For Indianapolis mother Demaris Contreras, the decision to take her daughter to the emergency room after a fall during cross country practice earlier this month was beyond difficult.
“She said it felt like it burned from her toes to her knees, and so it was just something that I could not ignore,” Contreras said.
Her daughter, Sierra, is in sixth grade and came home complaining of pain and a tingling sensation after falling during a run. Contreras admits she isn't a medical professional, but knew her daughter required “more than ice and Tylenol.”
Healthcare experts say the coronavirus pandemic, is causing fewer folks to seek routine, preventative care. Practitioners say they’re already seeing the results.
“Our docs are already seeing this,” Dr. John Kunzer President of Indianapolis-based Community Physician Network said. “If you ask our emergency room physicians, our cardiologists, our surgeons, our oncologists, people are presenting, unfortunately, with later stage diseases because they've been putting off that care. We're already seeing it today.”
Contreras reached out to friends who were doctors and nurses in hopes of avoiding a trip to the emergency room. Each recommended she take Sierra to get checked out, but Contreras, who had put off non-essential appointments and preventive care visits for herself and her family was hesitant.
The trip was unavoidable.
“It makes me nervous and I don’t like it,” she admitted. “But, we do it only when we have to.”
Contreras wasn’t worried about the hospital staff or doctors. She didn’t trust the folks sitting in the waiting room with her.
“When the waiting room filled up with people that were not so much aware or as cautious,” she said. “So, I felt a little uncomfortable even sitting in the waiting room, because I didn’t know.”
Hospitals have implemented strict cleaning, social distancing in their waiting rooms, and masks have been required long before the mandate. Despite those safeguards, Contreras is not alone.
Demand For Emergency And Non-Emergnecy Procedures Has Plummeted
Estimates show significantly fewer Hoosier are seeking preventative care visits and undergoing elective procedures amid the coronavirus pandemic, and that’s leading practitioners to sound alarms. Indiana hospitals saw emergency room visits down 40 percent and overall outpatient services dropped by 46 percent during the height of the pandemic.
While patient levels have returned to near-normal levels at Indianapolis-based Community Health Network, there is a significant portion of the population that remains hesitant, according to the President of Community’s Physician Network Dr. John Kunzer.
“We do know from our consumer research, there's about 20% of folks that just say they're not ready to come back this year, and that they're pushing off elective things to next year because they want to wait and see,” he said.
That’s something others across the state have noticed.
People Of Color Face Systemic Challenges Accessing Care
Dr. Cameual Wright, the Medical Director for CareSource Indiana, an insurance provider, believes these trends are most concerning in two populations.
“One is people of color, particularly African Americans,” she said. “We already have a lower rate of seeking preventative health care and we also have a higher rate of susceptibility to chronic diseases in COVID time.”
Wright says the situation now “is magnified.” Fewer people of color are scheduling or attending appointments.
That’s something Tracy Lewis, the Executive Director at Community Advocates of Northern Indiana sees first hand.
"It's not that people don't know they need to go to the doctor," she said. "You'd be surprised at how many people at a health fair, a church, or whatever will mention their symptoms to somebody like me. So it's not that there isn't the concern or the desire."
Lack of transportation or insurance are significant she says. Further for folks who are insured other barriers to care exist. Lewis says many patients lack "a doctor they have a good relationship with. Historically, a challenge has been issues around trust."
Rural Residents Face Different, Still Systemic Barriers
But it's not just people of color that face barriers to care.
Rural communities also face significant and unique challenges. Wright and other experts say a lack of broadband internet, longer trips to the doctor’s office, and poorer health outcomes exacerbate COVID-19’s impact on more vulnerable populations.
The hospitals located in these areas to care for residents are struggling too.
Data released last month from the Indiana Hospital Association reveals how the pandemic has affected Indiana healthcare systems.
Indiana’s 35 critical access hospitals reported spending nearly 30 percent more than they made.
Indiana Hospital Association President, Brian Tabor, says if action isn’t taken to help these facilities, cuts and closures could be inevitable.
"If some of these small, rural hospitals or even some of our urban safety net hospitals if they start to falter, there isn’t that same level of strength [present anymore]," Tabor said.
Health systems—especially those in rural communities—are facing significant budget shortfalls.
Reform Requires More Than A Single Program
“So, individuals in these communities are also less likely to seek preventative health care,” she said. “So, I think that we as an organization, and we as a community, need to think through how we bust through barriers that make sure that individuals in these communities get the necessary health care.”
For both groups, the issues are systemic and difficult to solve.
“These are not new issues,” Wright said. “These are known issues to my organizations and other people in the public health space. It's just that these issues have been magnified by coronavirus.”
The coronavirus pandemic has magnified the hesitancy present in certain communities.
Contreras is lucky she doesn’t face some of those barriers. However, she’s still going to hold off on making appointments that aren’t completely necessary. She and her husband have avoided wellness checks and preventative screenings. She doesn’t plan to have them until there is a vaccine or proven therapy.
For Contreras, the worry is not even for herself. Like most mothers, she worries for the health and safety of her two children.
“Moms tend to think of themselves last, and I guess that’s where I am.”