COVID-19 patients recovering at home under the age of 60 will no longer be provided care and monitoring unless they are on Paxlovid, the Pfizer oral antiviral treatment, raising concerns for younger but vulnerable patients.

Amid an omicron surge, a record 168,000 patients were under home recovery as of Monday afternoon across South Korea, exceeding the manageable maximum of 166,000 that was set previously by the government.

Home recovery became the default care arrangement for patients of all ages in November last year to offset the burden on hospitals. Patients at home were instead provided remote monitoring by health personnel and a care kit that includes thermometers, pulse oximeters and medications like fever reducers.

But starting Thursday, such care will be restricted to patients 60 and older and patients taking Paxlovid, who make up a small minority. Over the three weeks since the first shipments arrived here, only about 1,200 patients have been able to receive the pills due both to limited eligibility and the many commonly used drugs that it cannot be taken together with. Patients must be at least 50 and clinically vulnerable to be eligible for a Paxlovid prescription.

Similarly last week, access to highly accurate PCR testing for confirming a COVID-19 diagnosis became limited to people 60 and up and close contacts of confirmed patients. Anyone younger needs a doctor’s note from a select clinic and a positive rapid test result to be able to get a PCR test.

This leaves out patients who are not high risk by age, but who are otherwise at increased risk of severe disease.

According to the Korea Disease Control and Prevention Agency, among those at higher risk from COVID-19 are pregnant women, unvaccinated people and people with certain medical conditions, such as cancer, chronic kidney or lung disease, diabetes or obesity. Under the omicron plan, none of them get priority access to testing or medical attention if they do not meet the age criteria or are not prescribed Paxlovid.

On this change, Ministry of Health and Welfare spokesperson Son Young-rae pointed out that hospitalizations and deaths from COVID-19 were considerably higher among people 60 and above.

On excluding people in their 50s from at-risk groups, who were given higher priority over those younger in vaccine distribution last year, Son said that they were not as at risk with omicron. Although 50-somethings were more likely to be hospitalized compared to younger people, the ministry’s analysis of 22,703 patients with known omicron infection showed that no one in their 50s had died.

In a Feb. 4 briefing, the ministry said with delta the hospitalization rates among people in their 50s was 1.4 percent. With omicron, it was zero. Korea would start managing COVID-19 like a seasonal flu, the ministry said.

Another senior Health Ministry official in charge of the home recovery program said in response to press questions that special attention will be paid to pregnant women and small children who show worrying symptoms. As for younger patients with vulnerabilities, he said they would be able to seek care at designated GP offices or hospital emergency rooms.

Dr. Eom Joong-sik, an infectious disease specialist at Gachon University Medical Center, said that the verdict that omicron is mild “may be premature.” “We also have to think about bed availability, which is a huge factor in determining survival rates.” Although omicron may be less severe, the absolute number of hospitalizations was feared to rise, he said. At his hospital in Incheon, only four out of 22 semi-ICU beds remained.

“We already know who are more at risk from COVID-19. They are the ones who are being offered boosters first and watched more closely when they get to hospitals. At-risk groups as defined by the omicron plan leave out a huge subset of vulnerable people,” he said.

By Kim Arin (arin@heraldcorp.com)