The second wave has been a test of self-discipline and trust in others also playing their part. The hardest part of noticing a trend towards an upward swing of cases (and the inevitable deaths that sadly follow) is the knowledge that for a brief time it almost looked like the virus was under control.
The initial lockdown measures of 2020 aimed to reduce the rate of transmission, and also attempt to prevent a further additional loss of life from healthcare systems being overwhelmed by COVID-19 cases. The purpose of Behind the Mask is to better understand those systems, and the beliefs and behaviours of the people who run them and use them.
Starting with the positives, we found extremely strong agreement that the measures taken so far had been necessary (69% ‘agreed’, 44% were in ‘very strong agreement’), and 62% of people felt that ‘flattening the curve’ had protected their healthcare system. Positive sentiment was highest in the UK (74%), but lowest in the US (55%), largely due to the negative views that American patients had of the measures.
Overall, the messages to protect our healthcare systems worked…. but will they continue to have the same impact as the Northern Hemisphere moves into winter? Our research has highlighted some important challenges to preparedness, community and trust that will be critical to address in maintaining protection for healthcare systems.
Were we ready for round two?
Between May and our most recent survey, we have seen a slight overall improvement in belief that ‘care is available’. But, as discussed in more detail in “Were we ready for round two?”, not all groups recognise it.
“The dust has settled here, for now. I think we are in a better place for the next wave.”
Primary Care Physician, USA, August 2020
“That there has been and will be insufficient testing. And if there is a further wave that there are not sufficient beds available in hospitals and the supply chain breaks down.”
Patient with multiple conditions, Germany, August 2020
Only 37% of German, 28% of US, and 18% of UK respondents felt that all healthcare services were ‘completely available’. Concerningly low numbers to have entered wave two of the pandemic with, as once again our systems were forced to pivot into COVID-19 care and treatment, where frontline staff had already struggled to address the needs of patient groups in wave one.
“It has exhausted the teams. Many are fearful of dying with COVID and the second wave and susceptibility. Demand is going up, patients are exhausting medical staff with their demand. Hospital teams are overwhelmed. Care is becoming fast and not complete.”
Primary Care Physician, UK, August 2020
It’s not me, it’s them
Across surveys we found a clear pattern of spheres of control. It is apparent that those closest to the patient are most trusted as doing their part.
In fact, even in these difficult and unsettling times those surveyed were prepared to pay higher taxes or insurance to increase doctors’ (60% agreed) and nurses’ (70%) wages. However, at the same time when asked if doctors and nurses had benefited from the measures to ‘flatten the curve’ we found that views were split: those within the systems believed that they had benefitted, whereas outsiders did not recognise the curve-flattening measures as a beneficial reason to implement lockdowns (or at best were unsure). This lack of clarity in fundamental purpose poses a huge challenge as we move forward.
These challenges will lead to emerging a knock-on effects among different groups, which will take public attention away from the needs of healthcare and those who deliver it. Already prior to the second wave we found that only half of respondents believed governments were primarily concerned with protecting their healthcare system, and 60% consistently felt that people were not following appropriate social distancing measures.
48% of patients felt extremely strongly that other people will not continue social distancing measures
But the virus needs a community to spread, and so people must trust that others will do their part in stopping it.
Community infection
We now live in a world where despite the fact that 79% of patients believe the disruptive measures to date have been justified, and 89% would prioritise doing anything to stop the virus, patients still don’t feel safe in supermarkets (61%) or on public transport (84%). A view shared with Secondary Care Physicians, 30% of whom don’t feel safe in their own hospitals. At a time where infection rates are rising, worryingly 69% of doctors now anticipate that future lockdowns will be less stringent, and 67% believe that the economy will be prioritised over healthcare systems.
When it comes to maintaining economic freedom and mitigating for the socioeconomic impact of the pandemic, the actions of the public should be under great scrutiny. Two of the main defences, beyond isolation and basic hygiene measures, are wearing masks and contact tracing. In the latest Behind the Mask survey, we found that 73% of respondents did not believe those around them were wearing masks correctly. Moreover, it is not the professionals but those outside of the healthcare systems who see this most. We also saw a divide and great uncertainty as to whether contact tracing could be as effective as universal lockdown measures. While healthcare professionals tended to believe in its usefulness (56%) patients cannot see it working (68%).
The worrying part for doctors is that at a time when we need clarity of purpose and full public cooperation, as early as May people felt that poor and inconsistent information from their governments and the media had had a detrimental effect on care (55% and 62% respectively). The biggest culprit was social media, with 72% of people believing that fake stories and incorrect information had led to harm.
Where to focus trust?
As people prioritise family welfare over all else (95%) they are concentrating their actions on the things they can take personal control of. However, for the pandemic to be kept in check everyone must play their part. It is here where clear and effective communication becomes so essential. Even if people understand what the right behaviours are, if they do not believe that the majority are following them, a herd mentality bias develops which leads individuals to believe that their need to act responsibly is absolved.
The messages have been there from the start, although they have perhaps not been hitting home. Could it be that we need new spokespeople? Our data shows that those on the front line are most convincing – based on that alone, we should be finding ways to ensure it is their voices that get heard.
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