Background The coronavirus disease 2019 (COVID-19) pandemic has demonstrated significantly worse outcomes for minority (black and Hispanic) individuals. Understanding the reasons for COVID-19–related disparities among patients with asthma has important public health implications. Objective To determine factors contributing to health disparities in those with asthma during the COVID-19 pandemic. Methods An anonymous survey was sent through social media to adult patients with asthma, and a separate survey was sent to physicians who provide asthma care. The patient survey addressed demographic information including socioeconomic status, asthma control, and attitudes/health behaviors during COVID-19. Results A total of 1171 patients (10.1% minority individuals) and 225 physicians completed the survey. Minority patients were more likely to have been affected by COVID-19 (eg, became unemployed, lived in a community with high COVID-19 cases). They had worse asthma control (increased emergency visits for asthma, lower Asthma Control Test score), were more likely to live in urban areas, and had a lower household income. Initial differences in attitudes and health behaviors disappeared after controlling for baseline demographic features. Institutional racism was demonstrated by findings that minority individuals were less likely to have a primary care physician, had more trouble affording asthma medications due to COVID-19, and were more likely to have lost health insurance because of COVID-19, and that 25% of physicians found it more challenging to care for black individuals with asthma during COVID-19. Conclusions Differences in socioeconomic status and the effects of institutional racism, but not health behaviors, sources of information, or attitudes, are playing a role in disparities seen for patients with asthma during COVID-19.

OBJECTIVE: The aim of this study was to explore differences in attitudes, behaviors and expectations related to COVID-19 between physicians and patients with asthma. METHODS: An anonymous survey was distributed through email and social media to adult patients with asthma during a three-week period in April-May 2020. A separate survey was sent to physicians. The surveys asked about demographic information, specific challenges and concerns due to COVID-19, and attitudes/behaviors during this time. RESULTS: A total of 1171 patients and 225 physicians completed the surveys. Overall, patients with asthma and physicians had large differences in expectations related to COVID-19. Patients were more likely than physicians to believe that individuals with asthma are at a higher risk to get COVID-19 (37.5% vs. 12.0%, p < 0.001), have increased anxiety due to COVID-19 (79.6% vs 70.0%, p = 0.002), and should not go to work (62.7% vs 11.9%, p < 0.001). Neither patients nor physicians felt confident they could distinguish COVID-19 symptoms from asthma (61.2% and 74.5% did not feel confident, respectively). Patients with severe asthma were significantly more impacted by the pandemic (e.g. became unemployed [OR 2.15], had difficulty getting asthma meds [OR 2.37]) compared to those with nonsevere asthma. CONCLUSION: Patients with asthma and their physicians have markedly different attitudes and opinions regarding care during the COVID-19 pandemic. Such differences have important implications when providing patient-centered care.

The COVID-19 pandemic resulted in sudden changes to the established practice of using high dependency (HDU) for the first night of postoperative care following microvascular free tissue transfer. Patients were managed instead on the head and neck ward. This retrospective case-note review aimed to report outcomes in consecutive patients treated before and during the pandemic and to reflect on the implications of ward-based care rather than HDU. 235 patients had free tissue transfer between 3 rd January 2019 and 25 th February 2021, 125 before the pandemic (lockdown 23 rd March 2020), and 110 during the pandemic (52 ward managed and 58 HDU managed). There were subtle case-mix differences during the pandemic, with 92% of ward treated patients having oral cancers compared with 64% of HDU patients and 73% of ward patients having a tracheostomy compared with 40% of HDU patients. Ward patients were less likely to receive electrolyte replacement (45% HDU Vs 0% Ward) and inotropes (12% HDU Vs 2% Ward). There were fewer returns to theatre for evacuation of haematoma or re-anastomosis during the pandemic than before. Other than fewer haematoma complications occurring during the pandemic the nature of complications was similar. In conclusion, the dramatic changes imposed by the pandemic have shown the ward to be a safe place for patients to be cared for immediately post-operatively and this alleviates bed pressures experienced in HDU. Careful case selection and clear criteria are required to identify patients needing HDU.

Specific behaviors and beliefs that asthma patients and physicians have during the COVID-19 pandemic are unknown. The goal of this study was to understand differences in attitudes and expectations related to COVID-19 between physicians and patients. METHODS: An anonymous survey was distributed through email and social media channels to adult patients with asthma for a 3-week period between April-May 2020. A separate survey was sent to physicians. The surveys asked about demographic information, including asthma-specific demographics, specific challenges due to COVID-19, and attitudes/ behaviors during COVID-19. RESULTS: A total of 1171 patients and 225 physicians completed the surveys. Overall, patients with asthma and physicians had large differences regarding COVID-19 expectations. Patients were more likely to believe that individuals with asthma are at a higher risk to get COVID-19 (37.5% vs. 12.0%, p<0.001), would require hospitalization from COVID-19 (90.7% vs. 62.2%, p<0.001), and should not go to work (62.7% vs 11.9%, p <0.001). Patients also faced increased financial difficulties obtaining their medications due to COVID-19 more often than physicians anticipated (28.0% vs 16.4%, p< 0.001). Among patients, those with severe asthma (n5102, 8.7% of patients) were significantly more impacted (e.g., became unemployed [OR 2.15] and had difficulty getting asthma meds [OR 2.37]) compared to those with mild or moderate asthma. CONCLUSIONS: Patients with asthma and their physicians have markedly different attitudes and opinions regarding care during COVID-19. There are also differences in attitudes and experiences between patients with severe asthma and those with mild/moderate asthma. Such differences have important implications for patient care.