, hospitals faced a severe shortage of hospital beds, and cooperation, such as interhospital transfers, became challenging. In addition, medical resources intended for critically ill patients, such as those with cerebral hemorrhage, were diverted to treat COVID-19 patients, further exacerbating the shortage of healthcare personnel for managing critical cases. To address these challenges, it is essential to conduct regular assessments of healthcare resources. This will enable efficient bed management and facilitate the rapid mobilization of personnel and equipment based on medical needs in the event of future infectious disease outbreaks [1,2].

The Korea Disease Control and Prevention Agency (KDCA) regularly conducts surveys to assess the status of infectious disease control institutions, as designated under Articles 36 and 37 of the Infectious Disease Prevention and Control Act (Infectious Disease Prevention Act). These institutions are designated by the Minister of Health and Welfare, the KDCA Commissioner, city/provincial governors, or mayors/county governors/district heads, in accordance with the Infectious Disease Prevention Act. These infectious disease control institutions are required to establish facilities for investigating and examining patients with infectious diseases or for conducting patient quarantine and treatment. An “infectious disease control facility” is one that prevents the spread of infectious diseases and provides care for patients with such diseases. This includes single-occupancy patient rooms equipped with anterooms and negative pressure systems to prevent the transmission of infectious diseases. If an infectious disease control institution has ≥300 beds, it must have at least one negative pressure room, in compliance with the standards outlined in Appendix 4-2 of the Enforcement Decree of the Infectious Disease Prevention Act. For institutions with <300 beds, more than one consultation room or more than one room isolated from the outside must be installed.

This report analyzed the status of designated infectious disease control institutions and the availability of medical response resources (beds, equipment, and personnel) as of June 30, 2024. It also examines whether infectious disease control institutions with ≥300 beds comply with the standards for installing and operating negative pressure rooms, and whether those with <300 beds meet the requirements for isolation facilities. Thus, this report aimed to assess the medical response competencies of local infectious disease control institutions and provide foundational data to guide the development of resource utilization plans in the event of a new infectious disease crisis.

1. Subjects

The participants of this current status survey were 159 infectious disease control institutions located across 17 cities and provinces, all designated as of June 30, 2024, in accordance with Articles 36 and 37 of the Infectious Disease Prevention Act.

2. Data Source and Survey Items

The data sources for analysis included information on the installation and general status of infectious disease control facilities, provided by 17 local governments, as well as data on the current status of medical care institutions reported by each institution in compliance with the Enforcement Regulations of the National Health Insurance Act.

The survey items were developed by considering relevant laws, such as the Medical Act and the Infectious Disease Prevention Act, along with infection-related items found in other domestic surveys [3]. After consulting with central and regional infectious disease hospitals, three main survey items were identified: (1) designated status, (2) status of medical response resources, and (3) status of infectious disease control facility installation.

The first item, regarding designated status, addresses the designator (or designating authority), the type of medical institutions, and their classification. The second item, related to the status of medical response resources, was further divided into beds, equipment, and personnel. The subitems of “beds” include licensed beds, negative pressure isolation beds (single-occupancy/multi-occupancy patient rooms for critically ill adults/children and newborns, and general patients), and general isolation beds. The subitems of “equipment” include ventilators, extracorporeal membrane oxygenation (ECMO) devices, and continuous renal replacement therapy (CRRT) equipment. The subitems of “personnel” consist of specialists (infectious disease, respiratory medicine, pediatrics, pediatric infectious disease) and specialists and nurses working in infection control rooms. The third item, concerning the installation status of infectious disease control facilities, includes whether institutions with ≥300 beds meet the standards for installing and operating negative pressure isolation rooms, and whether institutions with <300 beds have patient rooms and consultation rooms that are isolated from the outside.

1. Status of Designated Infectious Disease Control Institutions

The results of the assessment of the status of infectious disease control institutions are shown in Figure 1.

Figure 1. Status of infectious disease management organizations designation (as of June 30, 2024)

As of June 30, 2024, a total of 159 infectious disease control institutions were designated, marking a 42.6% decrease from the 277 institutions designated in the third quarter of 2023. In terms of designator (or the designating authority), the highest number of infectious disease institutions were designated by city mayors, “gun” heads, or district heads, with 105 institutions (66.0%), followed by those designated by city/provincial governors (34 institutions, 21.4%), the KDCA Commissioner (15 institutions, 9.4%), public health center heads (5 institutions, 3.1%), and the Minister of Health and Welfare (0 institutions, 0.0%). Regarding establishment classification, 45 institutions (28.3%) were public medical institutions, while 114 institutions (71.7%) were private medical institutions. In terms of the type of medical institutions, 81 were general hospitals (50.9%), 51 were hospitals (32.1%), 26 were tertiary general hospitals (16.4%), and 1 was a psychiatric hospital (0.6%). There were no designated clinics or long-term care hospitals.

We analyzed the trend in the designation of infectious disease control institutions from the first quarter of 2022 to the second quarter of 2024, with the main results shown in Figure 2. In terms of designator (or the designating authority), the proportion of infectious disease control institutions designated by the Minister of Health and Welfare continued to decline, while the proportion of those designated by mayors, “gun” heads, or district heads continued to increase. In terms of establishment classification, the proportion of private medical institutions remained consistently high. In terms of the type of medical institutions, the proportion of tertiary general hospitals and hospitals was the highest in the second quarter of 2024 during the analysis periods, while the proportion of general hospitals was the lowest. In addition, since the survey on the status of infectious disease control institutions began in 2022, the COVID-19 pandemic has stabilized, leading to a decrease in the number of designated institutions across all categories.

Figure 2. Status of infectious disease management organizations designation (2022–2024)

2. Status of Medical Response Resources in Infectious Disease Control Institutions

1) Hospital beds

As of June 30, 2024, the status of hospital beds among medical response resources of designated infectious disease control institutions is presented in Table 1. Among the 159 designated infectious disease control institutions, 67 (42.1%) had ≥300 beds, while 92 (57.9%) had <300 beds. The total number of negative pressure isolation beds and rooms across all infectious disease control institutions was 1,052 and 798, respectively. Of these, 894 negative pressure isolation beds (85.0%) and 677 negative pressure isolation rooms (85.8%) were located in institutions with ≥300 beds. In contrast, institutions with <300 beds had 158 negative pressure isolation beds (15.0%) and 121 negative pressure isolation rooms (15.2%). Additionally, 3 institutions with ≥300 beds and 6 institutions with <300 beds lacked both negative pressure facilities and rooms isolated from the outside.

Table 1 Status of hospital beds at infectious disease management

Category					Status of negative pressure facilities in organizations with 300 beds or morea)							Status of quarantine facilities in organizations with less than 300 bedsb)
No.	Location		Total		Total of organizations with 300 beds or more	Negative pressure isolation beds						Total of organizations with fewer than 300 beds	Negative pressure isolation beds						Hospital beds isolated from the outside			Number of treatment rooms isolated from the outside
	Region	City/ province				Total number of hospital beds	1 person room	Shared room	Intensive care unit				Total number of hospital beds	1 person room	Shared room	Intensive care unit			Total number of hospital beds	1 person room	Shared room
									Adult	Pediatric + newborn						Adult	Pediatric + newborn
Total			159 (100.0)		67	894 (677)	340 (340)	235 (72)	293 (246)	26 (19)		92	158 (121)	81 (81)	50 (17)	25 (21)	2 (2)		748 (467)	311 (311)	437 (156)	42
1	Capital	Seoul	6		6	127 (96)	55 (55)	31 (11)	40 (29)	1 (1)		-	- (-)	- (-)	- (-)	- (-)	- (-)		- (-)	- (-)	- (-)	-
2		Incheon	3		3	123 (66)	33 (33)	51 (13)	36 (20)	3 (-)		-	- (-)	- (-)	- (-)	- (-)	- (-)		- (-)	- (-)	- (-)	-
3		Gyeonggi	18		13	116 (109)	64 (64)	8 (2)	43 (42)	1 (1)		5	23 (23)	14 (14)	- (-)	9 (9)	- (-)		18 (18)	18 (18)	- (-)	3
4		Gangwon	16		5	41 (30)	16 (16)	8 (2)	15 (12)	2 (-)		11	27 (22)	12 (12)	8 (3)	7 (7)	- (-)		74 (52)	42 (42)	32 (10)	20
Total of Capital region			43 (27.0)		27	407 (301)	168 (168)	98 (28)	134 (103)	7 (2)		16	50 (45)	26 (26)	8 (3)	16 (16)	- (-)		92 (70)	60 (60)	32 (10)	23
5	Chung cheong	Daejeon	8		6	64 (61)	30 (30)	6 (3)	27 (27)	1 (1)		2	1 (1)	- (-)	- (-)	1 (1)	- (-)		8 (5)	2 (2)	6 (3)	-
6		Chungnam	10		4	43 (34)	22 (22)	14 (5)	7 (7)	- (-)		6	11 (11)	11 (11)	- (-)	- (-)	- (-)		33 (27)	19 (19)	14 (8)	2
7		Chungbuk	2		1	29 (19)	5 (5)	18 (8)	6 (6)	- (-)		1	- (-)	- (-)	- (-)	- (-)	- (-)		44 (22)	6 (6)	38 (16)	1
8		Sejong	1		1	7 (7)	1 (1)	- (-)	2 (2)	4 (4)		-	- (-)	- (-)	- (-)	- (-)	- (-)		- (-)	- (-)	- (-)	-
Total of Chungcheong region			21 (13.2)		12	143 (121)	58 (58)	38 (16)	42 (42)	5 (5)		9	12 (12)	11 (11)	- (-)	1 (1)	- (-)		85 (54)	27 (27)	58 (27)	3
9	Gyeongbuk	Daegu	2		2	34 (19)	8 (8)	22 (7)	4 (4)	- (-)		-	- (-)	- (-)	- (-)	- (-)	- (-)		- (-)	- (-)	- (-)	-
10		Gyeongbuk	3		2	12 (10)	6 (6)	4 (2)	2 (2)	- (-)		1	18 (5)	- (-)	16 (5)	2 (-)	- (-)		- (-)	- (-)	- (-)	-
Total of Gyeongbuk region			5 (3.1)		4	46 (29)	14 (14)	26 (9)	6 (6)	- (-)		1	18 (5)	- (-)	16 (5)	2 (-)	- (-)		- (-)	- (-)	- (-)	-
11	Gyeongnam	Ulsan	4		4	26 (26)	8 (8)	- (-)	18 (18)	- (-)		-	- (-)	- (-)	- (-)	- (-)	- (-)		- (-)	- (-)	- (-)	-
12		Busan	14		5	79 (46)	20 (20)	41 (10)	18 (16)	- (-)		9	8 (7)	6 (6)	- (-)	2 (1)	- (-)		62 (48)	38 (38)	24 (10)	1
13		Gyeongnam	28		5	46 (33)	21 (21)	6 (3)	19 (9)	- (-)		23	30 (23)	19 (19)	8 (2)	3 (2)	- (-)		215 (120)	74 (74)	141 (46)	9
Total of Gyeongnam region			46 (28.9)		14	151 (105)	49 (49)	47 (13)	55 (43)	- (-)		32	38 (30)	25 (25)	8 (2)	5 (3)	- (-)		277 (168)	112 (112)	165 (56)	10
14	Honam	Gwangju	3		2	37 (37)	12 (12)	- (-)	19 (19)	6 (6)		1	- (-)	- (-)	- (-)	- (-)	- (-)		- (-)	- (-)	- (-)	-
15		Jeonnam	29		3	7 (7)	5 (5)	- (-)	2 (2)	- (-)		26	36 (25)	16 (16)	18 (7)	- (-)	2 (2)		198 (117)	80 (80)	118 (37)	6
16		Jeonbuk	3		3	46 (43)	21 (21)	4 (1)	17 (17)	4 (4)		-	- (-)	- (-)	- (-)	- (-)	- (-)		- (-)	- (-)	- (-)	-
17		Jeju	9		2	57 (34)	13 (13)	22 (5)	18 (14)	4 (2)		7	4 (4)	3 (3)	- (-)	1 (1)	- (-)		96 (58)	32 (32)	64 (26)	-
Total of Honam region			44 (27.7)		10	147 (121)	51 (51)	26 (6)	56 (52)	14 (12)		34	40 (29)	19 (19)	18 (7)	1 (1)	2 (2)		294 (175)	112 (112)	182 (63)	6

Unit: n (%), n (number of rooms). As of June 30, 2024. -=not available. ^a)When analyzing the status of negative pressure facilities in organizations with 300 beds or more, 3 organizations (Gyeongnam 1, Jeonnam 2) without negative pressure facilities were excluded. ^b)When analyzing the status of quarantine facilities in organizations with less than 300 beds, 6 (Gangwon‧Busan‧Gyeongnam‧Gwangju 1, Jeonnam 2) organizations without quarantine facilities were excluded..

Among the 894 negative pressure isolation beds in infectious disease control institutions with ≥300 beds, 340 (38.0%) were single-occupancy beds for general patients, 235 (26.3%) were multi-occupancy beds, 293 (32.8%) were for critically ill adult patients, and 26 (2.9%) were for pediatric and neonatal patients. By city/province, Seoul had the highest total number of negative pressure beds, with 127 beds (14.2%), while Sejong and Jeollanam-do had the lowest, each with 7 beds (0.8%). In terms of regions, the capital area had the highest total number of negative pressure beds, with 407 beds (45.5%), while the Gyeongbuk region had the lowest, with 46 beds (5.1%).

The results of the investigation into the installation and operation of negative pressure isolation rooms in institutions with ≥300 beds, in accordance with the standards outlined in Appendix 4-2 of the Enforcement Regulations of the Infectious Disease Prevention Act, are shown in Figure 3. While most institutions meet the installation and operation standards for negative pressure isolation rooms specified in the Act, some institutions have areas that require improvement to fully comply with facility and installation standards.

Figure 3. Results of meeting the standards for installation and operation of negative pressure facilities in organizations with 300 beds or more

Among the 158 negative pressure isolation beds in institutions with <300 beds, 81 (53.3%) were single-occupancy beds for general patients, 50 (31.6%) were multi-occupancy beds, 25 (15.8%) were for critically ill adult patients, and 2 (1.3%) were for pediatric and neonatal patients. By city/province, the highest number of negative pressure beds in institutions with <300 beds was in Jeollanam-do, with 36 beds (22.8%), while 8 regions (Seoul, Incheon, Chungbuk, Sejong, Daegu, Ulsan, Gwangju, and Jeollabuk-do) had no negative pressure beds. By region, the capital area had the highest number of negative pressure beds, with 50 beds (31.6%), while the Chungcheong region had the lowest, with 12 beds (7.6%).

The total number of beds and rooms isolated from the outside in institutions with <300 beds was 748 and 467, respectively. Of the 748 beds isolated from the outside, 311 (41.6%) were single-occupancy beds, while 437 (58.4%) were multi-occupancy beds. By city/province, the highest number of beds isolated from the outside was in Gyeongnam, with 215 beds (28.7%), while 8 regions (Seoul, Incheon, Sejong, Daegu, Gyeongbuk, Ulsan, Gwangju, and Jeonbuk) had no such beds. By region, the Honam area had the highest number of beds isolated from the outside, with 294 beds (39.3%), while no beds were available in Gyeongbuk region.

The total number of isolated consultation rooms in institutions with <300 beds was 42. By city/province, the highest number of isolated consultation rooms in these institutions was in Gangwon, with 20 rooms (47.6%), while 10 regions (Seoul, Incheon, Daejeon, Sejong, Daegu, Gyeongbuk, Ulsan, Gwangju, Jeonbuk, and Jeju) had no isolated consultation rooms. By region, the capital area had the highest number of isolated consultation rooms in the institutions with <300 beds, with 23 rooms (54.8%), while no rooms were available in Gyeongbuk region.

2) Equipment

To assess the critical care capacity for critically ill patients in designated infectious disease control institutions as of June 30, 2024, an analysis was conducted on three types of medical equipment: ventilators, ECMO machines, and CRRT equipment (Table 2).

Table 2 Status of equipment and personnel at infectious disease management organizations

No.	Location		Total	Equipment				Personnel				Infection management room staff
	Region	City/province		Ventilator	ECMO	CRRT		Specialist				Total number of infection management room specialist	Specialist (charged+discharged)			Total number of infection management room nurse	Nurse
								Infection	Pulmonology	Pediatric (infection)			Infection	Pulmonology	Pediatric (infection)		General nurse	Infection management specialist nurse	Infection management practice expert
Total			159 (100.0)	4,156 (100.0)	236 (100.0)	562 (100.0)		139 (100.0)	218 (100.0)	28 (100.0)		149 (100.0)	124 (100.0)	4 (100.0)	21 (100.0)	441 (100.0)	303 (100.0)	76 (100.0)	62 (100.0)
1	Capital	Seoul	6	560	37	67		25	34	4		25	23	-	2	48	18	17	13
2		Incheon	3	261	13	29		12	12	1		12	11	-	1	25	21	4	-
3		Gyeonggi	18	812	52	145		37	44	10		40	31	2	7	94	62	20	12
4		Gangwon	16	307	15	35		5	12	-		6	5	1	-	31	27	4	-
Total of Capital region			43 (27.0)	1,940 (46.7)	117 (49.6)	276 (49.1)		79 (56.8)	102 (46.8)	15 (53.6)		83 (55.7)	70 (56.5)	3 (75.0)	10 (47.6)	198 (44.9)	128 (42.2)	45 (59.2)	25 (40.3)
5	Chung cheong	Daejeon	8	259	13	35		8	21	3		11	8	-	3	33	16	15	2
6		Chungnam	10	176	9	22		2	3	-		2	2	-	-	19	15	4	-
7		Chungbuk	2	99	6	12		2	7	1		2	1	-	1	7	6	1	-
8		Sejong	1	35	2	5		3	4	1		3	2	-	1	3	2	1	-
Total of Chungcheong region			21 (13.2)	569 (13.7)	30 (12.7)	74 (13.2)		15 (10.8)	35 (16.1)	5 (17.9)		18 (12.1)	13 (10.5)	- (-)	5 (23.8)	62 (14.1)	39 (12.9)	21 (27.6)	2 (3.2)
9	Gyeongbuk	Daegu	2	114	9	10		4	6	1		5	4	-	1	10	10	-	-
10		Gyeongbuk	3	62	-	2		-	2	-		-	-	-	-	11	10	1	-
Total of Gyeongbuk region			5 (3.1)	176 (4.2)	9 (3.8)	12 (2.1)		4 (2.9)	8 (3.7)	1 (3.6)		5 (3.4)	4 (3.2)	- (-)	1 (4.8)	21 (4.8)	20 (6.6)	1 (1.3)	- (-)
11	Gyeongnam	Ulsan	4	153	10	26		1	11	-		1	1	-	-	19	15	3	1
12		Busan	14	170	12	30		8	12	1		8	7	-	1	33	22	3	8
13		Gyeongnam	28	396	19	42		10	18	3		12	10	-	2	38	24	-	14
Total of Gyeongnam region			46 (28.9)	719 (17.3)	41 (17.4)	98 (17.4)		19 (13.7)	41 (18.8)	4 (14.3)		21 (14.1)	18 (14.5)	- (-)	3 (14.3)	90 (20.4)	61 (20.1)	6 (7.9)	23 (37.1)
14	Honam	Gwangju	3	198	9	41		9	7	1		8	8	-	-	18	18	-	-
15		Jeonnam	29	132	1	7		2	4	-		2	2	-	-	11	9	-	2
16		Jeonbuk	3	270	15	26		6	12	1		6	5	-	1	19	10	2	7
17		Jeju	9	152	14	28		5	9	1		6	4	1	1	22	18	1	3
Total of Honam region			44 (27.7)	752 (18.1)	39 (16.5)	102 (18.1)		22 (15.8)	32 (14.7)	3 (10.7)		22 (14.8)	19 (15.3)	1 (25.0)	2 (9.5)	70 (15.9)	55 (18.2)	3 (3.9)	12 (19.4)

Unit: n (%). As of June 30, 2024. ECMO=extracorporeal membrane oxygenation; CRRT=continuous renal replacement therapy; -=not available..

The total number of ventilators was 4,156. By city/province, the highest number of ventilators was in Gyeonggi, with 812 (19.5%), while the lowest was in Sejong, with 35 (0.8%). By region, the capital area had the highest number of ventilators, with 1,940 (46.7%), while the Gyeongbuk region had the lowest, with 176 (4.2%). The total number of ECMO machines was 236. By city/province, Gyeonggi had the highest number of ECMO machines, with 52 (22.0%), while Gyeongbuk had none. By region, the capital area had the highest number of ECMO machines, with 117 (49.6%), while the Gyeongbuk region had the lowest, with 9 (3.8%). The total number of CRRT equipment was 562. By city/province, Gyeonggi had the highest number of CRRT devices, with 145 (25.8%), while Gyeongbuk had the lowest, with 2 (0.4%). By region, the capital area had the highest number of CRRT equipment, with 276 (49.1%), while the Gyeongbuk region had the lowest, with 12 (2.1%).

3) Medical personnel

We analyzed the status of specialists (infectious disease, respiratory medicine, and pediatric infectious disease specialists) working in designated infectious disease control institutions as of June 30, 2024, as well as the specialists and nurses working in infection control rooms (Table 2).

The total number of infectious disease specialists in the designated infectious disease control institutions was 139. By city/province, Gyeonggi had the highest number of infectious disease specialists, with 37 (26.6%), while Gyeongbuk had none. By region, the capital area had the highest number of infectious disease specialists, with 79 specialists (56.8%), while Gyeongbuk region had the lowest, with 4 specialists (2.9%). The total number of respiratory medicine specialists in these institutions was 218, with the highest number in Gyeonggi (44 specialists, 20.2%), and the lowest in Gyeongbuk (2 specialists, 0.4%). By region, the capital area had the highest number of respiratory medicine specialists, with 102 (46.8%), while Gyeongbuk region had the lowest, with 8 (3.7%). The total number of pediatric infectious disease specialists was 28, with the highest number in Gyeonggi (10 specialists, 35.7%). However, there were no pediatric infectious disease specialists in 5 regions: Gangwon, Chungnam, Gyeongbuk, Ulsan, and Jeonnam. By region, the capital area had the highest number of pediatric infectious disease specialists, with 15 (53.6%), while Gyeongbuk region had the lowest, with 1 (3.6%).

The total number of doctors working in infection control rooms, in accordance with Article 46 (1) of the Enforcement Regulation of the Medical Act, was 149. This included 124 infectious disease specialists, 4 respiratory medicine specialists, and 21 pediatricians. By city/province, Gyeonggi had the highest number of doctors working in infection control rooms, with 40 (26.8%), while Gyeongbuk had none. By region, the capital area had the highest number of doctors, with 83 (55.7%), while Gyeongbuk region had the lowest, with 5 (3.4%). The total number of nurses working in infection control rooms was 441, consisting of 303 general nurses, 76 infection control nurses, and 62 infection control practitioners. By city/province, Gyeonggi had the highest number of nurses, with 94 (21.3%), while Sejong had the lowest, with 3 (0.7%). By region, the capital area had the highest number of nurses, with 198 (44.9%), while Gyeongbuk region had the lowest, with 21 (4.8%).

4) Status of medical response resources (beds, equipment, personnel) per 1 million people

The analysis of medical response resources per 1 million people in designated infectious disease control institutions as of June 30, 2024, is presented in Table 3.

Table 3 Status of infectious disease management organizations resources (beds, equipment, personnel) compared to population (per 1,000,000)^a)

No.	Location		Total	Intensive patient isolation bed			General patient isolation bed			Equipment				Personnel				Infection management room staff
	Region	City/province		Adult	Pediatric+newborn		Negative pressure isolation (negative pressure air conditioning)			Ventilator	ECMO	CRRT		Specialist				Specialist (charged+discharged)				Nurse
				Negative pressure	Negative pressure		1 person	Multi-person (2 or more people)						Infection	Pulmonology	Pediatric (infection)		Infection	Pulmonology	Pediatric (infection)		General nurse	Infection management specialist nurse	Infection management practice expert
Total			159 (100.0)	6.20	0.55		8.21	5.56		81.01	4.60	10.96		2.71	4.25	0.55		2.42	0.08	0.41		5.91	1.48	1.21
1	Capital	Seoul	6	4.26	0.11		5.85	3.30		59.57	3.94	7.13		2.66	3.62	0.43		2.45	0.00	0.21		1.91	1.81	1.38
2		Incheon	3	12.00	1.00		11.00	17.00		87.00	4.33	9.67		4.00	4.00	0.33		3.67	0.00	0.33		7.00	1.33	0.00
3		Gyeonggi	18	3.80	0.07		5.69	0.58		59.27	3.80	10.58		2.70	3.21	0.73		2.26	0.15	0.51		4.53	1.46	0.88
4		Gangwon	16	14.67	1.33		18.67	10.67		204.67	10.00	23.33		3.33	8.00	0.00		3.33	0.67	0.00		18.00	2.67	0.00
Capital region			43 (27.0)	5.43	0.25		7.03	3.84		70.29	4.24	10.00		2.86	3.70	0.54		2.54	0.11	0.36		4.64	1.63	0.91
5	Chung cheong	Daejeon	8	20.00	0.71		21.43	4.29		185.00	9.29	25.00		5.71	15.00	2.14		5.71	0.00	2.14		11.43	10.71	1.43
6		Chungnam	10	3.33	0.00		15.71	6.67		83.81	4.29	10.48		0.95	1.43	0.00		0.95	0.00	0.00		7.14	1.90	0.00
7		Chungbuk	2	3.75	0.00		3.13	11.25		61.88	3.75	7.50		1.25	4.38	0.63		0.63	0.00	0.63		3.75	0.63	0.00
8		Sejong	1	5.00	10.00		2.50	0.00		87.50	5.00	12.50		7.50	10.00	2.50		5.00	0.00	2.50		5.00	2.50	0.00
Chungcheong region			21 (13.2)	7.82	0.91		12.55	6.91		103.45	5.45	13.45		2.73	6.36	0.91		2.36	0.00	0.91		7.09	3.82	0.36
9	Gyeongbuk	Daegu	2	1.67	0.00		3.33	9.17		47.50	3.75	4.17		1.67	2.50	0.42		1.67	0.00	0.42		4.17	0.00	0.00
10		Gyeongbuk	3	1.60	0.00		2.40	8.00		24.80	0.00	0.80		0.00	0.80	0.00		0.00	0.00	0.00		4.00	0.40	0.00
Gyeongbuk region			5 (3.1)	1.63	0.00		2.86	8.57		35.92	1.84	2.45		0.82	1.63	0.20		0.82	0.00	0.20		4.08	0.20	0.00
11	Gyeongnam	Ulsan	4	16.36	0.00		7.27	0.00		139.09	9.09	23.64		0.91	10.00	0.00		0.91	0.00	0.00		13.64	2.73	0.91
12		Busan	14	6.06	0.00		7.88	12.42		51.52	3.64	9.09		2.42	3.64	0.30		2.12	0.00	0.30		6.67	0.91	2.42
13		Gyeongnam	28	6.88	0.00		12.50	4.38		123.75	5.94	13.13		3.13	5.63	0.94		3.13	0.00	0.63		7.50	0.00	4.38
Gyeongnam region			46 (28.9)	7.89	0.00		9.74	7.24		94.61	5.39	12.89		2.50	5.39	0.53		2.37	0.00	0.39		8.03	0.79	3.03
14	Honam	Gwangju	3	13.57	4.29		8.57	0.00		141.43	6.43	29.29		6.43	5.00	0.71		5.71	0.00	0.00		12.86	0.00	0.00
15		Jeonnam	29	1.11	1.11		11.67	10.00		73.33	0.56	3.89		1.11	2.22	0.00		1.11	0.00	0.00		5.00	0.00	1.11
16		Jeonbuk	3	10.00	2.35		12.35	2.35		158.82	8.82	15.29		3.53	7.06	0.59		2.94	0.00	0.59		5.88	1.18	4.12
17		Jeju	9	27.14	5.71		22.86	31.43		217.14	20.00	40.00		7.14	12.86	1.43		5.71	1.43	1.43		25.71	1.43	4.29
Honam region			44 (27.7)	10.18	2.86		12.50	7.86		134.29	6.96	18.21		3.93	5.71	0.54		3.39	0.18	0.36		9.82	0.54	2.14

Unit: n (%). As of June 30, 2024. ECMO=extracorporeal membrane oxygenation; CRRT=continuous renal replacement therapy. ^a)Korean Statistical Information Service (KOSIS)-Population by administrative district (city, county, district)..

(1) Hospital beds

The number of isolation beds for critically ill adult patients per 1 million people was 6.20, while the number of isolation beds for critically ill pediatric and neonatal patients per 1 million people was 0.55. The number of single-occupancy isolation beds for general patients per 1 million people was 8.21, and the number of multi-occupancy isolation beds for general patients per 1 million people was 5.56. Notably, the number of isolation beds for critically ill pediatric and neonatal patients per 1 million people was less than 1 in 4 regions, except in the Honam region. Additionally, there were no beds available in Gyeongbuk and Gyeongnam regions.

(2) Equipment

The number of ventilators per 1 million people was 81.01, the number of ECMO machines per 1 million people was 4.60, and the number of CRRT equipment per 1 million people was 10.96. Most regions secured medical equipment, but no ECMO was available in Gyeongbuk.

(3) Medical personnel

The number of infectious disease specialists per 1 million people was 2.71, the number of respiratory medicine specialists per 1 million people was 4.25, and the number of pediatric infectious disease specialists per 1 million people was 0.55. In all five regions, the number of pediatric infectious disease specialists was less than 1 per 1 million people, and neither infectious disease specialists nor pediatric infectious disease specialists were available in Gyeongbuk.

The number of doctors working in infection control rooms per 1 million people was as follows: 2.42 infectious disease specialists, 0.08 respiratory medicine specialists, and 0.41 pediatric infectious disease specialists. Regarding nurses working in infection control rooms, the number of general nurses per 1 million people was 5.91, the number of infection control nurses per 1 million was 1.48, and the number of infection control practitioners per 1 million people was 1.21. Specifically, the number of respiratory medicine specialists working in infection control rooms was less than 1 per 1 million people in all regions except for Jeju. Additionally, while the number of general nurses in infection control rooms was ≥1 per 1 million people in all 17 cities and provinces, the number of infection control nurses did not exceed 1 per 1 million people in 7 regions (Chungbuk, Daegu, Gyeongbuk, Busan, Gyeongnam, Gwangju, and Jeonnam). Similarly, the number of infection control practitioners did not exceed 1 per 1 million people in 10 regions (Incheon, Gyeonggi, Gangwon, Chungnam, Chungbuk, Sejong, Daegu, Gyeongbuk, Ulsan, and Gwangju).

As highlighted in numerous studies, a lack of healthcare resources accelerates the spread of infectious diseases and exacerbates their severity. In both domestic and foreign cases of infectious disease response, there is frequent discussion about the importance of developing appropriate response strategies that take into account the critical shortage of resources, such as medical personnel, as well as socio-cultural factors influenced by geographical characteristics [4]. Given that the demand for healthcare increases significantly during an infectious disease outbreak, it is crucial to establish legal frameworks and systematic governance structures for infectious disease response. This will ensure the efficient use of healthcare resources and enhance the quality of care during a pandemic situation [1,5].

This report investigated the medical response capabilities of infectious disease control institutions by analyzing the current status of medical resources in designated facilities. It also seeks to provide foundational data for developing strategies to efficiently utilize these resources in the event of a future infectious disease crisis.

As of June 30, 2024, there were a total of 159 designated infectious disease control institutions. Among these, 67 institutions had ≥300 beds, with a total of 894 negative pressure beds. The remaining 92 institutions had <300 beds, with 748 isolation beds, 42 consultation rooms isolated from the outside, and 158 negative pressure beds. Notably, 3 institutions with ≥300 beds lacked any negative pressure beds, while 6 institutions with <300 beds had neither isolation beds nor consultation rooms isolated from the outside, and no negative pressure beds. These findings suggest that, when designating infectious disease control institutions, the availability of isolation facilities and medical resources should be considered more comprehensively.

The results of investigating the distribution of medical response resources by city, province, and region revealed that among the 1,052 negative pressure beds owned by all the infectious disease control institutions, 457 (43.4%) were available in the capital area (43 institutions, 27.0% of the total negative pressure beds). Additionally, medical equipment, infection-related specialists, infection control room specialists, and nurses in the capital area accounted for more than 45% of the total numbers. In contrast, in the Gyeongnam region, which had the largest number of infectious disease control institutions (46 institutions, 28.9% of the total), negative pressure beds, medical equipment, infection-related specialists, infection control room specialists, and nurses accounted for less than 20% of the total numbers. This highlights significant regional differences in the distribution of medical response resources.

The examination of medical response resources per 1 million people revealed that the number of negative pressure isolation beds for critically ill pediatric and neonatal patients was less than 1 per 1 million people in all regions except the Honam region. Notably, no such beds were available in the Gyeongbuk and Gyeongnam regions. Furthermore, while other regions had more than 1 infectious disease specialist per 1 million people, Gyeongbuk region had fewer than 1 infectious disease specialist per 1 million people. This highlights regional disparities in the availability of medical response resources relative to the population.

In preparation for an infectious disease outbreak, it is essential to enhance the designation and management systems of infectious disease control institutions and regularly assess their medical response capabilities through surveys of resource availability. Furthermore, in regions where response resources are insufficient relative to the population, efforts should be made to expand the number of designated infectious disease control institutions. Most importantly, establishing cooperative systems at the regional level between infectious disease control institutions can enable more efficient resource utilization during an outbreak. This approach will help address regional healthcare disparities, reduce the spread of infectious diseases, and better manage the surge in medical demand.

Ethics Statement: Not applicable.

Funding Source: None.

Acknowledgments: None.

Conflict of Interest: The authors have no conflicts of interest to declare.

Author Contributions: Conceptualization: SYK, MSC. Data curation: YJK, NYK, SYK, MSC. Formal analysis: YJK, NYK. Investigation: YJK, NYK, SYK, MSC. Methodology: YJK, NYK, SYK, MSC, JYP. Resources: SYK, MSC, JYP. Supervision: JYP. Visualization: NYK, YJK. Writing – original draft: YJK, NYK, SYK, MSC. Writing – review & editing: YJK, NYK, SYK, SJH, MSC, JYP.