Many adults would forgo care for serious symptoms to avoid SARS-CoV-2 exposure, survey finds
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One in 6 adults would waive care for myocardial infarction symptoms and 1 in 4 would waive care for appendicitis symptoms to avoid exposure to SARS-CoV-2, according to survey results published in JAMA Network Open.
Rebecca Gale, MPH, a research specialist at Cedars-Sinai Center for Outcomes Research and Education, said “the clinical relevance is twofold.”
“One: By delaying treatment or staying home entirely, patients put themselves at risk for greater harm and perhaps even death by letting conditions like a heart attack or stroke go untreated. Two: As we have seen stark decreases in care-seeking for emergency conditions, it stands to reason that many people are also delaying routine or preventive care visits, which we know are crucial to public health,” she told Healio Primary Care. “When the pandemic subsides and in the following years, we may see sharp increases in cases of avoidable diseases, like colon and cervical cancers, because of delayed preventive care.”
Gale and colleagues conducted a cross-sectional survey study using a national sample of U.S. adults who responded to an invitation that was sent on June 1, 2020. None of the respondents had previously tested positive for SARS-CoV-2.
The study cohort was asked whether they would go to the ED or stay home when presented with scenarios in which they experienced symptoms consistent with MI or appendicitis. The order in which the scenarios were presented to respondents was randomized.
The researchers received responses from 933 adults, among whom 54.6% were women, 63.7% were non-Hispanic white and 11.7% were Latino. The mean age was 40.1 years.
Responses to MI scenarios
When presented with scenarios involving MI symptoms, 16.9% of respondents prioritized avoidance of SARS-CoV-2 over seeking care in an ED, according to Gale and colleagues. The odds of prioritizing COVID-19 avoidance were greater among individuals aged 40 to 49 years (P = .006), occasional smokers (P = .002) and those who did not consume news (P = .001). Respondents were less likely to avoid care if they had a usual source of care (P=.001), worse self-reported health status (P = .008), annual household incomes of $100,000 or more (P = .04), or a higher perceived chance of contracting SARS-CoV-2 (P = .007), which the researchers said “may appear counterintuitive” but could indicate “health-related anxiety.”
Responses to appendicitis scenarios
When presented with scenarios involving appendicitis symptoms, 25.5% of respondents said they would prioritize avoiding COVID-19 exposure over seeking care in an ED. Similar to those with MI symptoms, individuals with appendicitis symptoms were less likely to avoid care if they had a usual source of care (P = .003) and a higher perceived chance of contracting SARS-CoV-2 (P = .01).
Answers to free-response questions revealed that severity of symptoms, safety measures implemented in the ED, wait times, financial considerations, proximity and transportation to the ED, alternatives to in-person care and reputation of the ED or hospital may have impacted decisions to seek care.
Role of PCPs
Primary care providers can communicate with patients to encourage them to seek care, Gale said.
“Physicians can reassure their patients that it is safe to seek care for both urgent and routine issues, as hospitals and clinics have many safety precautions in place. They can also tell their patients that studies show the chance of getting COVID-19 while in the hospital is very, very low,” she said. “Finally, physicians should strongly encourage their unvaccinated patients to get vaccinated, since that might remove some of the fear of contracting COVID-19 and reduce community spread in the process.”
Perspective
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Eileen Barrett, MD, MPH, SFHM, MACP
Patients’ well-documented hesitation to seek emergency care during the pandemic is highlighted in this paper and should give us pause about how we are communicating and mitigating risk. These and other findings underscore the imperative that hospitals and systems provide transparency about measures to protect patients from nosocomial COVID-19 infections. All hospitals and systems should collaborate with patients to create and promote efforts to mitigate the effects of COVID-19 upon patient care, including but not limited to widespread vaccination of health care workers, providing safe staffing levels and facilitating easy monoclonal antibody availability to reduce severity of infection. As we move into the next stage of the pandemic, we should use this and other data to engage patients in how to best communicate patient safety within communities.
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