Parental perspectives on emergency health service use during the first wave of the COVID-19 pandemic in the United Kingdom: A qualitative study.

UK 'Lockdown' measures introduced in March 2020 aimed to mitigate the spread of COVID-19. Although seeking healthcare was still permitted within restrictions, paediatric emergency department attendances reduced dramatically and led to concern over risks caused by delayed presentation. Our aim was to gain insight into healthcare decisions faced by parents during the first wave of the COVID-19 pandemic and to understand if use of urgent healthcare, self-care, and information needs differed during lockdown as well as how parents perceived risks of COVID-19. We undertook qualitative telephone interviews with a purposive sample of parents living in the North East of England recruited through online advertising. We used a semi-structured interview schedule to explore past and current healthcare use, perceptions of risk and the impact of the pandemic on healthcare decisions. Interviews were transcribed and analysed using Thematic Analysis. Three major themes were identified which concerned (i) how parents made sense of risks posed to, and by their children, (ii) understanding information regarding health services and (iii) attempting to make the right decision. These themes contribute to the understanding of the initial impact of COVID-19 and associated restrictions on parental decisions about urgent healthcare for children. These findings are important to consider when planning for potential future public health emergencies but also in the wider context of encouraging appropriate use of urgent healthcare.

Parents’ views of using children’s emergency services during the covid-19 pandemic

AimsIn March 2020 the World Health Organisation declared COVID-19 as a global pandemic. At this time the UK’s healthcare services were becoming overwhelmed. To relieve the pressures the government initiated the first ever ‘lockdown’, the key message being ‘Stay home, Protect the NHS, Save Lives’.Although seeking healthcare was still permitted, there was an alarming reduction in the number of attendances to paediatric accident and emergency units. The Royal College of Paediatrics and Child Health expressed concern in relation to delayed presentation, identifying nine deaths across the UK where delay was a potential factor.We aimed to describe parents’ decision-making regarding use of children’s urgent healthcare services during the first wave of COVID-19 and the experience of those who had accessed services.MethodsThe study was in two phases: 1) Parents were invited, via online platforms, to complete an online survey which collected demographic data and responses about use of, and attitudes towards, accessing urgent paediatric healthcare during the pandemic. 2) A purposive sample of survey respondents were invited to take part in a telephone interview, where a semi-structured topic guide was used to further explore experiences and views. Interviews were recorded, transcribed, and analysed according to principles of Thematic Analysis.ResultsIn total 121 parents responded to the online survey, in order to obtain maximum variation we purposely sampled, 21 were then interviewed. The largest represented age group was 35-39 years, with most families having 2 children.When asked if COVID-19 impacted their decision around the use of emergency departments, 8 (38.1%) replied yes, 11 (52.5%) replied no and 2 (9.5%) responses were missing.The interviews identified three main themes: i) Making sense of risks: Parents differentiated between the risk to the child of contracting COVID-19 in the emergency department (ED) and the potential risk of viral transmission from the child to the wider community;it was the latter that commonly took precedence. Most regarded the risk to their child from COVID-19 as small.(ii) Understanding information regarding health service availability: Many parents understood that emergency services were accessible throughout, however some inferred ‘protect the NHS’ meant they should not be used. Parents cited that the overwhelming amount of information and resources available often lead to dissemination of misinformation and made identifying correct guidance difficult.(iii) Attempting to make the right decision: Parents stated it was a perpetual struggle between managing risks and acting within the ‘rules’. They were acutely aware of not applying unnecessary pressure on an already stretched NHS but most stated that ultimately their primary concern would be their childrens’ health.ConclusionThe data provides a real time snapshot of parental views on seeking emergency healthcare for children during the early stages of the pandemic. Our insights into parental decision-making help to explain part of the reduction in ED attendance. This work could be used to formulate future messages and improve communication from governmental and local bodies to the public during public health emergencies. Post-pandemic this may contribute to initiatives encouraging the appropriate use of urgent healthcare.

COVID-19 pandemic in the United Kingdom.

OBJECTIVES: To describe epidemiological data on cases of COVID-19 and the spread of Severe Acute Respiratory Syndrome Coronavirus 2 in the United Kingdom (UK), and the subsequent policy and technological response to the pandemic, including impact on healthcare, business and the economy. METHODS: Epidemiological, business and economic data were extracted from official government sources covering the period 31st January to 13th August 2020; healthcare system data up to end of June 2019. RESULTS: UK-wide COVID-19 cases and deaths were 313,798 and 46,706 respectively (472 cases and 70 deaths per 100,000 population) by 12th August. There were regional variations in England, with London and North West (756 and 666 cases per 100,000 population respectively) disproportionately affected compared with other regions. As of 11th August, 13,618,470 tests had been conducted in the UK. Increased risk of mortality was associated with age (≥60 years), gender (male) and BAME groups. Since onset of the pandemic, emergency department attendance, primary care utilisation and cancer referrals and inpatient/outpatient referrals have declined; emergency ambulance and NHS111 calls increased. Business sectors most impacted are the arts, entertainment and recreation, followed by accommodation and food services. Government interventions aimed at curtailing the business and economic impact have been implemented, but applications for state benefits have increased. CONCLUSIONS: The impact of COVID-19 on the UK population, health system and economy has been profound. More data are needed to implement the optimal policy and technological responses to preventing further spikes in COVID-19 cases, and to inform strategic planning to manage future pandemics.

Rationing care by frailty during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic is disproportionately affecting older people and those with underlying comorbidities. Guidelines are needed to help clinicians make decisions regarding appropriate use of limited NHS critical care resources. In response to the pandemic, the National Institute for Health and Care Excellence published guidance that employs the Clinical Frailty Scale (CFS) in a decision-making flowchart to assist clinicians in assessing older individuals' suitability for critical care. This commentary raises some important limitations to this use of the CFS and cautions against the potential for unintended impacts. The COVID-19 pandemic has allowed the widespread implementation of the CFS with limited training or expert oversight. The CFS is primarily being used to assess older individuals' risk of adverse outcome in critical care, and to ration access to care on this basis. While some form of resource allocation strategy is necessary for emergencies, the implementation of this guideline in the absence of significant pressure on resources may reduce the likelihood of older people with frailty, who wish to be considered for critical care, being appropriately considered, and has the potential to reinforce the socio-economic gradient in health. Our incomplete understanding of this novel disease means that there is a need for research investigating the short-term predictive abilities of the CFS on critical care outcomes in COVID-19. Additionally, a review of the impact of stratifying older people by CFS score as a rationing strategy is necessary in order to assess its acceptability to older people as well as its potential for disparate impacts.