ABSTRACT
Objective The objective of this national survey was to explore pregnant women's perceptions of COVID-19 and their healthcare experiences. Design Online survey. Method Through patient and public involvement, a questionnaire was developed and advertised via the BBC website, Twitter and other online media during May 2020. The findings were analysed by qualitative thematic analysis. Women who are currently pregnant, or who have delivered during the COVID-19 pandemic were invited to partake in a national online survey. Results 1451 participants replied to the online questionnaire. Participants provided significant insight into the perceived barriers to seeking healthcare during this pandemic. These include 'not wanting to bother anyone', 'lack of wider support from allied healthcare workers' and the influence of the media. Other concerns included the use of virtual clinics antenatally and their acceptability to patients, the presence of birthing partners, and the way in which information is communicated about rapidly changing and evolving services. The influence of the media has also had a significant impact on the way women perceive hospital care in light of COVID-19 and for some, this has shaped whether they would seek help. Conclusions This is the first ever reported study in the United Kingdom to explore pregnant women's perceptions of COVID-19 and their subsequent healthcare experiences. Maternity services have undergone a significant change due to the pandemic. Whilst these changes may be temporary, they highlight significant questions as to how services should be delivered in the future. It cannot be assumed that the current way of service delivery is necessarily acceptable to patients, and it is important to involve the voices of women and their families when designing such services. We hope the findings from this study will be used to shape future maternity services including the use of virtual antenatal care.
ABSTRACT
Recurrent pain causes significant morbidity for individuals with sickle cell disease (SCD) and is a marker of mortality. Considering the current pandemic, it's important to understand how COVID-19 impacts individuals with SCD, a medically vulnerable population. We sought to identify factors associated with more severe COVID-19 illness and hospitalization in the SCD population. We established the international SECURE-SCD Registry to collect COVID-19 data in SCD patients. Providers were instructed to report confirmed COVID-19 cases after the disease course was known. Providers reported demographics, prior SCD complications and COVID-19 related hospitalization, severity/management strategies and death. Data were without protected health information. We used multivariable models to estimate the independent effects of age, sex, genotype, SCD-related and non-related comorbidities grouped by organ systems on the outcomes of severe COVID-19 and hospitalization. We defined the pain variable as 0, 1-2 or >2 prior acute care visits (i.e., emergency department visits, hospitalizations) for pain in the last 3 years. As of October 12th, 2020, 366 COVID-19 cases in SCD patients were reported, 41.5% were children and 52.7% were female. Acute pain was the most common presenting symptom of COVID-19 in SCD patients (54.6%), followed by pneumonia (27.0%). Children who had more than 2 acute care visits for pain had a more severe course of COVID-19 (OR=3.964, 95% CI (1.420, 11.065), p=0.03) and required hospitalization (OR=4.641, 95% CI (1.976, 10.900), p=0.006). Children who had 1-2 acute care visits for pain showed no significant association with COVID-19 severity (p=0.73) or hospitalization (p=0.82). In adults, there was no association between with history of frequent SCD pain and COVID outcomes. Pain is the most common presenting symptom of COVID-19 in SCD patients. Further, more than 2 prior acute care visits for pain is associated with severe COVID-19 course and hospitalization in children with SCD and not in adults. This work was supported by Grant 2020079 from the Doris Duke Charitable Foundation.