Severe COVID-19 in the Republic of Korea: Epidemiology, Risk Factors, Therapeutics, and Prognostic Models From Nationwide Data

Comprehensive Summary

This review, presented by Choi, investigates the epidemiology, risk factors, treatments, and prognostic models associated with severe COVID-19 in the Republic of Korea using nationwide data. The author synthesizes findings from large-scale surveillance systems, cohort studies, clinical trials, and registry-based analyses conducted between January 2020 and August 2023, alongside relevant global research. This comprehensive review leverages Korea’s robust national datasets to evaluate disease patterns, clinical outcomes, and healthcare responses over the course of the pandemic. The findings show that Korea experienced over 34 million COVID-19 cases, with relatively low severity and case fatality rates compared to other developed countries. Severe disease was strongly associated with advanced age and comorbidities such as cardiovascular disease, diabetes, cancer, and immunocompromised states, while vaccination and physical activity were protective. Therapeutically, antiviral agents (e.g., nirmatrelvir/ritonavir, molnupiravir) and immunomodulators (e.g., dexamethasone, tocilizumab) significantly reduced severe outcomes, and advanced interventions such as ECMO and lung transplantation improved survival in select patients. Prognostic models incorporating clinical, radiologic, and machine learning approaches demonstrated utility in predicting disease progression. In the discussion, the author emphasizes the importance of sustained research infrastructure and data-driven strategies for managing future infectious disease outbreaks.

Outcomes and Implications

Understanding the determinants and management of severe COVID-19 is critical for reducing mortality, optimizing healthcare resource allocation, and improving pandemic preparedness. By integrating nationwide real-world data, the study provides a comprehensive framework for identifying high-risk populations and evaluating effective interventions at both clinical and public health levels. Clinically, the findings support targeted prevention strategies, including prioritization of vaccination and booster programs for high-risk groups such as older adults and individuals with comorbidities or immunocompromised conditions. The demonstrated effectiveness of antiviral therapies and immunomodulators reinforces their role in standard treatment protocols for preventing disease progression. Additionally, prognostic models offer valuable tools for early risk stratification, enabling clinicians to allocate resources such as intensive care and advanced respiratory support more efficiently. The study suggests that many of these approaches are already clinically implemented, highlighting their immediate relevance, while continued refinement of predictive models and therapies will enhance future responses. Ultimately, the article underscores that maintaining surveillance systems, research capacity, and evidence-based treatment frameworks is essential not only for ongoing COVID-19 management but also for preparedness against future emerging infectious diseases.