Seeking Emergency Care during COVID-19
Fears of contracting COVID-19 in health care settings have resulted in many individuals avoiding emergency care despite potentially life-threatening illnesses. As a result, hospitals have documented striking drops in the number of patients presenting with a range of clinical conditions, including but not limited to coronary artery disease, stroke, and uncontrolled hyperglycemia 1,2. However, the foregoing of critical care for otherwise treatable conditions increases rates of easily preventable morbidity and mortality. What do individuals prioritize when deciding whether to present to the emergency department, and how can this help inform efficient health care for all?
One 2020 study assessed the electronic health records of the emergency department of a Swiss university hospital. Results revealed that significantly more patients died in the emergency room during early phases of their disease, when gaining awareness and seeking to mitigate its impact 3 – highlighting the hefty responsibility of healthcare authorities and hospitals to deliberately minimize any barriers to routine treatment.
Another 2020 study sought to determine the American public’s likelihood of using an emergency department for an acute illness during the pandemic. Overall, only half of all study participants were willing to visit the emergency department if they felt sick, down from over 70% prior to the pandemic 4. This study also found that nearly one quarter of individuals believed the pandemic did not represent a serious threat to society. Respondents with a better knowledge of COVID-19 were more likely to consider the pandemic serious – pointing to an important societal leverage point in the form of boosting public awareness and education.
More recently, a 2021 Dutch study probing the severity and motivations of individuals who sought delayed emergency department care found that nearly half of enrolled study participants delayed seeking emergency care 5, most frequently motivated by a fear of catching COVID-19. However, emergency department avoidance was also linked to a desire not to burden health care workers and a perception of one’s own symptoms as less severe or deserving of attention than those of COVID-19 cases, among others.
Consistently, a 2021 survey sampling nearly 1,000 individuals across the US using a mixed-methods approach revealed that approximately one fifth and one quarter of individuals suffering from myocardial infarction or appendicitis, respectively, would prefer to avoid being exposed to COVID-19 in the emergency department than seek appropriate care 6. Interestingly, political affiliations, sociodemographic background, and individual knowledge or attitudes with regard to COVID-19 were found not to impact patient decision-making.
Overall, study findings point to the responsibility of health care systems to deploy effective communication channels for patients to feel reassured and empowered to seek health care in a timely fashion for critical conditions 7. In the future, such communication initiatives should apply not only to the ongoing COVID-19 pandemic, but also in the context of outbreaks and scenarios that could promote similarly maladaptive behaviors. Further research probing the psychological underpinnings of pathogen-avoidant behaviors is warranted to best inform the development of the most effective strategies to support adequate care seeking.
References
1. Kansagra, A. P., Goyal, M. S., Hamilton, S. & Albers, G. W. Collateral Effect of Covid-19 on Stroke Evaluation in the United States. N. Engl. J. Med. (2020). doi:10.1056/nejmc2014816
2. Oseran, A. S. et al. Changes in Hospital Admissions for Urgent Conditions during COVID-19 Pandemic. Am. J. Manag. Care (2020). doi:10.37765/ajmc.2020.43837
3. Hautz, W. E. et al. Barriers to seeking emergency care during the COVID-19 pandemic may lead to higher morbidity and mortality – A retrospective study from a Swiss university hospital. Swiss Med. Wkly. (2020). doi:10.4414/smw.2020.20331
4. Niforatos, J. D., Chaitoff, A., Zheutlin, A. R., Feinstein, M. M. & Raja, A. S. Barriers to emergency department usage during the COVID‐19 pandemic. J. Am. Coll. Emerg. Physicians Open (2020). doi:10.1002/emp2.12316
5. Nab, M., van Vehmendahl, R., Somers, I., Schoon, Y. & Hesselink, G. Delayed emergency healthcare seeking behaviour by Dutch emergency department visitors during the first COVID-19 wave: a mixed methods retrospective observational study. BMC Emerg. Med. (2021). doi:10.1186/s12873-021-00449-9
6. Gale, R. et al. Public Perspectives on Decisions about Emergency Care Seeking for Care Unrelated to COVID-19 during the COVID-19 Pandemic. JAMA Netw. Open (2021). doi:10.1001/jamanetworkopen.2021.20940
7. Dong, E., Du, H. & Gardner, L. An interactive web-based dashboard to track COVID-19 in real time. The Lancet Infectious Diseases (2020). doi:10.1016/S1473-3099(20)30120-1