COVID-19 fear kept many Americans from seeking care

Doctors' message to patients: Hospitals are safe

COVID-19 fear kept many Americans from seeking care

BOSTON — Infection with Covid-19 might kill you. And a new study suggests fear of Covid-19 infection might, too -- if that is, you avoid seeking medical care because of it.

And apparently, many Americans did just that.

The study, published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR) found 41% of those responding to a survey avoided or delayed seeking medical care in the first six months of the pandemic.

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“It was a combination of people not seeking care and care not being available,” said Charles Czeisler, MD, PhD, chief of the Division of Sleep and Circadian Medicine at Brigham and Women’s Hospital, Boston and one of the study authors. “Really concerning is the 12% who delayed or avoided emergency care during the pandemic.”

Czeisler said compared with the same period in 2019, emergency department visits dropped by 42%.

“Compared with the three months before, there was over a 20 percent decrease in heart attack visits, similar decrease in stroke visits, 10% decrease in visits for very high blood sugar,” Czeisler said. “It’s not that these conditions went away. People were not seeking emergency care.”

Last July, a study in the Journal of the American Medical Association suggested possible lack of care might have led to serious consequences -- at least in New York City.

From March 1 to April 25, 2020, researchers noted that not only did New York see massive numbers of Covid-19 deaths -- but also huge increases in deaths due to cardiovascular disease (398% more than expected) and diabetes (356% more than expected).

The study could not conclude those deaths were due to purposeful lack of seeking care -- but mentioned possible lack of access or other societal disruptions as potential contributors.

Czeisler said what was particularly concerning in his study is finding that certain groups strayed from getting care more than others. Young adults, students, African-Americans and Latinos were among the groups reporting medical care avoidance.

Perhaps even more troubling, more than half of those with potentially life-threatening co-morbidities, including cardiovascular disease, diabetes and obesity reported they avoided or delayed routine visits; about a quarter said they treated urgent medical matters the same way.

“We have a real problem on our hands and it comes down to people’s fear,” said David Rosman, MD, MBA, president of the Massachusetts Medical Society. “And ultimately, what’s helping in a society isn’t fear. It’s knowledge, it’s understanding, it’s science.”

One thing Rosman wants patients to understand is that delaying a medical visit out of fear can be a life or death decision.

“What we know is that when people come in later for care, they’re getting harmed,” he said. “It means they come in at a later stage of a heart attack. It means they come in at a later stage of a stroke. And whenever we talk about a heart attack, we mean time is heart. Time is brain in a stroke. And we’ve got to see those patients as quickly as possible.”

Czeisler plans to redo the study to see if things have improved since June, given the CDC guidelines hospitals are following to keep patients safe from Covid infection.

He said patients should be assured hospitals are safe: “Those lingering fears should be put aside and people should seek the care that they need.”

“Hospitals are safe, your doctor’s offices are safe,” Rosman said. “There was some recent work done at one of the local hospitals where there had been a recent outbreak from Covid and it was community-acquired. And actually, the rate of infection at the hospital was lower than in the community.”

Rosman said the positive Covid test rate at that hospital was 0.5% compared with 3-5% positive in the community.

“The procedures that we do at the hospital, the fact that we’re all wearing masks, we’re fastidious about washing our hands,” Rosman said. “And it works.”

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