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The Unanticipated Effects of COVID-19

AJN, American Journal of Nursing: August 2020 - Volume 120 - Issue 8 - p 12
doi: 10.1097/01.NAJ.0000694500.11289.b2
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Abstract

Multiple surveys and studies are beginning to document the broader health effects of the COVID-19 pandemic, including missed cancer screenings and immunizations because of fear of contagion.

According to the Epic Health Research Network (www.ehrn.org), which examined 2.7 million patient records across 23 states, screenings for cervical, colon, and breast cancers in each week of 2020 dropped between 86% and 94% compared with equivalent weeks from 2017-2019. Another review of 7 million patient records across 17 states revealed that between March 13, when the United States declared the outbreak of COVID-19 a national emergency, and April 7, the weekly reported incidence of acute myocardial infarctions (AMIs) and strokes decreased by 45% and 38%, respectively. It is unclear from the data whether fewer people experienced AMIs and strokes during this period, or whether fear of exposure to the virus deterred them from seeking care.

Childhood immunizations decreased by 42% last spring compared with previous years, with approximately 260,000 missed or delayed immunizations between March 8 and May 9. Among infants ages six months and younger, an estimated 29,000 did not receive needed vaccines. While immunizations for the youngest patients (those ages six to 17 months) have begun to resume, vaccinations are still lagging. These findings are echoed by the Centers for Disease Control and Prevention, which found that from mid-March to mid-April, clinicians participating in the Vaccines for Children program ordered about 2.5 million fewer doses of noninfluenza vaccines and 250,000 fewer doses of measles vaccines compared with the same period in 2019.

Access to medical care has been disrupted in other ways, too. A survey of 185,000 patients nationwide by data analysis company Evidation Health (https://evidation.com/news/covid-19-pulse-first-data-evidation) revealed that between March 31 and April 8, 42% of respondents said they were worried or very worried about going to medical appointments or to the ED, and an additional 10% reported being so worried that they would avoid seeking care. One-third of respondents reported having to miss or cancel scheduled appointments in the previous two weeks; of these, 39% used some form of telemedicine instead, meaning that more than 60% of those who missed appointments did not receive care. The survey also found that more than half of those with such chronic conditions as type 2 diabetes, hypertension, and migraine did not substitute missed appointments with another form of consultation.

The pandemic has left people with substance use disorder (SUD) particularly vulnerable. Some of them are more susceptible to COVID-19 and its associated complications because of housing instability and incarceration. Those with opioid use disorder may have difficulty obtaining needed medications such as buprenorphine, despite the government's relaxation of rules regulating prescriptions. And, in the event of an overdose, they may be unable to receive naloxone. There have been reports of some first responders and police officers refusing to administer naloxone or their agencies discontinuing provision of naloxone kits because of the risk of patients waking up and coughing out coronavirus droplets, according to the U.S. Substance Abuse and Mental Health Services Administration. For those in recovery from SUD, social distancing measures have also been challenging, as they limit access to peer support groups and other social networks.—Dalia Sofer

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