Collateral Impact of the COVID-19 Pandemic on Acute Care of Non-COVID Patients: An Internet-based Survey of Critical Care and Emergency Personnel
Swagata Tripathy, Bharath KT Vijayaraghavan, Manoj K Panigrahi, Asha P Shetty, Rashan Haniffa, Rajesh C Mishra, Abi Beane
Acute care, COVID-19, LMIC, Pandemic, Service delivery, Survey
Citation Information :
Tripathy S, Vijayaraghavan BK, Panigrahi MK, Shetty AP, Haniffa R, Mishra RC, Beane A. Collateral Impact of the COVID-19 Pandemic on Acute Care of Non-COVID Patients: An Internet-based Survey of Critical Care and Emergency Personnel. Indian J Crit Care Med 2021; 25 (4):374-381.
Purpose: The impact of disruption to the care of non-coronavirus disease (COVID) patients (COVID collateral damage syndrome-CCDS) is largely unknown in resource-limited settings. We investigated CCDS as perceived by healthcare workers (HCWs) providing acute and critical care services in India.
Materials and methods: A clinician and nurse codesigned and validated an internet-based survey, which was disseminated to HCWs using a multiple frame sampling technique.
Results: Responses were received from 468 HCWs (completion rate 84%); at the time of the survey, 48% were working in critical care, 41% aged 30–40 years, and 53% represented public institutions. Respondents perceived a decrease in service utilization and disruption to time-sensitive acute interventions (60.1% and 40.8%, respectively), with fear of infection (score, 63.0; standard deviation (SD), 31.8) and restrictions due to lockdown (61.4; SD 32.5) being cited as the causes of service disruption. Being overwhelmed or lack of protective equipment was perceived to contribute less to CCDS. Insistence on COVID test results X2 (p = 0.02) and duty-avoidance (p < 0.01) was perceived as significant causes for CCDS by HCWs from private hospitals and those in leadership roles, respectively.
Conclusions: Fear of infection and the effect of lockdown were perceived as important contributors to CCDS resulting in disruption to services and decreased service utilization. Perceptions were influenced by HCWs’ role and hospital organizational structure.
Levin PJ, Gebbie EN, Qureshi K. Can the health-care system meet the challenge of pandemic flu? Planning, ethical, and workforce considerations. In: Public health reports, vol. 122. Washington, DC: Association of Schools of Public Health; 2007, pp. 573–578.
Duley MGK. The next pandemic: anticipating an overwhelmed health care system. Yale J Biol Med 2005;78:355–362. DOI: 10.1016/j.jaip.2020.03.012
Chatterjee K, Chatterjee K, Kumar A, Shankar S. Healthcare impact of COVID-19 epidemic in India: a stochastic mathematical model. Med J Armed Forces India 2020;76(2):147–155. DOI: 10.1016/j.mjafi.2020.03.022.
The Lancet. India under COVID-19 lockdown. Lancet 2020;395(10233):1315. DOI: 10.1016/S0140-6736(20)30938-7.
Over 580,000 surgeries in India may be cancelled due to COVID-19: study. The Economic Times. Available from: https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/covid-19-pandemic-will-lead-to-over-28-million-cancelled-surgeries-worldwide-study/articleshow/75757140.cms. Accessed 25 August 2020.
Atif M, Malik I. Why is Pakistan vulnerable to COVID-19 associated morbidity and mortality? A scoping review. Int J Health Plann Manage 2020; 35(5):1041–1054. DOI: 10.1002/hpm.3016.
De Guzman R, Malik M. Dual challenge of cancer and COVID-19: Impact on health care and socioeconomic systems in Asia Pacific. JCO Glob Oncol 2020;(6):906–912. DOI: 10.1200/GO.20.00227.
Malina D, Rosenbaum L. The untold toll-the pandemic's effects on patients without Covid-19. 2020.
Galarza M, Gazzeri R. Letter: Collateral pandemic in face of the present COVID-19 pandemic: a neurosurgical perspective. Neurosurgery 2020;87(2):E186–E188. DOI: 10.1093/neuros/nyaa155.
Date P. First do no harm with COVID-19: corona collateral damage syndrome. West J Emerg Med 2020;21(4):746–747. DOI: 10.5811/westjem.2020.5.48013.
Chandir S, Siddiqi DA, Setayesh H, Khan AJ. Impact of COVID-19 lockdown on routine immunisation in Karachi, Pakistan. Lancet Glob Health 2020;8(9):e1118–e1120. DOI: 10.1016/S2214-109X(20)30290-4.
IRIS ICU Registry. Available from: http://www.irisicuregistry.org/. Accessed 1 August 2020.
CRIT CARE ASIA. Establishing a critical care network in Asia to improve care for critically ill patients in low- and middle-income countries. Crit Care 2020;24:608. DOI: 10.1186/s13054-020-03321-7.
Indian Society of Critical Care Medicine. Available from: https://isccm.org/. Accessed 31 December 2020.
Critical Care Nurses Society. Critical care nursing society. Available from: http://www.criticalcarenursessociety.com/. Accessed 31 December 2020.
SurveyMonkey. Free online survey software and questionnaire tool. Available from: https://www.surveymonkey.com/welcome/sem/?program=7013A000000mweBQAQ&utm_bu=CR&utm_campaign=71700000059186490&utm_adgroup=58700005408390198&utm_content=43700049188951718&utm_medium=cpc&utm_source=adwords&utm_term=p49188951718&utm_kxconfid=s4bvpi0ju&language=&gclid=CjwKCAiAirb_BRBNEiwALHlnDyoLz0okLa1o6Xwrlpn92IAErArOXyywGQGId-JKuZkUGVKbhLKmPRoCuvAQAvD_BwE&gclsrc=aw.ds. Accessed 31 December 2020.
Eysenbach G, Wyatt J. Using the Internet for surveys and health research. J Med Internet Res 2002; 4:76–94. DOI: 10.2196/jmir.4.2.e13.
Wilhelm JA, Helleringer S. Utilization of non-Ebola health care services during Ebola outbreaks: a systematic review and meta-analysis. J Glob Health 2019;9(1):010406. DOI: 10.7189/jogh.09.010406.
Yalamanchi R, Chandra Dasari B, Narra L, Oomman A, Kumar P, Nayak R, et al. Cardiac intensive care unit admissions during COVID-19 pandemic-a single center experience. Indian J Crit Care Med. 2020;24(11):1103–1105. DOI: 10.5005/jp-journals-10071-23660.
Lu TH, Chou YJ, Liou CS. Impact of SARS on healthcare utilization by disease categories: implications for delivery of healthcare services. Health Policy 2007;83(2–3):375–381. DOI: 10.1016/j.healthpol.2007.03.001.
Lee SY, Khang YH, Lim HK. Impact of the 2015 middle east respiratory syndrome outbreak on emergency care utilization and mortality in South Korea. Yonsei Med J 2019;60(8):796–803. DOI: 10.3349/ymj.2019.60.8.796.
Ebola T, Africa W. CMI BRIEF Ebola outbreak 2014-2016, vol. 3. Bergen: CMI Brief; 2020.
Li W, Yang Y, Ng CH, Zhang L, Zhang Q, Cheung T, et al. Global imperative to combat stigma associated with the coronavirus disease 2019 pandemic. In: Psychological medicine. Cambridge: Cambridge University Press; 2020. p. 1.
Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health 2020;4:e10–e11. DOI: 10.1016/S2352-4642(20)30108-5.
Tai DY. SARS plague: duty of care or medical heroism? Ann Acad Med 2006;35:374–378. PMID: 16830007.
Alsubaie S, Hani Temsah M, Al-Eyadhy AA, Gossady I, Hasan GM, Al-Rabiaah A, et al. Middle East Respiratory Syndrome Coronavirus epidemic impact on healthcare workers’ risk perceptions, work and personal lives. J Infect Dev Ctries 2019;13(10):920–926. DOI: 10.3855/jidc.11753.
Sokol D. Virulent epidemics and scope of healthcare workers’ duty of care. Emerg Infect Dis 2006;12:1238–1241. DOI: 10.3201/eid1208.060360.
Malm H, May T, Francis LP, Omer SB, Salmon DA, Hood R. Ethics, pandemics, and the duty to treat. Am J Bioeth 2008;8(8):4–19. DOI: 10.1080/15265160802317974.
Hopkins Bloomberg J, Roberton T, Carter ED, Chou VB, Stegmuller AR, Jackson BD, et al. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. Lancet Glob Health 2020;8:e901–e908. DOI: 10.1016/S2214-109X(20)30229-1.
Thornton J. Covid-19: A&E visits in England fall by 25% in week after lockdown. BMJ 2020;369:m1401. DOI: 10.1136/bmj.m1401.
Willan J, King AJ, Djebbari F, Turner GDH, Royston DJ, Pavord S, et al. Assessing the impact of lockdown: fresh challenges for the care of haematology patients in the COVID-19 pandemic. Br J Haematol 2020;189(6):e224–e227. DOI: 10.1111/bjh.16782.
Lippi G, Henry BM, Bovo C, Sanchis-Gomar F. Health risks and potential remedies during prolonged lockdowns for coronavirus disease 2019 (COVID-19). Diagnosis 2020;7(2):85–90. DOI: 10.1515/dx-2020-0041.
Ivanov D. Predicting the impacts of epidemic outbreaks on global supply chains: a simulation-based analysis on the coronavirus outbreak (COVID-19/SARS-CoV-2) case. Transp Res Part E Logist Transp Rev 2020;136:101922. DOI: 10.1016/j.tre.2020.101922.
Govt. nod to private labs for COVID-19 testing likely soon. The Hindu. Available from: https://www.thehindu.com/news/cities/Hyderabad/govt-nod-to-private-labs-for-covid-19-testing-likely-soon/article31717826.ece. Accessed 9 July 2020.
India's high use of antigen tests risks underestimating COVID-19 spread, says diagnostician. Reuters. Available from: https://in.reuters.com/article/health-coronavirus-india-tests/indias-high-use-of-antigen-tests-risks-underestimating-covid-19-spread-says-diagnostician-idINKBN27D2LX. Accessed 31 December 2020.
Wyatt JC. When to use web-based surveys. J Am Med Inform Assoc 2000;7:426–430. DOI: 10.1136/jamia.2000.0070426.
Burns KEA, Duffett M, Kho ME, Meade MO, Adhikari NKJ, Sinuff T, et al. A guide for the design and conduct of self-administered surveys of clinicians. CMAJ 2008;179(3):245–252. DOI: 10.1503/cmaj.080372.
Eysenbach G. Improving the quality of web surveys: the checklist for reporting results of internet e-surveys (CHERRIES). J Med Internet Res 2004;6(3):e34. DOI: 10.2196/jmir.6.3.e34.
Jones TL, Baxter M, Khanduja V. A quick guide to survey research. Ann R Coll Surg Engl 2013;95(1):5–7. DOI: 10.1308/003588413X13511609956372.
Mafham MM, Spata E, Goldacre R, Gair D, Curnow P, Bray M, et al. COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England. Lancet 2020;396(10248):381–389. DOI: 10.1016/S0140-6736(20)31356-8.