Barriers to Care Amidst Covid-19
If the coronavirus pandemic has revealed anything in America it is that our healthcare system needs to be revamped and needs to serve the needs of the people. Healthcare in America is a revenue-generating system, and as cases of Covid-19 increase, the more we are starting to realize how broken this system is. A lack of resources and ineffective communication are just two of many barriers to care that have characterized this pandemic. I surveyed 103 people in order to understand their personal experiences with healthcare barriers during this pandemic, and these two barriers are the most significant ways that they have struggled to access care due to Covid-19 related symptoms. These types of barriers and gaps are not benign, and they do not merely cause confusion within the system. These gaps cause harm and are a part of a larger system of social suffering and structural violence that has plagued our healthcare system for years. When people are unable to get access to care or receive inferior care, health outcomes take a turn for the worse on both the individual and community level (Scott, 2020; Case and Dean 2020).
Ignorance is Not Bliss
"Disjumbled" is a term that was used to describe the US Healthcare system in a survey I distributed about the barriers to care people have witnessed or experienced in this pandemic (Personal Communication, 2020). There are no clear lines of communication between the public and healthcare officials. People are unsure where to get tested, and there are not easily accessible guidelines to care, treatment, or protection (Personal Communication, 2020). In the survey, many people wrote that even when they went into a clinic or drive-through testing area, they were turned away because only people with the most severe symptoms were being tested due to a shortage of testing kits (Case and Dean, 2020). There has also been a lot of miscommunication and confusing messaging surrounding the symptoms and protection measures of Covid-19. When asked what they thought was the most significant barrier to care, one source said that “slow initial response to pandemic, confusing and conflicting messaging and information from top administration,” was what has kept individuals from receiving care (Personal Communication, 2020). The primary health organizations and the White House administration have not been offering concise, coordinated facts and advice, leaving many people confused and frightened. Clear lines of communication are also an essential factor in combating the fear and panic that build in these situations. Proper communication is the first step towards containing the coronavirus because the more information we have, the better we can protect ourselves and our communities (Mukherjee, 2020).
Preparedness equals Timeliness
Resource allocation is inextricably tied to communication and is another significant gap and barrier to care. In this pandemic, we have seen a deficit of necessary equipment such as N95 masks, PPE, ventilators, and tests (Mukherjee, 2020; Scott, 2020a). Due to a shortage of tests, many people are not being tested for a variety of reasons. Children who exhibit symptoms are turned away and not tested for Covid-19, only patients with severe symptoms or those who can provide evidence of contact tracing are being tested (Personal Communication, 2020). In the survey I conducted, one person wrote that a "patient who would have typically been admitted to the hospital, was instead given oxygen, sent home and told no test was needed, even though all the symptoms for Covid-19 were present," (Personal Communication, 2020). Not only does this cause misrepresentation of how Covid-19 is affecting our country, but it also allows patients with Covid-19 to slip through the cracks and not receive any aid or treatment. Increased testing reveals important information that can tell us how many people have the disease, how fast it spreads, what populations are more at risk, and gives a clue into the true mortality rate. If we can increase our testing, we can create an accurate picture of how the disease affects our population, we can create more targeted plans for containment and treatment (BBC Network, 2020; Scott, 2020a).
To add to an already alarming situation, our hospitals and healthcare workers (HCWs) are experiencing a shortage of personal protective gear (PPE) and masks. This is particularly dangerous for patients and HCWs because it increases the risk of infection in both parties and creates a burden on the healthcare system as HCWs contract Covid-19 and are unable to work. Resource allocation has failed the people at this moment. Many people that I surveyed felt that these issues of resource shortages could have been avoided if we had prepared sooner (Personal Communication, 2020; Klebnikov, 2020). We live in a society where the healthcare system is first revenue-generating, and second a healthcare system (Case and Dean, 2020). Until this changes, resource allocation is going to continue to be a barrier to care instead of assistance to care.
A Better Tomorrow?
These systems of structural violence are not unique to the Covid-19 pandemic -- the US healthcare system operates under them consistently -- but with the pandemic at the forefront of every mind and media outlet in the world, we are starting to question how our healthcare system can do better. The answer to this question is not an easy one. It will take the cooperation of the whole country to revamp the system so that these kinds of violence and harm are no longer able to hinder the care and treatment of those in need.
One way that we have started to see our healthcare system change is through the use of telemedicine (Scott, 2020b; Levey, 2020). In order to prevent the spread of Covid-19, while still providing healthcare for patients, doctors and hospitals have begun to use virtual appointments to see their patients. This use of technology has been pushed for years and has not gotten the traction necessary for implementation due to its lack of revenue-generating capabilities (Levey, 2020). Telemedicine is not only useful during pandemics, but can be used to decrease costs of treatment and prevent the spread of infection in hospitals (Niles, 2016). This is only one way that we have seen a change in the operation of the US healthcare system; there are many courses of action that must take place to create a system that benefits everyone. We are learning that prioritizing healthcare is more than just putting money into a pot and expecting good health outcomes. Hopefully we will use this pandemic as a launching point to adapt the system to our country’s needs and to eliminate the systems in place that create these processes of structural violence and social suffering.
Works Cited:
BBC Network. n.d. “Why Do I Need to Be Tested?” BBC News. Accessed May 8, 2020. https://www.bbc.com/news/av/52534657/coronavirus-why-do-i-need-to-be-tested.
Case, Anne, and Angus Deaton. 2020. “America Can Afford a World-Class Health System. Why Don’t We Have One?” The New York Times, April 14, 2020, sec. Opinion. https://www.nytimes.com/2020/04/14/opinion/sunday/covid-inequality-health-care.html.
Klebnikov, Sergei. n.d. “‘Taking Action Earlier’ Could Have Delayed U.S. Outbreak, Says CDC’s No. 2 Official.” Forbes. Accessed May 8, 2020. https://www.forbes.com/sites/sergeiklebnikov/2020/05/02/taking-action-earlier-could-have-delayed-us-outbreak-says-cdcs-no-2-official/.
Levey, Noam N. 2020. “Coronavirus Already Changing Medical Care in the U.S.” Los Angeles Times. April 10, 2020. https://www.latimes.com/politics/story/2020-04-10/coronavirus-lasting-changes-healthcare.
Mukherjee, Siddhartha. n.d. “What the Coronavirus Crisis Reveals About American Medicine.” The New Yorker. Accessed May 8, 2020. https://www.newyorker.com/magazine/2020/05/04/what-the-coronavirus-crisis-reveals-about-american-medicine.
Niles, Nancy J. 2016. Basics of the U.S. Health Care System. 3 edition. Burlington, MA: Jones & Bartlett Learning.
Scott, Dylan. 2020a. “Coronavirus Is Exposing All of the Weaknesses in the US Health System.” Vox. March 16, 2020. https://www.vox.com/policy-and-politics/2020/3/16/21173766/coronavirus-covid-19-us-cases-health-care-system.
———. 2020b. “How the Covid-19 Pandemic Will Leave Its Mark on US Health Care.” Vox. April 15, 2020.https://www.vox.com/the-highlight/2020/4/15/21211905/coronavirus-covid-19-pandemic-medical-health-care-hospitals.
Bio: Abi is a rising senior at Wake Forest majoring in Anthropology and minoring in Health Policy and Administration. She is passionate about healthcare as a human right and plans to continue her education by pursuing a Masters of Public Health with a concentration in Health Policy. Abi hopes to work with organizations such as the CDC and Partners in Health to help deliver quality healthcare and promote healthcare as a human right.