Running Head: ACCESS TO MEDICAL CARE DURING PANDEMIC 1

Access to Medical Care during Pandemics.

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Access to Medical Care during Pandemic

From generation to generation, numerous disease outbreaks have been characterized as

pandemics due to their high rate of infection. Typically a disease is referred to as a pandemic

when it simultaneously spreads significantly and continuously across many nations. Pandemics

are more probable when a virus is fresh new, readily infects individuals, and spreads quickly and

sustainably from person to person, for instance, the swine flu, Covid 19n, SARs, and HIV

&AIDs. During pandemics, the strain is normally felt in the medical sector, significantly

affecting access to medical care. Therefore nations globally focus on facilitating access to

medical care. Enhancing access entails assisting individual ls in commanding convenient

healthcare services to maintain or enhance their well-being. Access is a complicated topic that

requires examination in at least four areas. Assuming facilities are accessible and in sufficient

quantity, people will be able to receive health care, and a population will be capable 'gain access

to services. The degree where a society 'gains access' to amenities is also influenced by financial,

organizational, social, and cultural obstacles. As a result, acceptability of services, physical

accessibility, and the cost, and not only the adequacy of supply, determine access assessed in

terms of utilization. If the public is to 'get access to acceptable health outcomes,' the services

provided must be appropriate and useful. The accessibility of services and obstacles to access

must be evaluated in the context of different groups' views, health needs, and social and socio-

economic contexts. Accessibility may be analyzed in terms of service availability, use, or results.

Equity must be considered on both a horizontal and vertical level. Therefore, access to medical

facilities during pandemics is critical and can be analyzed using the response in hospital

personnel in terms of self-protection to enhance patient care, a technique adopted to improve

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access of medication in case of infectious pandemic and the impact of the pandemic to health

facilities.

Frontline workers usually do their best to ensure medical access to every person in

society. However, access to this medical care depends on the safety of the health practitioners.

When the primary caregivers lack appropriate protective gear creates a hindrance to access to

medical care. Nonetheless, SARS-COV-2 is an infectious disease, and it requires more self-

safety than droplet containment. The lack of personal protective equipment (PPE) needed for

respiratory infection control and safe examination and testing of patients with COVID-19

remains an obstacle to providing effective treatment for COVID-19 patients. The industrial base

for personal protective equipment (PPE) was insufficient to meet domestic and global demand

during the current pandemic, with primarily overseas suppliers accused of unequal pricing and

distribution incidences, abandoning first responders and local healthcare providers who had to

work without safety gears, putting them at higher risk for infection (Al Ghafri et al. 2020).

Primary health professionals seldom provide pPEs with the necessary level of protection – high-

grade N-96 mask and safety clothing - furthermore, they are uncertain about having kept the gear

for a majority of medical seekers. The medical centers also lacked poor personal protective

equipment (PPE) for screening the people in the society, requiring them to refer patients to the

primary care clinics for therapy and testing instructions, which overloaded doctors. In addition,

health institutions stored resources for patients admitted and anticipated an increase in intakes as

community diseases spread. Due to a shortage of resources, access to healthcare was severely

hampered during the SARs epidemic in 2002-2004. The scarcity of healthcare resources was a

major barrier to medical access, limiting access to treatments and increasing the likelihood of

poor health outcomes, for instance, physician shortages. As a result of the shortages, patients
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have to wait longer and get delayed treatment. Many health treatments are more easily accessible

in regions where individuals are registered for health insurance; however, the type and location

of insurance also matters. For instance, Medicaid patients usually struggle with treatment when

they reside in areas where few physicians are taking Medicaid because of the long waiting period

before payments.

Nevertheless, the Centers for Disease Control (CDC) published five modifications to

provider advice on requesting COVID-19 lab tests from March to May, culminating in the most

recent consolidated guidance. In addition to testing recommendations, the CDC revised its

guidelines on testing criteria and priority. Even though healthcare professionals intended to test

patients, most towns did not have enough test kits for symptomatic individuals. Limited

availability for nasal swab equipment towards the beginning of May  2020 required updated

procedures to highlight the test to validate the diagnosis of COVID-19 for individuals

hospitalized. Therefore the CDC instructed institutions to prioritize examining and performing

lab tests on patients that are already hospitalized instead of on the symptomatic ones. Such

directive affected access to medical care in terms of laboratory examination.

When combined, experiences from health workers with getting PPE and changing

guidance on reusing EPIs and information on COVID testing options indicate the continuing

need for a squad with the skills and knowledge to address the actualities of care in an urgent

situation in the society and the importance of doing so. Such includes distribution networks and

the ability to transmit new information and innovations to suppliers to respond to laboratory

trials, environmental safety, and pandemic treatment.

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However, a lack of PPE for examining patients hampered the examination of patients;

primary care clinicians also faced an upsurge of disease spread, with one case causing 3.4 (1.5–

6.6) more cases on average. Outpatient providers were rightly worried for their safety, given the

levels of infection rates and restricted access to PPE, and they needed to develop new methods of

serving and treating their clients. Accelerating telemedicine in hospitals was one of the

emergency plans possible if the equipment was built and training was finished; doctors and staff

were assigned to places that allowed those at the least probability of infections to provide direct

patient care. In other instances, crucial sign examination and screening were relocated from the

clinic to the home visits or driveway/ garage.

White patients in the adolescents were significantly more likely to need more care hours

than ethnic minorities. These groups are likely to have been negatively affected by the lockdown

limitations' uncertain socio-economic environment, characterized by income loss, insecure

housing, heightened psychological suffering, and decreased community support. It covers

residential healthcare and social requirements, which may help identify additional needs during

pandemics that induce lockdowns. In addition, ethnic minorities are overrepresented among

important employees. Increased hours of labor, atypical work settings, tighter job-related

restrictions, and more contact of COVID-19 may have been required to fulfill the care

requirements of their communities, increasing mental and physical stress.

Numerous financially disadvantaged people encountered additional obstacles to obtaining

treatment due to the lack of primary care providers. An essential element of economic

development and progress is investing in human capital. Education and healthy living are both

important components of human capital. Meanwhile, the education and health sectors enhance

the value of human capital. When death rates are high, particularly among young people, returns
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on human capital expenditures are substantially reduced. Other people's health needs may also be

neglected if the expenses of treating AIDS patients continue to rise. When limited resources are

redistributed, it may affect everyone's health and slow down the economy's development.

HIV/AIDS medication has become more expensive, reducing the money available to treat other

illnesses.

Furthermore, During the COVID pandemic, clinicians reported barriers

and frustrations related to virtual office activities, voice mails referring patients to emergency

care and public health providers, and automated push notifications. Media outlets and health

agencies were telling the public to contact their doctor or clinic for guidance at the time. The

majority of patient appointments were deferred to phone screenings and web-based telehealth

sessions during this time. Many patients were advised to access telehealth visits in addition to

receiving guidance over the phone.

Despite this, adjustments in how health care is provided during this pandemic are

necessary to limit staff exposure to sick people, maintain PPE, and reduce the probability of

patient surges on institutions' infrastructure. Healthcare organizations had to alter how they

diagnosed, assessed, and cared for clients using methods that did not rely on personal services.

The utilization of telehealth amenities allows healthcare professionals and patients to get the

treatment they need while reducing the risk of infection of SARS-CoV-2, the pathogen which

leads to COVID-19.

The technology of telehealth and its usage is not new, but its broad acceptance by

healthcare professionals and patients beyond basic telephone communication has been rather

sluggish to come along. There was an upsurge in interest in using telehealth services even before
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the COVID-19 epidemic. As a result of recent policy reforms made during the COVID-19

epidemic, obstacles to telehealth access have been removed (Koonin et al. 2020). A variety of

professional medical organizations support telemedicine services, guiding how to offer

healthcare in this constantly changing world. Telehealth may also assist people in attaining

improved health outcomes. Because TV services may contribute to efforts to alleviate public

health in this pandemic by promoting social distance, access to medical services through TV

facilities has been increasingly prevalent during deadly pandemics, such as covid19. These

services may reduce the risk of infection for both Health care professionals and patients. In

addition, healthcare professionals may utilize less personal protective equipment (PPE) as a

result.

Furthermore, feasible, preventative, chronic, or regular treatment should be provided

promptly to avoid further harmful effects. Telemedicine may improve involvement among

medically or socially disadvantaged individuals or those without easy access to healthcare

professionals. Whenever an individual visit is not feasible and viable, non-physical access may

help to preserve the relationship between the patient and the physician.

To be helpful, the individual must have Wi-Fi and Access to telehealth technologies.

Telehealth is well adapted to meet the health care needs of those affected by a pandemic. As long

as the geographical location is intact and doctors are available to visit patients, telehealth may

provide care. State and federal policy reforms have only temporarily helped payment and

regulatory frameworks, state licensing, hospital credentialing, and program implementation for

telehealth at present. Healthcare organizations and medical groups that ventured into

telemedicine after COVID-19 are well equipped to guarantee that patients get the treatment they
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need in an emergency. Private and public insurance coverage must also be changed to encourage

the growth of telemedicine.

Individuals with limited access to treatment sought regular care for minor issues,

COVID-19 care, and real emergency care at the emergency room. While caring for non-

emergency patients, emergency rooms may become overloaded and divert resources away from

the treatment of critically sick patients.

Persons with chronic diseases were susceptible even before the COVID-19 shutdown and

needed greater access to medical care and support from care service relatives, care providers, and

acquaintances. The pandemic brought about significant changes in healthcare (with a change in

priority to COVID-19 victims) and social dynamics (instigated by restricted, unstable housing,

remuneration, changes to work patterns, and restricted movement). According to Ng et al. (2020)

people with chronic diseases had a high probability of their medical visits rescheduled during the

epidemic, possibly depriving them of necessary medical treatment. Such Individuals were also

significantly more likely to need additional hours of care. According to reports, about half of the

affected victims fulfilled their treatment hours, implying that a substantial number were denied

necessary treatment. After adjusting for protective letters and prior care hours, the results were

consistent, demonstrating their profound ties to the outcomes. Overall, individuals with chronic

diseases took a double whammy that may have long-term consequences for their well-being and

health. For those with numerous comorbidities, the unfavorable consequences were much more

apparent.

The incapacity to do extensive testing and monitoring, which health departments often

perform effectively with other illnesses such as sexually transmitted infections, TB, and food-

borne diseases, significantly impaired healthcare facilities. Once state health authorities
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recognized they wouldn't be able to handle the large number of individuals infected with

COVID-19, they advised social distance, along with the advice that anyone with cough and

fever remain at residence for fourteen days. Instead, health agencies with insufficient personnel

for contact tracing produced and distributed talking points to the public, instructing people on

how to determine whether they had been infected with the virus.

During an acute health crisis, healthcare providers and primary care clinics often

collaborate to inform, train, and create more awareness of health professionals and create new

policies and strategies and guarantee a competent staff. When treating viral infections, primary

care practices, look to the health department for contact tracing, support, and detailed

recommendations similar to what happened in 2001 when the state health department efficiently

and quickly devised a strategy to care for the public after many postmen died of anthrax.

Nevertheless, it is not unusual for these well-thought-out initiatives to be put away after a few

years. Although emergency programs are not inherently forgotten, the perceived value of

significant results diminishes in the lack of renewal education and contingency plan execution

exercises.

Additionally, insufficient health insurance during pandemics is one of the major barriers

to access to healthcare, and unequal distribution of insurance contributes to medical disparities.

Uninsured and insured persons are prevailing in medical debt and may lead to delays or neglect

of necessary care, for instance, dental care, doctor appointments, HIV and Covid19 check-ups

and medicines. Individuals with lesser incomes are often uninsured, and they make up for more

than half of the population without health insurance. For patients suffering from the severe

symptoms of the coronavirus, for example, we're inclined to delay treatment owing to the

expensive expense of oxygen ventilators, resulting in a significant patient fatality.

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The lack of equal distribution of health insurance may harm an individual's health.

Persons who are not insured have a reduced chance of getting chronic preventive treatment,

including heart disease, cancer, HIV & AIDS, diabetes, SARS, and COVID19 (Alcalá, Roby,

Grande, McKenna & Ortega, 2018). Adolescents lacking health insurance are unlikely to be

treated properly for diseases such as asthma and important preventive services such as dental

care, immunization, and child care that monitor physical development.

Different day-to-day objectives and variations in how doctors and public health officials

evaluate individual patients and handle large-scale community needs are difficulties in

maintaining a strong and prepared health system. Physicians are educated to concentrate on the

health of people and to treat them one at a time. Their offices are prepared to listen to a single

patient's and family's concerns, conduct physical exams, perform or guarantee that tests for

health screening are performed, and offer treatment suggestions. Officials from the health

department are concentrating on the community at large and other appealing public health

projects.

Several variables influence a community-based physician's capacity to offer up-to-date

treatment for patients. These include sufficient clinical and support personnel, suitable

equipment and supplies, patient education materials, and ensuring that their patients get

appropriate, timely treatment. Understanding the public health need and transferring it into their

practice environment is critical for a community-based primary care physician's capacity to adapt

to a pandemic scenario. Such may include reorganizing office procedures, training employees,

buying new equipment, and implementing new care algorithms. It may be difficult to maintain

regular medical office operations during these periods, and it can jeopardize access to treatment

when it is most needed.

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Public health departments aim to prevent epidemics and the spread of illness, help

communities recover, prevent injuries, protect the public against hazards and injuries, protect

against environmental dangers, promote and encourage healthy behavior, react against disasters,

and ensure the quality and affordability of health care.

State public health agencies and municipal health departments get money from various

sources, depending on the state and locality. Local governing bodies, such as community boards

of directors, county commissioners, and others, usually manage funding and support for local

public health departments, which are affected by other non-health objectives and the state and

local economy. Before COVID-19, these community members who are juggling many demands

may not have realized the significance of investing in the ability to react to an epidemic or other

public health disaster.

An incident like COVID-19 tests and strains the connection and support between the

health department and those caring for patients. Spending time together and working on an

emergency response plan may build mutual trust and knowledge of partner capabilities.

Organizational preparedness, defined as the connection between people, processes, and systems

that provides the foundation for a strong resolve, is best developed immediately after an incident,

but it must also be developed during a period when everything is running well (Wasserman et al

2019). Members must think about a problem, be dedicated to change, and have faith in their

group's capacity to make it happen. Completing tasks, overcoming obstacles, and having enough

resources are essential, committed to objective, cooperative conduct, and perseverance. Leaders

must communicate consistently and maintain a multilevel, complicated structure.

It's critical that all stakeholders attend the planning session. Stakeholders must be present

at the table and must represent all impacted groups in the community. Medical representatives
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must be informed about physician practice operations and have the respect of their peers.

Emergency planning also requires knowledge of other stakeholders and their capacities and the

linkages of other health and social care organizations. Furthermore, member attrition, especially

leadership changes, should be tracked yearly to fill vacancies with the best candidate for the job.

All factors must be identified and handled when developing a plan of this scale, and the

specifics must be recorded for future memory, reflection, planning, and execution. Following the

creation of the plan, the procurement of supplies, and the understanding of responsibilities, it is

critical to monitor all aspects of the plan and its capacity to function in anticipation of another

public health crisis.

Inadequate financing will remain to be an obstacle to putting in place a comprehensive

emergency strategy. COVID-19 has shown us that to respond to public health crises; we need

good preparation, sufficient funding, and responsibility from all stakeholders. A complete cost-

benefit analysis must be conducted, including expenses related to loss of life and long-term

expenditures connected with chronic diseases and disabilities caused by infection. Finally,

players must collaborate to develop a compelling voice and advocate for the significance and

advantages of pandemic preparation.

conclusion

Pandemics may span for many years since they are characterized by numerous waves.

Given the possibility of a fourth wave, public health agencies must take national actions to

enhance medical care and treatment access. Furthermore, health disorders within the first wave

are anticipated to increase late-stage diseases such as cancer that further stress the health system.

The issue confronting public health authorities is to encourage access to health care for

disadvantaged populations while at the same time minimizing the exposure of infections. States
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without a free health system in which people depend on purchased insurance, like the USA, are

even worse

During pandemics, access to medical care has been mainly characterized by a shortage of

required resources that enable immediate control of the spread of the diseases. Lack of required

PPEs led the medical practitioners to lose control of the Covid19 pandemic, making access to

medical facilities a nightmare. Furthermore, due to the high patient admission rate, the healthcare

facilities were overcrowded, which hindered access to medical care by other patients suffering

from other medical conditions. The health sector opted for appropriate measures to reduce the

numbers, thus initiating the social distancing and stay home initiative. The initiative led to high

casualties, especially in patients with vulnerable conditions who could not access specialized

medical care since most facilities were utilized in caring for the Covid19 and HIV & AIDS

positive patients. The health care sector opted for patients to access healthcare through telehealth

and telemedication since it reduces contact between the patients and health care practitioners.

However, access to medication through mobile devices had numerous critics since it only

favored the rich and people with Access to WIFI networks. Although, currently, most nations are

evolving towards telehealth because, since its enrolment, the congestion in medical facilities has

dropped by a significant percent. For years, access to medical facilities has been shaky due to

less planning and poor preparation. Nations and institutions should focus on investing in

healthcare and providing enough facilities to ensure that access to medical facilities is not

affected in case of a pandemic, thus increasing the odds of controlling an outbreak before it

spreads and destroys many people.

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References.

Alcalá, H. E., Roby, D. H., Grande, D. T., McKenna, R. M., & Ortega, A. N. (2018). Insurance

type and access to health care providers and appointments under the Affordable Care

Act. Medical care, 56(2), 186-192.

Wasserman, J., Palmer, R. C., Gomez, M. M., Berzon, R., Ibrahim, S. A., & Ayanian, J. Z.

(2019). Advancing health services research to eliminate health care disparities. American

journal of public health, 109(S1), S64-S69.

Ng, K. Y. Y., Zhou, S., Tan, S. H., Ishak, N. D. B., Goh, Z. Z. S., Chua, Z. Y., ... & Ngeow, J.

(2020). Understanding the psychological impact of COVID-19 pandemic on patients with

cancer, their caregivers, and health care workers in Singapore. JCO global oncology, 6,

1494-1509.

Al Ghafri, T., Al Ajmi, F., Anwar, H., Al Balushi, L., Al Balushi, Z., Al Fahdi, F., ... & Gibson,

E. (2020). The Experiences and Perceptions of Health-Care Workers During the COVID-

19 Pandemic in Muscat, Oman: A Qualitative Study. Journal of primary care &

community health, 11, 2150132720967514.

Koonin, L. M., Hoots, B., Tsang, C. A., Leroy, Z., Farris, K., Jolly, B., ... & Harris, A. M.

(2020). Trends in the use of telehealth during the emergence of the COVID-19 pandemic

—United States, January–March 2020. Morbidity and Mortality Weekly Report, 69(43),

1595.