Table 3

Impacts of COVID-19 pandemic on patients

SubthemeLevelIllustrative quote
Access to care2,3,4Also, transitions for people seeking treatment have been difficult. Our detox center for alcohol detox treatment now requires negative COVID-19 testing. Our outpatient based opioid treatment program partner now only utilizes phone appointments. Many community mental health programs are no longer accepting walk-ins. I’m hopeful this will change, but service access for patients with SUD [substance use disorder] is really difficult right now.—debriefing interview
Fear of infection2,3,4There’s a lot of patients that are being fully recognized by the ED now and it’s risky for them. They don't want to be there, I mean, they are there because they're having something unrelated to COVID-19, chest pain for example. Where they want emergency evaluation and they need one. But they fully realize that as the minutes tick, they perceive just being in the ER is risky and so they are anxious about that. A lot of questions like, “do I really need to do that? Can I just go? When is this test going to be done? Can I get this as an outpatient?”—debriefing interview
Presenting problems2,3,4We have not been as busy from a trauma perspective, although the last couple weeks have been picking up as people, I think, are getting a little more antsy with the social distancing and things. We’ve certainly seen a lot, like a lot more, or it seems like more at least of the self-harm and non-accidental type of traumas, which has been challenge in and of itself. And then on the general surgery side it seems like people with like normal problems like appendicitis and you know infected gallbladders are coming in later than the otherwise would I think out of concern for, you know, being in the hospital if they don’t need to be which is a valid concern.—debriefing interview
Risk disparities1,2,4One thing that I have noticed in taking care of patients with COVID-19 how many people with COVID-19 have a lot of vulnerabilities in the social determinants of health that kind of layer on that person’s ability to manage their assets. And so, the number of patients non-English-speaking is 75% of the patients that I have seen with COVID-19 English-speaking. Either service sector uninsured or underinsured with little access to ability to physically distance at home or multi-generational living where the mom works but she has a baby and Grandma takes care of the baby during the day and how do you take care of a baby and older parent? How do you reconcile that in a two-bedroom condo 1 bathroom when someone take public transportation and so I just been struck with the fact that this is going to take a huge toll on people of color or the Spanish-speaking people who are immigrants?—debriefing interview