Survey: 41% of Americans have avoided medical care because of COVID-19

Results of a nationwide survey today show that 40.9% of Americans have avoided medical care because of the novel coronavirus pandemic, including 12.0% who avoided emergency care and 31.5% who avoided routine care. The results are published in Morbidity and Mortality Weekly Report (MMWR).

A total of 5,412 adults answered the web-based survey, which was administered during the last week of June. Young adults ages 18 to 24 were the most likely group to say they had avoided seeking medical care because of COVID-19 (30.9% for urgent or emergency care; 57.2%  for any care), followed by unpaid adult caregivers (29.8% for emergency care; 64.3% for routine care), and Hispanic adults (24.6%; 55.5%). Adults with disabilities also reported delaying medical 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,” the authors wrote, adding that “excess deaths directly or indirectly related to COVID-19 have increased in 2020 versus prior years.”

The authors said the delay or avoidance of care may be due in part to stay-at-home orders, fear of contracting the virus and then spreading it to care recipients, and general concerns about the virus.
Sep 11 MMWR study

 

Study highlights high cost of COVID-19 response for low-income countries

A modeling study led by researchers from the World Health Organization (WHO) estimates that the healthcare costs of COVID-19 treatment in low- and middle-income countries (LMICs) is more than $52 billion a month, an amount that could triple over 3 months without reduced coronavirus transmission.

In the study, published yesterday in The Lancet Global Health, the researchers projected the number of COVID-19 cases for 73 LMICs after Jun 26 based on an epidemiologic model from Imperial College London, then calculated what the additional healthcare costs of implementing a strategic preparedness and response plan (SPRP) would be for 4-week and 12-week timeframes under three scenarios: a status quo scenario in which current transmission levels are maintained, a 50% increase in transmission, and a 50% decrease in transmission.

The estimated costs are based on nine SPRP pillars laid out by the WHO in February and include the cost of healthcare staff, equipment (such as diagnostic tests and personal protective equipment), and infrastructure (such as field hospitals and diagnostic labs). Isolation and quarantine costs were not included in the analysis.

The total cost under the status quo scenario was $52.4 billion over 4 weeks, with a per-capita cost of $8.60. Under a 50% decrease or increases in transmission, the costs were estimated at $33.08 billion and $61.92 billion, respectively. In the 12-week timeframe, the costs would triple under the status quo and increased transmission scenario, while the costs of the 50% decreased transmission scenario over 12 weeks would be equal to the cost of the status quo scenario over 4 weeks. Under the status quo scenario, the main cost drivers were case management (54% of costs), maintaining essential health services (21%), rapid response and case investigation (14%), and infection prevention and control (9%).

The authors say the findings underscore the importance of an early and comprehensive response to limit the spread of the virus.

“The costs of a COVID-19 response in the health sector will escalate, particularly if transmission increases,” study co-author Agnès Soucat, PhD, Director of the Department of Health Systems Governance and Financing at WHO, said in a press release. “So instituting early and comprehensive measures to limit the further spread of the virus will be vital if we are to conserve resources and sustain the response.”
Sep 9 Lancet Glob Health study
Sep 9 Lancet press release

 

Substantial rate of severe outcomes noted in young adult COVID patients

A study yesterday in JAMA Internal Medicine shows that young adults are not immune to severe outcomes from COVID-19, particularly young men with morbid obesity and high blood pressure.

The study by researchers at Brigham and Women’s Hospital in Boston identified and collected data on 3,222 young adults ages 18 to 34 diagnosed with COVID-19 and discharged from the hospital from Apr 1 to Jun 30. During hospitalization, 684 of these young adult patients (21%) required intensive care, 331 (10%) required mechanical ventilation, and 88 (2.7%) died.

Morbid obesity was present in 140 patients (41%) who died or required mechanical ventilation. More than half of the patients requiring hospitalization were black or Hispanic.

Using multivariable logistics regression analysis, the researchers determined that morbid obesity (adjusted odds ratio [aOR], 2.30; 95% confidence interval [CI], 1.77 to 2.98; P < .001), hypertension (aOR, 2.36; 95% CI, 1.79 to 3.12; P < .001), and male sex (aOR, 1.53; 95% CI, 1.20 to 1.95; P = .001) were associated with greater risk of death or mechanical ventilation. Diabetes was associated with increased risk of these outcomes on univariable analysis but did not reach statistical significance after adjustment (aOR, 1.31; 95% CI, 0.99 to 1.73; P = .06). Odds of death or mechanical ventilation did not vary significantly with race or ethnicity.

Patients with multiple risk factors (morbid obesity, hypertension, and diabetes) faced risks similar to 8,862 middle-aged adults (ages 35 to 64) without these conditions.

“Given the sharply rising rates of COVID-19 infection in young adults, these findings underscore the importance of infection prevention measures in this age group,” the authors wrote.
Sep 9 JAMA Intern Med research letter

 

Ebola infects 1 more in DRC, bringing outbreak total to 113 cases

Tests have confirmed Ebola in one more person in the Democratic Republic of the Congo (DRC), pushing the outbreak total to 113 cases, the WHO African regional office said in an update on Twitter today.

No new deaths were reported, keeping the fatality count at 48.

The outbreak, first detected in early June, is occurring in the same area where a 2018 outbreak sickened 54 people, 33 of them fatally. Investigations so far suggest it is probably linked to a new zoonotic introduction, rather than the earlier outbreak or a large outbreak that unfolded around North Kivu province in the eastern DRC and was declared over in June.

Health officials are worried about the latest outbreak, because cases are spread over a large geographic region, some confirmed case-patients have remained in the community, the location poses a travel threat to Kinshasa and neighboring countries, and health resources are stretched thin owing to the COVID-19 pandemic.
Sep 10 WHO African regional office tweet



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