Health Letter, February 2021
By Azza AbuDagga, M.H.A., Ph.D.
The coronavirus disease 2019 (COVID-19) pandemic has reached a large scale in the U.S., causing substantial loss of life and placing an unprecedented demand on the American health care system.
It also has led to a major reduction in the supply and delivery of medical services for non-COVID-19 conditions, as overwhelmed health care facilities continue to focus their resources on responding to the rising number of COVID-19 cases. This is a concerning issue because the U.S. has lagged behind other developed nations — even before the pandemic — in terms of life expectancy and many health measures (including the rate of chronic diseases as well as the number of hospitalizations for preventable causes and avoidable deaths).
A nationally representative web-based survey showed that, overall, four in 10 American adults reported postponing or avoiding routine, urgent or emergency care because of COVID-19 concerns. This finding compounds the indirect impact of the pandemic, given that delaying or avoiding medical care can increase the risk of life-threatening medical emergencies. In addition, any delay in medical care can lead to missed opportunities for the treatment of chronic conditions, receipt of necessary vaccinations and early detection of complications or new conditions, all of which can worsen health outcomes.
The survey was conducted by the COVID-19 Outbreak Public Evaluation Initiative, which is led by a group of researchers who are interested in assessing public attitudes, behaviors and beliefs related to the pandemic. Its detailed findings were published in the Sept. 11, 2020, issue of the Centers for Disease Control and Prevention’s (CDC’s) Morbidity and Mortality Weekly Report.
Survey details and findings
The survey was completed in late June 2020 by a sample of 4,975 Americans aged 18 or older who were representative of the U.S. population with regards to age, gender and race/ethnicity. It asked the respondents whether they have delayed or avoided three types of medical care during the pandemic due to COVID-19 concerns: emergency (such as immediate life-threatening conditions), urgent (such as immediate non–life-threatening conditions) and routine (such as annual check-ups) medical care.
Overall, 41% of the respondents reported delaying or avoiding at least one of the three types of medical care — including 12% who avoided urgent or emergency care and 32% who avoided routine care — due to COVID-19 concerns.
These findings align with recent studies demonstrating that hospital admissions for urgent conditions (including heart attack, stroke, appendicitis and gastrointestinal bleeding) as well as emergency department visits for certain life-threatening conditions (such as heart attack, stroke and high-blood-sugar crisis) have dropped significantly since the beginning of the pandemic.
The survey showed that delay or avoidance of medical care due to COVID-19 concerns was significantly higher among certain population groups.
Mainly, 57% of young-adult respondents (aged 18 to 24 years) as well as 56% of Hispanic and 48% of non-Hispanic Black respondents reported delaying or avoiding medical care due to COVID-19 concerns.
Importantly, 64% of the respondents who provided unpaid care (including helping with personal needs or household chores, going to doctor’s appointments or outside services) to an adult relative or friend in the preceding three months reported delaying or avoiding medical care. In fact, one in four of these caregivers reported that they cared for adults who were at increased risk of severe COVID-19.
Furthermore, 55% of the respondents who reported having two or more medical conditions known to increase the risk of severe COVID-19 (defined as being obese or having diabetes, high blood pressure, cardiovascular disease or any type of cancer) and 60% of those with disabilities (defined as having a physical, mental or emotional condition that limits activities) reported delaying or avoiding medical care.
In addition, 47% of the respondents who knew someone who tested positive for COVID-19 and 49% of those who believed that they belonged to a group at high risk of severe COVID-19 reported delaying or avoiding medical care.
Possible contributing factors
Notably, the survey did not ask the respondents about the specific COVID-19-related reasons that led them to defer or forgo medical care, such as adherence to community mitigation efforts (including stay-at-home orders), temporary closures of health facilities, reduced availability of public transportation, fear of exposure to the coronavirus and other access-related factors.
However, the researchers offered a few reasons that may explain why certain groups tended to significantly delay or avoid medical care more often than others. For example, caregivers of adult family members or friends may have been concerned about passing the virus on to the recipients of their care if they contracted it by visiting health care facilities.
Respondents who believed that they belonged to a group at high risk of severe COVID-19 may have avoided seeking health care due to fear of being exposed to the virus.
Additionally, disabled respondents may have had challenges accessing medical services due to disruptions to their essential support services (such as transportation) or because they tend to have specialized care needs that are difficult to meet through telehealth visits.
Higher reports of delay or avoidance of medical care among Hispanic and non-Hispanic Black respondents are particularly troubling because multiple analyses of federal, state and local data document that these two groups also are experiencing a disproportionately high burden of COVID-19 cases and deaths. Delaying or missing non-COVID-19 care further compounds health care disparities for these groups, which have faced long-standing structural inequities before the pandemic.
Implications of findings
A recent U.S. study found that states with the highest numbers of COVID-19 deaths also experienced a large increase in deaths attributed to other causes (including diabetes and heart disease), suggesting that serious consequences of delayed medical care have already started to occur.
To mitigate these negative consequences, it is important for all Americans to seek medical care right away, especially in the case of medical emergencies, because health care facilities are implementing important safety precautions that can prevent the spread of COVID-19 among patients and health care professionals. Americans also need to adhere to the latest CDC instructions for protecting themselves and others from COVID-19.
For routine or non-urgent medical care, telehealth can help many patients receive essential health care without needing to visit a doctor’s office or health care facility.
To stay healthy and safe during the pandemic, individuals with high-risk medical conditions should develop treatment plans with their health care professionals, paying attention to the CDC guidance for their specific conditions. This includes having at least a 30-day supply of prescription and non-prescription medications on-hand, calling their health care professionals if they have any concerns about their medical conditions or think they are getting sick with COVID-19 or another condition, and calling 911 right away if they need emergency help.