Delay or Avoidance of Medical Care Because of COVID-19–Related Concerns — United States, June 2020

Czeisler, Mark É; Marynak, Kristy; Clarke, Kristie E N; Salah, Zainab; Shakya, Iju; Thierry, J.; Ali, Nida; McMillan, Hannah; Wiley, Joshua F.; Weaver, Matthew D.; Czeisler, Charles A.; Rajaratnam, Shanthakumar M W; Howard, Mark

doi:10.15585/mmwr.mm6936a4

Cited by 1,264 publications

(1,308 citation statements)

References 7 publications

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“…This is a concerning finding, as important health care including women’s health checks may be being delayed. This finding is in agreement with a study from the US that reported 41% of respondents had delayed or avoided medical care during the pandemic, and this was significantly higher among females than males and those with carer responsibilities for other adults [ 16 ]. This may be due to females putting their health needs aside to prioritise care for their families, a phenomenon that has been recognised previously, for example among females with cardiovascular disease [ 43 , 44 ].…”

Section: Discussionsupporting

confidence: 92%

“…There is evidence that the COVID-19 pandemic has been associated with changes to people’s health seeking behaviours, prompting concerns of delayed care or late presentations for important health conditions. A large study in the United States reported that 41% of respondents had avoided or delayed medical care during the pandemic, and this was particularly evident among females and adults with carer responsibilities for other adults [ 16 ]. A recent online survey of over 700 people in Australia reported that 32% of respondents had delayed or avoided a general practitioner appointment and that the predominant reason provided was that people were worried about contracting the virus during appointments [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Detrimental Health Behaviour Changes among Females Living in Rural Areas during the COVID-19 Pandemic

Glenister

Ervin

Podubinski

2021

IJERPH

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Women are predicted to be disproportionately impacted by the COVID-19 pandemic due to increased carer responsibilities, loss of income, worry about the virus and a predominantly female healthcare workforce. Whilst there is emerging evidence that negative mental health impacts associated with the COVID-19 pandemic may be more pronounced for women than men, less attention has focussed on changes to health behaviours and health seeking experienced by women. Similarly, the impact of the pandemic in rural areas has not been investigated in detail. Our research questions were ‘have females residing in rural areas experienced changes in alcohol consumption, unhealthy food consumption, smoking, exercise or health seeking during the COVID-19 pandemic?’ and ‘are there differences in health behaviour changes between rural females living with or without children?’. Net increases (scale of 0–1) in consumption of unhealthy food (95% CI 0.05, 0.22) and alcohol (95% CI 0.12, 0.29) were observed. Net decreases (scale of −1 to 0) in visits to the doctor (95% CI −0.23, −0.35) and other health professionals (95% CI −0.40, −0.54) were observed. Compared with females living without children, females who lived with children were significantly associated with increased alcohol consumption (OR 2.4 (95% CI 1.4, 4.1), decreased visits to the doctor (OR 1.9 (95% CI 1.1, 3.2) and decreased visits to other health professionals (OR 1.9 (95% CI 1.1, 3.3). Results suggest that public health approaches may be required to support females residing in rural areas to optimise their health behaviours during the pandemic, particularly for those living with children. Policies must be gender responsive to counteract worsening health and social inequities both during and after the pandemic.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Detrimental Health Behaviour Changes among Females Living in Rural Areas during the COVID-19 Pandemic

Glenister

Ervin

Podubinski

2021

IJERPH

View full text Add to dashboard Cite

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“…In the initial phases of the response to COVID-19 in California, hospitals lacked protocols and equipment to ensure safety of staff who were not absolutely required to be present in the hospital, such as social workers and substance use navigators and most were removed from the EDs (Internal communication). Patients experienced transportation disruptions, fear of contracting coronavirus at hospitals, and concerns of not being treated or worse—not being treated well ( Czeisler, Marynak, & Clarke, 2020 ; Spagnolo et al, 2020 ). Most EDs developed tight screening procedures and triage processes including external tents staffed with medical personnel in head-to-toe personal protective equipment, which created a natural disincentive to seek MOUD from the ED ( Noble et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Sharp decline in hospital and emergency department initiated buprenorphine for opioid use disorder during COVID-19 state of emergency in California

Herring

Kalmin

Speener

et al. 2021

Journal of Substance Abuse Treatment

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“…In addition to patients' personal fear of contracting COVID19, they were being advised by primary care physicians, the media, and even healthcare systems to avoid public places, including the emergency department (ED) [ 3 ]. Many patients suffering from symptoms of chest pain, shortness breath, or weakness, for which people typically come to the ED and that are potential indicators of serious conditions, not necessarily associated with COVID19, did not seek medical care [ 4 , 5 ]. Starting in March, some patients who called 911 and required advanced life support (ALS) may have been more critically ill than they would have been before COVID19.…”

Section: Introductionmentioning

confidence: 99%

Effect of COVID19 on prehospital pronouncements and ED visits for stroke and myocardial infarction

Jain

Berkenbush

Feldman

et al. 2021

The American Journal of Emergency Medicine

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Objective: The Novel Coronavirus19 (COVID19) arrived in northern New Jersey (NJ) in early March 2020, peaked at the beginning of April, and then declined. Starting in March, some patients who called 911 and required advanced life support (ALS) may have decompensated more rapidly than would have been expected, possibly because of concomitant COVID19 infection and/or delays in seeking medical care because of fear of exposure to the virus, and social isolation. In this study, our goal was to determine if there was an increase in prehospital ALS pronouncements and a decrease in ED visits for potentially serious conditions such as MI and stroke during the peak of the COVID-19 pandemic in northern NJ. Methods study design: Retrospective cohort of prehospital patients pronounced dead by paramedics and patients with MI and stroke in the EDs of receiving hospitals of these paramedics. Study Setting and Population: Ten ground ALS units in northern NJ and nine receiving hospital EDs. Each ALS unit is staffed by two NJ-certified mobile intensive care paramedics and respond with a paramedic flycar in a two-tiered dispatch system. Data Analysis: We identified prehospital pronouncements using the EMSCharts electronic record (Zoll Medical, Chelmsford, Massachusetts). We tabulated the number of pronouncements by week from January 1 to June 30 in 2019 and 2020. We tabulated the combined total number of pronouncements and ED visits by month along with visits for MI and stroke and calculated the changes during the same timeframe. We used Chi-square to test for statistical significance for the monthly changes from 2019 to 2020. Results: For January through June in 2019 and 2020, there were 12,210 and 13,200 ALS dispatches, and 366 and 555 prehospital pronouncements, respectively. In 2020, pronouncements rose from a weekly baseline of 13 in early March, reached a peak of 45 at the beginning of April, then returned to the baseline level by the end of May. April 2020, the month with the most pronouncements, had 183% more pronouncements than April 2019 but total ED visits and visits for MI and stroke were 49%, 46% and 42% less, respectively (p < 0.0001 for each of these changes). Conclusion: Following the arrival of the COVID-19 pandemic in northern NJ, we found pre-hospital ALS death pronouncements increased and ED visits for MI and stroke decreased. Although we have speculated about the reasons for these findings, further studies are needed to determine what the actual causes were.

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Delay or Avoidance of Medical Care Because of COVID-19–Related Concerns — United States, June 2020

Cited by 1,264 publications

References 7 publications

Detrimental Health Behaviour Changes among Females Living in Rural Areas during the COVID-19 Pandemic

Detrimental Health Behaviour Changes among Females Living in Rural Areas during the COVID-19 Pandemic

Sharp decline in hospital and emergency department initiated buprenorphine for opioid use disorder during COVID-19 state of emergency in California

Effect of COVID19 on prehospital pronouncements and ED visits for stroke and myocardial infarction

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