Q&A: Hospitalization fears in US common amid COVID-19 pandemic
The Seconds Count survey conducted by the Society for Cardiovascular Angiography and Interventions has unearthed some of the fears and hesitations of Americans about contracting COVID-19 after hospitalization for CVD.
According to the survey, 36% of respondents considered going to the hospital as more risky behavior than going to the salon (27%) or the beach (16%). In addition, 61% of participants believed they were somewhat or very likely to contract the disease while at a hospital, and half overall were more afraid of getting COVID-19 than experiencing an MI or stroke.
Healio spoke with Kirk N. Garratt, MD, the John H. Ammon chair of cardiology and medical director of the Center for Heart and Vascular Health in the ChristianaCare and past president of the Society for Cardiovascular Angiography and Interventions (SCAI), about the findings of this survey, its implications for CV health in the U.S. and what hospitals have been doing to mitigate these fears.
Q: Can you explain some of the background of this survey?
A: We were concerned that there might be hesitancy on the part of the general population to seek help when they really needed it. That concern was driven by an observation that ED visits seem to be in decline, developing very quickly after the onset of the COVID-19 pandemic. The survey largely confirmed our suspicions.
We have seen similar changes at ChristianaCare. We believe that the community here shares the same anxieties as were expressed in the survey. We did not see quite as steep of a drop-off in STEMI as has been reported elsewhere. We saw a 20% drop. Other reports have shown 30% or greater reductions in patients coming to hospital for STEMI. We did see a precipitous drop-off in all ED visits, similar to what had been described in other literature. The ED was eerily quiet in April and May.
What did the survey find?
This was a survey of almost 1,100 people. It was a sample of people taken from around the nation. These were all adults 30 and older. People were asked a series of questions about their age, their gender, income bracket, etc. Then there were a series of questions aimed at understanding their perceptions about the risk of going to a hospital.
What the survey found was that people had great concern about their chance of catching COVID-19 if they went to a hospital. Their fears were so great that a substantial number of people said that they would be hesitant to go to a hospital, even if they thought they were having symptoms suggesting MI or stroke.
A significant majority of people felt that hospitals would have to be doing things very differently for them to feel comfortable going there. They identified things such as daily COVID-19 tests for all the health care providers and clear partitions around areas that are being used to care for COVID-19 patients. Some said they would not feel comfortable going back to hospitals until there was a vaccine available.
If you don’t need to go to the ED in the next year or 2, that’s OK, but if you are having a serious health care problem now, such as MI or a stroke, then delaying care can have very grave consequences. If you’ve made your mind up that you’re not going to go, even if you feel like you’re having one of these serious problems, you’re very likely exposing yourself to far greater risk than you would if you just accepted that whatever risk exists there in the hospital is very low compared to the risk of harm from the event you’re experiencing.
Q: What are hospitals doing to minimize the risk for disease transmission?
A: Hospitals have done a lot to make their environments safe for people. None of us have the resources to do daily COVID-19 testing on every health care provider, but what we can do is survey our team of health care providers to make sure that they’re not showing signs or symptoms of any illness including COVID-19.
In my hospital, for example, every health care provider is required to fill out a short survey of how they’re feeling, and if they have signs or symptoms that may be related to COVID-19, they’re pulled aside for evaluation. As workers enter the building, everybody has their temperature taken with an electronic thermometer aimed at their forehead. If you have any abnormal temperature, you’re pulled aside for evaluation. Things that people don’t see also include directing patients who have COVID-19 or who are thought to have COVID-19 into one care area, either in an ED or inside the hospital, and then putting those who are here for other reasons — MI, stroke or trauma — into a different area.
If people had an opportunity to see those things with their own eyes, they would be very much more comfortable. But we have to admit that as hospital systems, we have made it hard for people to see those things because we are asking them to stay out of hospitals if they don’t need to come here. That is not because we’re so worried that they’ll come and catch the coronavirus. We are worried that people from the community coming in the building could be carriers of the germ. That could create exposure to health care workers and the patients here who need care. That is a risk that we can control by asking them to stay away.
Q: What kinds of conversations need to occur between physicians and their patients?
A: It is the responsibility of individual doctors, hospital systems and, very importantly, independent agencies like SCAI to attest to the truth of this message: Hospitals are safe places. Hospitals have every reason to safeguard the people who come to them for services. The last thing any hospital wants is for somebody to come to them for care and leave with a new problem. Hospitals are really pulling out all the stops to create safety for people coming into their buildings. Now we need to reassure Americans that this is so; particularly since we have indications that people may be avoiding hospitals when they should come in for care.
Q: Is there anything else that you would like to add?
A: We really want people to feel comfortable. We know that it is hard, and we all have fears. None of us want to catch this terrible virus, but it is tough as a doctor to see hospital visits for serious problems going down, especially at a time when we might expect the stress of the COVID pandemic, joblessness, financial strains and sheltering to increase the frequency of adverse events.
We also are starting to see evidence that patients that are sicker when they do come to hospitals because they’ve delayed care. I can attest to seeing that in my own hospital. We have absolutely seen patients arrive too late for us to help them.
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