Avoidance or Delay of Care Was Common Earlier in COVID-19 Pandemic

A significant percentage of Americans with medical conditions didn’t seek appropriate care earlier in the COVID-19 pandemic, according to a nationwide survey. That likely is of special concern to pharmacists, who, as available healthcare professionals throughout the shutdowns, probably recommended some of that follow-up. Here is more information.

ATLANTA – With pharmacists available to the public throughout the COVID-19 pandemic, they often were used as a resource on health issues. One of the frustrations was finding out that some people urged to get acute or urgent care didn’t follow through.

That wasn’t unusual, however.

A report in the Morbidity & Mortality Weekly Report notes that, as of June 30, 2020, an estimated 41% of U.S. adults reported having delayed or avoided medical care during the pandemic because of concerns about COVID-19, including 12% who reported having avoided urgent or emergency care.

“These findings align with recent reports that hospital admissions, overall emergency department (ED) visits, and the number of ED visits for heart attack, stroke, and hyperglycemic crisis have declined since the start of the pandemic, and that excess deaths directly or indirectly related to COVID-19 have increased in 2020 versus prior years,” according to the report in the national Centers for Disease Control and Prevention publication.

The CDC’s COVID-19 response team conducted a web-based survey with researchers from Johns Hopkins and Harvard University, as well as Australian medical institutions, to assess delay or avoidance of urgent or emergency and routine medical care because of concerns about COVID-19. The survey administered by Qualtrics, LLC, during June 24–30, 2020, targeted a nationwide representative sample of U.S. adults. Among the 5,412 participants, 4,975 (91.9%) provided complete data for all variables in this analysis.

The authors report that, by June 30, 2020, because of concerns about COVID-19, 12% of respondents said they had delayed or avoided urgent or emergency care, and 32% said they had delayed or avoided routine care. Avoidance of urgent or emergency care was more prevalent among the following groups:

  • unpaid caregivers for adults,
  • persons with underlying medical conditions,
  • Black adults,
  • Hispanic adults,
  • young adults, and
  • persons with disabilities.

With nearly a third of adult respondents reported having delayed or avoided routine medical care, during a time of community mitigation efforts such as stay-at-home orders, temporary closures of health facilities, or additional factors, the authors write, “However, if routine care avoidance were to be sustained, adults could miss opportunities for management of chronic conditions, receipt of routine vaccinations, or early detection of new conditions, which might worsen outcomes,” the study notes.

The article emphasizes that avoidance of both urgent or emergency and routine medical care because of COVID-19 concerns was highly prevalent among unpaid caregivers for adults, respondents with two or more underlying medical conditions, and those with disabilities.

“For caregivers who reported caring for adults at increased risk for severe COVID-19, concern about exposure of care recipients might contribute to care avoidance,” the researchers explain. “Persons with underlying medical conditions that increase their risk for severe COVID-19 (6) are more likely to require care to monitor and treat these conditions, potentially contributing to their more frequent report of avoidance. Moreover, persons at increased risk for severe COVID-19 might have avoided health care facilities because of perceived or actual increased risk of exposure to SARS-CoV-2, particularly at the onset of the pandemic.”

That arguably was a dangerous tradeoff because healthcare facilities implemented safety precautions to reduce the risk of SARS-CoV-2 infection, according to the authors, adding, “In contrast, delay or avoidance of care might increase risk for life-threatening medical emergencies. In a recent study, states with large numbers of COVID-19–associated deaths also experienced large proportional increases in deaths from other underlying causes, including diabetes and cardiovascular disease.”

Discrepancies in delayed care also affected certain racial ethnic groups, according to the report. “Increased prevalences of reported urgent or emergency care avoidance among Black adults and Hispanic adults compared with White adults are especially concerning given increased COVID-19-associated mortality among Black adults and Hispanic adults,” it states. “In the United States, the age-adjusted COVID-19 hospitalization rates are approximately five times higher among Black persons and four times higher among Hispanic persons than are those among White persons.”

Researchers suggest that factors contributing to racial and ethnic disparities in SARS-CoV-2 exposure, illness, and mortality might include both structural inequities that influence life expectancy, including prevalence and underlying medical conditions, health insurance status, and health care access and utilization, as well as work and living circumstances, including use of public transportation and essential worker status.

A surprising finding was the higher prevalence of medical care delay or avoidance among respondents with health insurance, compared to those without insurance, but the authors point out that, before the pandemic, adults without insurance sought medical care much less frequently than did those with insurance, resulting in fewer opportunities for medical care delay or avoidance.

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