Delay in seeking health care from community residents during a time with low prevalence of COVID-19: A cross-sectional national survey in China.

Background: The pandemic of COVID-19 has significant implications on health resources allocation and health care delivery. Patients with non-COVID illness may have to change their care seeking behaviors to mitigate the risk of infections. The research aimed to investigate potential delay of community residents in seeking health care at a time with an overall low prevalence of COVID-19 in China. Methods: An online survey was conducted in March 2021 on a random sample drawn from the registered survey participants of the survey platform Wenjuanxing. The respondents who reported a need for health care over the past month (n = 1,317) were asked to report their health care experiences and concerns. Logistic regression models were established to identify predictors of the delay in seeking health care. The selection of independent variables was guided by the Andersen's service utilization model. All data analyses were performed using SPSS 23.0. A two-sided p value of <0.05 was considered as statistically significant. Key results: About 31.4% of respondents reported delay in seeking health care, with fear of infection (53.5%) as a top reason. Middle (31-59 years) age (AOR = 1.535; 95% CI, 1.132 to 2.246), lower levels of perceived controllability of COVID-19 (AOR = 1.591; 95% CI 1.187 to 2.131), living with chronic conditions (AOR = 2.008; 95% CI 1.544 to 2.611), pregnancy or co-habiting with a pregnant woman (AOR = 2.115; 95% CI 1.154 to 3.874), access to Internet-based medical care (AOR = 2.529; 95% CI 1.960 to 3.265), and higher risk level of the region (AOR = 1.736; 95% CI 1.307 to 2.334) were significant predictors of the delay in seeking health care after adjustment for variations of other variables. Medical consultations (38.7%), emergency treatment (18.2%), and obtainment of medicines (16.5%) were the top three types of delayed care, while eye, nose, and throat diseases (23.2%) and cardiovascular and cerebrovascular diseases (20.8%) were the top two conditions relating to the delayed care. Self-treatment at home was the most likely coping strategy (34.9%), followed by Internet-based medical care (29.2%) and family/friend help (24.0%). Conclusions: Delay in seeking health care remained at a relatively high level when the number of new COVID-19 cases was low, which may present a serious health risk to the patients, in particular those living with chronic conditions who need continuous medical care. Fear of infection is the top reason for the delay. The delay is also associated with access to Internet-based medical care, living in a high risk region, and perceived low controllability of COVID-19.

Spatial and temporal patterns and factors influencing the spread of the COVID-19 pandemic in China

It is essential to unravel the spatial and temporal patterns of the spread of the epidemic in China during the backdrop of the global coronavirus disease 2019 (COVID-19) outbreak in 2020, as the underlying drivers are crucial for scientific formulation of epidemy-preventing strategies. A discriminant model for the spatio-temporal pattern of epidemic spread was developed for 317 prefecture-level cities using accumulated data on confirmed cases. The model was introduced for the real-time evolution of the outbreak starting from the rapid spread of COVID-19 on January 24, 2020, until the control on March 18, 2020. The model was used to analyze the basic characteristics of the spatio-temporal patterns of the epidemic spread by combining parameters such as peak position, full width at half maximum, kurtosis, and skewness. A multivariate logistic regression model was developed to unravel the key drivers of the spatio-temporal patterns based on traffic accessibility, urban connectivity, and population flow. The results of the study are as follows. (1) The straight-line distance of 588 km from Wuhan was used as the effective boundary to identify the four spatial patterns of epidemic spread, and 13 types of spatio-temporal patterns were obtained by combining the time-course categories of the same spatial pattern. (2) The spread of the epidemic was relatively severe in the leapfrogging model. Besides the short-distance leapfrogging model, significant differences emerged in the spatial patterns of the time course of epidemic spread. The peaks of the new confirmed cases in various spatio-temporal patterns were mostly observed on February 3, 2020. The average full widths at the half maximum of all ordinary cities were approximately 14 days, thus, resonating with the incubation period of the COVID-19 virus. (3) The degree of the population correlation with Wuhan city has mainly influenced the spreading and the short-distance leapfrogging spatial patterns. The existence of direct flight from Wuhan city exhibited a positive effect on the long-distance leapfrogging spatial pattern. The number of population outflows has significantly affected the leapfrogging spatial pattern. The integrated spatial pattern was influenced by both primary and secondary epidemic outbreak sites. Thus, cities should pay great attention to traffic control during the epidemic as analysis has shown that the spatio-temporal patterns of epidemic spread in the respective cities can curb the spread of the epidemic from key links. © 2022, Science Press. All right reserved.