As of May 16, 2020, the World Health Organization (WHO) reported a total of 4,434,653 confirmed cases of coronavirus disease 2019 (COVID-19) worldwide, including 302,169 COVID-19-related deaths.
1) Since the first case of COVID-19 was reported on January 20, 2020, Korea has extensively tested all contacts, with an emphasis on identifying individuals with respiratory illness, tracing, and testing for severe respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes COVID-19.
2) Older adults are vulnerable to COVID-19; moreover, residents of long-term care facilities (LTCFs) are extremely frail, which is associated with high mortality.
3-6) One of the goals of establishing the Korean Geriatrics Society (KGS) is to make “Recommendations on healthcare for the aged to organizations and institutions”.
7) Accordingly, the authors representing the KGS composed a COVID-19 preventive strategy for older adults and posted it to the KGS website on March 13, 2020 (
Table 1).
8) The strategies employed the following principles: (1) two separate guidelines for older adults residing in community and LTCFs, respectively, reflecting the unique differences in their health conditions and environments; (2) strategies for LTCF health workers because their roles are crucial in LTCF infection control; (3) written in an easily comprehensible manner so that it can be clearly followed; (4) to follow general recommendations from international organizations such as the WHO and the Centers for Disease Control and Prevention (CDC), with modifications according to domestic policies as stipulated by the Korea Centers for Disease Control and Prevention (KCDC); and (5) to encourage indoor activities to prevent frailty, depression, and enhance resilience.
9-11)
Our guidelines have some unique features. First, we included strategies for long-term care hospitals (LTCHs) among strategies for LTCFs. LTCHs are a wide-spread unique form of hospitals for frail and activities of daily living (ADL)-dependent older people in Korea; however, we assumed that the strategies for LTCHs are similar to those for LTCFs (nursing homes).
12,13) Second, we emphasized the importance of wearing facemasks regularly even in encounters with older adults or healthcare workers without respiratory symptoms, as 5% to 75% of positive cases are reportedly asymptomatic SARS-CoV-2 carriers.
14) Third, we divided the LTCF strategies into three parts; namely, blocking spread INTO, WITHIN, and BETWEEN facilities. In addition, the Ministry of Health and Welfare issued a temporary regulation that permits telephone-based consultation and prescription and covers half of the expenses for COVID-19 testing for all new inpatients of LTCHs.
11)
On May 2, 2020, the KCDC announced zero positive cases from randomly-screened samples from among 6,544 residents and care assistants of 46 LTCHs in the Seoul area.
15) However, new outbreaks have occurred since then and even tertiary transmission of COVID-19 has been reported in communities;
16) therefore, we believe our recommendations should be strictly followed until these conditions resolve, with revision of these guidelines as needed.