Purpose
TO assess perceptions and implications of COVID-19 infection across the spectrum of individuals with visually impairment (VI) and those with normal sight.
Design
Prospective cross-sectional comparative study.
Methods
Setting: institutional. Patients: 232 patients and their caregivers. Four groups were created based on better eye characteristics: blind (best-corrected distance visual acuity [BCDVA] <3/60 or visual field <10 central degrees); severe VI (BCDVA ≤3/60 to <6/60; vertical cup-to-disc ratio ≥0.85 or neuroretinal rim width ≤0.1); moderate VI (BCDVA ≤6/60 to <6/18); or no or mild VI (controls: BCDVA ≥6/18) based on International Classification of Diseases-10 criteria and Foster and Quigley’s consensus definition of glaucoma. Procedure: telephone questionnaires. Main outcome measures: differences in perceptions and implications of COVID-19 infection across various levels of VI. Caregiver perceptions were a secondary outcome measure.
Results
Surveys were completed by 232 participants, with 58 participants in each VI group. Mean age was 58.9 ± 13.2 years old. Greater degrees of VI were associated with older age ( P = .008) and lower education level ( P = .046). Blind participants more commonly perceived vision as a risk factor for contracting COVID-19 ( P = .045), were concerned about access to health care ( P <.001), obtained news through word of mouth ( P <.001), and less commonly wore masks ( P = .003). Controls more commonly performed frequent handwashing ( P = .001), were aware of telemedicine ( P = .029), and had fewer concerns about social interactions ( P = .020) than groups with substantial VI. All caregivers reported more frequent patient care since the COVID-19 pandemic began.
Conclusions
The pandemic might have had a disproportionate impact on the visually impaired, and evidence-based assessments of COVID-19 health outcomes in this population are warranted.
C CORONAVIRUS disease 2019 (COVID-19) was declared a pandemic by the World Health Organization on March 11, 2020. The disease and its consequent shutdown brought various challenges to patients with visual impairment (VI) who were seeking eye care either electively or on an emergent basis. Analysis revealed that ophthalmology lost more patient volume than any other specialty during the acute phase of COVID-19 infection in the United States and possibly worldwide. In India, as in most countries across the world, travel restrictions were in place, private eye clinics were closed, and multispecialty hospitals focused all efforts on the overwhelming numbers of COVID-19 patients. Although all nonurgent cases were cancelled, a few specialized eye hospitals remained open to serve patients with urgent problems, including the Aravind Eye Care System (AECS), Pondicherry, a multispecialty tertiary eye care center serving 550,000 outpatients per year at the base hospital and 12 primary eye care centers (Vision Centers).
Studies evaluating an increased risk of contracting COVID-19 infection or worse outcomes in the setting of VI have not been performed. However, the presence of comorbidities such as hypertension, diabetes, chronic cardiac, pulmonary, or renal diseases, autoimmune disease, cancer, and tuberculosis have been associated with poor COVID-19 prognoses. Additionally, a decline in emergency department visits for conditions other than COVID-19 disease has been associated with higher morbidity and mortality rates due to other causes. , Individuals with VI face certain disadvantages that may make them vulnerable to worse health outcomes. An unpublished survey of more than 1,900 individuals from the United States with VI revealed concerns regarding safety of public transit and taxis and access to health care, groceries, and other key essentials. Additionally, concomitant disabilities were reported in 40% of individuals with VI, and 60% of individuals with VI stated that they felt particularly vulnerable if exposed to COVID-19 infection.
Currently, there is no evidence regarding differences in the perceptions of COVID-19 between VI individuals and those with normal vision. The present study aimed to assess the perceptions and implications of the COVID-19 pandemic in patients and their caregivers across the spectrum of VI. These perceptions included knowledge of COVID-19 infection, experience with COVID-19 infection, preventive measures undertaken, perceptions of VI affecting COVID-19 outcomes, delivery of eye care and associated obstacles, general physical and mental health, and caregiver perceptions.
METHODS
This prospective cross-sectional comparative study was performed using telephone surveys from July 20, 2020, to August 15, 2020. Institutional review board approval was obtained at AECS-Pondicherry, and research adhered to the tenets of the Declaration of Helsinki. The medical records database was used to obtain demographic data, ophthalmic findings, diagnoses, best-corrected distance visual acuity (BCDVA), and the telephone numbers of patients who presented to AECS-Pondicherry between July 2019 and February 2020. During their in-person visit to AECS prior to the onset of the pandemic, all participants underwent a complete ophthalmic examination including BCDVA, slit lamp biomicroscopy, gonioscopy, a fundus examination, and if able, visual field examination and optical coherence tomography imaging. Patients were consecutively recruited from the database based on their registration date (starting July, 2019), until the planned sample size was achieved.
Inclusion criteria included status as an established patient >18 years old, active telephone number, fluency in the regional language (Tamil), and willingness to participate. Exclusion criteria included incisional surgery or laser procedures performed elsewhere after their most recent visit to AECS, presence of neurocognitive disorders, and status as a health care worker, as this group might have been more familiar with COVID-19 infection. We also interviewed caregivers whom the patients identified as being responsible for their basic needs. Patients were divided into 4 groups based on the degree of their VI in the better eye, as shown in Table 1 . , Those with moderate VI, severe VI, or blindness were considered case groups, whereas those with mild or no VI were controls. Furthermore, VI was classified as either reversible or irreversible based on diagnosis. For example, cataract, pterygium, and keratitis were classified as reversible, whereas proliferative diabetic retinopathy, glaucoma, and retinitis pigmentosa were classified as irreversible. In patients with multiple diagnoses, the diagnosis with the more advanced disease state (presumably responsible for greater VI) was considered primary.
| Visual Impairment Category | Classification Type | Definition |
|---|---|---|
| Blind | International Classification of Diseases-10 13 | BCDVA worse than 3/60 or a visual field < 10 degree in radius around central fixation in the better eye |
| Severe Visual Impairment (fulfilled either of the following criteria) | International Classification of Diseases-10 13 | BCDVA worse than 6/60 but better than or equal to 3/60 in the better eye |
| Foster and Quigley Criteria – Advanced Disc Damage 14 | Vertical CDR or CDR asymmetry greater than or equal to 99.5 th percentile (CDR 0.85) in normal population; neuroretinal rim width reduced to ≤ 0.1 of CDR | |
| Moderate Visual Impairment | International Classification of Diseases-10 13 | BCDVA worse than 6/18 but better than or equal to 6/60 in the better eye |
| No / Mild Visual Impairment (controls) | International Classification of Diseases-10 13 | BCDVA better than or equal to 6/18 in the better eye |
A pilot study was performed in July 2020 in 40 participants (10 in each category) to validate survey questions, assess feasibility, and calculate sample size. During the phone call, survey details were discussed, and participants were asked to provide oral consent. Caregivers, if available, were also free to accept or decline the survey. The validated patient survey questionnaire and the caregiver survey questionnaire were administered in Tamil by 1 of 4 experienced study coordinators.
Statistical Analysis
We performed statistical analyses using SPSS version 27.0 software (IBM Analytics, Chicago, Illinois, USA). Continuous variables were presented as mean ± SD. Proportions (%) were used to describe categorical variables. Between-group comparisons were performed using 1-way analysis of variance (ANOVA) for continuous variables (age) and χ 2 tests for categorical variables (and all other variables). Post-hoc Tukey honest significant difference tests were performed using significant P values for multiple comparisons and to uncover specific differences between groups. P values <.05 were considered significant. Estimation of sample size was performed by considering outcomes from the pilot study, which included the same surveys included in the main study. To allow for 80% power and an alpha of .05, an estimated 232 participants (58 in each group) were required to identify differences among varying levels of VI in regard to obtaining information about COVID-19 and perceptions regarding vision as a risk factor for disease contraction.
RESULTS
Characteristics of the Study Group
A total of 470 participants were eligible for the study, and contact was made with 248 households. Of this group, 10 individuals declined participation, and 6 individuals had died (cause of death was not asked). The questionnaire was completed by 232 participants, with 58 participants in each group. Baseline characteristics of survey respondents and nonrespondents are represented in Table 2 and Supplemental Table 1, respectively. Caregivers of 132 participants (56.9% of total) responded to the survey. Participation by caregivers varied across groups, and was more common among caregivers of blind participants (72.4% vs. 34.5%-60.3%, respectively; P <.001).
| Controls N = 58 | Moderate VI N = 58 | Severe VI N = 58 | Blindness N = 58 | Total N = 232 | P-value * | ||
|---|---|---|---|---|---|---|---|
| Age | 54.6 ± 11.7 a | 57.7 ± 13.2 a | 61.1 ± 12.4 b | 62.2 ± 14.3 b | 58.9 ± 13.2 | 0.008 | |
| Females (%) | 43.1 % | 46.6% | 32.8% | 37.9% | 40.1% | 0.451 | |
| Education Level | No schooling | 6 (10.3) a | 18 (31.1) a | 12 (20.7) a | 10 (17.2) a | 46 (19.8) | 0.046 |
| Elementary school | 18 (31) a | 21 (36.2) a | 27 (46.6) a | 24 (41.4) a | 90 (38.8) | ||
| Secondary or high school | 22 (37.9) a | 15 (25.9) a | 14 (24.1) a | 19 (32.8) a | 70(30.2) | ||
| Graduate or postgraduate | 12 (20.7) a | 4 (6.9) b | 5 (8.6) b | 5 (8.6) b | 26 (11.2) | ||
| Residential Setting | Urban or semi-urban | 26 (44.8) | 24 (41.4) | 20 (34.5) | 19 (32.8) | 89 (38.4) | 0.496 |
| Rural | 32 (55.2) | 34 (58.6) | 38 (65.5) | 39 (67.2) | 143 (61.6) | ||
| Diagnosis | Early cataract | 42 (72.4) a | 17 (29.3) b | 0 c | 0 c | 59 (25.4) | < 0.001 |
| Advanced cataract | 0 a | 2 (3.4) b | 15 (25.9) c | 10(17.2) b | 27 (11.6) | ||
| Refractive error | 7 (12.1) a | 0 b | 1 (1.7) b | 0 b | 8 (3.4) | ||
| Conjunctival disorder | 5 (8.6) a | 0 b | 0 b | 0 b | 5 (2.2) | ||
| Corneal disorder | 2 (3.4) a | 2 (3.4) a | 1 (1.7) a | 1 (1.70) a | 6 (2.6) | ||
| Non-proliferative diabetic retinopathy | 2 (3.4) a | 0 a | 1 (1.7) a | 0 a | 3 (1.3) | ||
| Proliferative diabetic retinopathy | 0 a | 9 (15.5) a | 7 (12.1) a | 2 (3.4) a | 18 (7.8) | ||
| Other retinal disorder ∞ | 0 a | 21 (36.2) b | 10 (17.2) c | 4 (6.9) c | 35 (15.1) | ||
| Optic neuropathy | 0 a | 5 (8.6) b | 1 (1.7) a | 0 a | 6 (2.6) | ||
| Glaucoma | 0 a | 2 (3.4) a | 22 (37.9) b | 41 (70.7) c | 65 (28.2) | ||
| Primary Diagnosis Associated WithIrreversible Vision Loss | 0 a | 37 (63.8) b | 40 (69.0) b | 47 (81.0) c | 124 (53.4) | < 0.001 | |
Older patients were commonly more visually impaired ( P = .008), controls were more likely to have a graduate degree ( P = .046). The frequency of irreversible blinding primary diagnoses varied among groups and were most common among blind participants (81.0%) and least common among controls (0%) ( P <.001). Questions and answers for the patient survey are reported in Table 3 and for the caregiver survey are reported in Table 4 .
| Controls N = 58 | Moderate VI N = 58 | Severe VI N = 58 | Blindness N = 58 | Total N = 232 | P-value * | ||
|---|---|---|---|---|---|---|---|
| Have you heard about the COVID-19 pandemic? | Yes | 57 (98.3) | 58 (100) | 58 (100) | 57 (89.3) | 230 (99.1) | 0.569 |
| How did you find out about the COVID-19 pandemic? | Word of mouth | 13 (22.4) a | 23 (39.7) b | 26 (44.8) b | 41 (70.7) c | 103 (44.4) | < 0.001 |
| TV (audio and visual) | 54 (93.1) a | 55 (94.8) a | 54 (93.1) a | 40 (69.0) b | 203 (87.5) | < 0.001 | |
| Newspaper (in print or online) | 19 (32.8) | 19 (32.8) | 10 (17.2) | 10 (17.2) | 58 (25.0) | 0.059 | |
| Social media | 9 (15.5) | 5 (8.6) | 3 (5.2) | 2 (3.4) | 19 (8.2) | 0.086 | |
| TV audio only | 0 a | 0 a | 1 (1.7) a | 4 (6.9) b | 5 (2.2) | 0.032 | |
| Have you been sick with COVID-19? | Yes | 1 (1.7) | 0 | 0 | 0 | 1 (0.4) | 0.390 |
| No | 57 (98.3) | 58 (100) | 58 (100) | 58 (100) | 231 (99.6) | ||
| I am not sure | 0 | 0 | 0 | 0 | 0 | ||
| Do you know anyone who has been sick with COVID-19? | Yes | 8 (13.8) | 4 (6.9) | 2 (3.4) | 3 (5.2) | 17 (7.3) | 0.290 |
| No | 49 (84.5) | 54 (93.1) | 55 (94.8) | 55 (94.8) | 213 (91.8) | ||
| I am not sure | 1 (1.7) | 0 | 1 (1.7) | 0 | 2 (0.9) | ||
| Have you taken any preventive measures? | Avoid leaving the home | 27 (46.6) a | 52 (89.7) b | 33 (56.9) b | 45 (77.6) c | 157 (67.7) | < 0.001 |
| Wearing a mask | 56 (96.6) a | 48 (82.8) a | 55 (94.8) a | 45 (77.6) b | 204 (87.9) | 0.003 | |
| Frequent hand washing | 49 (84.5) a | 33 (56.9) b | 42 (72.4) b | 30 (51.7) b | 154 (66.4) | 0.001 | |
| Social distancing from others | 21 (36.2) a | 3 (5.2) b | 8 (13.8) c | 8 (13.8) c | 40 (17.2) | < 0.001 | |
| Other | 13 (22.4) | 5 (8.6) | 14 (24.1) | 16 (27.6) | 48 (20.7) | 0.061 | |
| None | 0 | 0 | 0 | 0 | 0 | ||
| If not, why not? | I do not feel the virus will affect me | 1 (1.7) | 0 | 0 | 1 (1.7) | 2 (0.9) | 0.569 |
| I lack the resources | 0 | 0 | 0 | 0 | 0 | ||
| Do you feel your vision may put you at greater risk of contracting COVID-19? | Yes | 2 (3.4) a | 7 (12.1) a | 2 (3.4) a | 8 (13.8) b | 19 (8.2) | 0.045 |
| No | 54 (93.1) a | 51 (87.9) a | 56 (96.6) a | 50 (86.2) a | 211 (90.9) | ||
| Maybe | 0 a | 0 a | 0 a | 0 a | 0 | ||
| I am not sure | 2 (3.4) a | 0 a | 0 a | 0 a | 2 (0.9) | ||
| Do you feel your vision may put you at greater risk of poor outcomes if you contract COVID-19? | Yes | 2 (3.4) | 8 (13.8) | 2 (3.4) | 10 (17.2) | 22 (9.5) | 0.053 |
| No | 51 (87.9) | 48 (82.8) | 54 (93.1) | 48 (82.8) | 201 (86.6) | ||
| Maybe | 1 (1.7) | 0 | 1 (1.7) | 0 | 2 (0.9) | ||
| I am not sure | 4 (6.9) | 2 (3.4) | 1 (1.7) | 0 | 7 (3.0) | ||
| Do you feel that your eye treatment may put you at greater risk of contracting COVID-19 or suffering worse disease? | Yes | 6 (10.3) | 8 (13.8) | 8 (13.8) | 12 (20.7) | 34 (14.7) | 0.310 |
| No | 49 (84.5) | 50 (86.2) | 48 (82.8) | 45 (77.6) | 192 (82.8) | ||
| Maybe | 0 | 0 | 1 (1.7) | 1 (1.7) | 2 (0.9) | ||
| I am not sure | 3 (5.2) | 0 | 1 (1.7) | 0 | 4 (1.7) | ||
| Do you feel your vision has worsened during the pandemic? | Yes | 9 (15.5) | 8 (13.8) | 14 (24.1) | 16 (27.6) | 47 (20.3) | 0.356 |
| No | 49 (84.5) | 49 (84.5) | 43 (74.1) | 41 (70.7) | 182 (78.4) | ||
| Maybe | 0 | 0 | 1 (1.7) | 1 (1.7) | 2 (0.9) | ||
| I am not sure | 0 | 1 (1.7) | 0 | 0 | 1 (0.4) | ||
| Did you face any additional difficulties because of the lockdown? | Obtaining eye medications | 1 (1.7) | 7 (12.1) | 3 (5.2) | 3 (5.2) | 14 (6.0) | 0.123 |
| Seeing the eye doctor | 6 (10.3) a | 48 (82.8) b | 25 (43.1) c | 22 (37.9) c | 101 (43.5) | < 0.001 | |
| Undergoing an eye procedure | 4 (6.9) a | 1 (1.7) b | 12 (20.7) a | 12 (20.7) a | 29 (12.5) | 0.002 | |
| I have not faced any above difficulties | 47 (81.0) a | 8 (13.8) b | 24 (41.4) c | 24 (41.4) c | 103 (44.4) | < 0.001 | |
| If you had difficulty obtaining eye medications or seeing the eye doctor, what were some reasons for this? | Unable to travel to pharmacy or hospital | 1 (1.7) a | 10 (17.2) b | 6 (10.3) a | 1 (1.7) a | 18 (7.8) | 0.003 |
| Lack of transport due to the lockdown | 10 (17.2) a | 50 (86.2) b | 35 (60.3) c | 35 (60.3) c | 130 (56.0) | < 0.001 | |
| I did not feel it was safe to travel | 2 (3.4) | 3 (5.2) | 4 (6.9) | 8 (13.8) | 17 (7.3) | 0.153 | |
| I was too sick to travel | 0 | 1 (1.7) | 0 | 1 (1.7) | 2 (0.9) | 0.569 | |
| Financial burden of lockdown | 0 a | 0 a | 3 (5.2) b | 0 a | 3 (1.3) | 0.028 | |
| Medications were not available | 0 | 0 | 0 | 0 | 0 | ||
| Would you prefer going to a vision center rather than a base hospital? | Yes | 9 (15.5) a | 34 (58.6) b | 6 (10.3) a | 3 (5.2) c | 52 (22.4) | < 0.001 |
| Would you undergo a laser, injection, or surgical intervention during this period if advised by your eye physician? | Yes | 32 (55.2) a | 42 (72.4) b | 46 (79.3) b | 43 (74.1) b | 163 (70.3) | 0.002 |
| No | 11 (19.0) a | 15 (25.9) a | 8 (13.8) a | 6 (10.3) a | 40 (17.2) | ||
| It depends on the intervention | 10 (17.2) a | 1 (1.7) a | 2 (3.4) a | 8 (13.8) a | 21 (9.1) | ||
| I am not sure | 5 (8.6) a | 0 a | 2 (3.4) a | 1 (1.7) a | 8 (3.4) | ||
| Would you appear for regular follow up after the procedure as per medical advice? | Yes | 38 (65.5) a | 43 (74.1) a | 49 (84.5) a | 48 (82.8) a | 178 (76.7) | 0.013 |
| No | 10 (17.2) a | 14 (24.1) a | 7 (12.1) a | 6 (10.3) a | 37 (15.9) | ||
| I prefer delaying my appointments | 3 (5.2) a | 0 a | 0 a | 3 (5.2) a | 6 (2.6) | ||
| I am not sure | 7 (12.1) a | 1 (1.7) b | 2 (3.4) b | 1 (1.7) b | 11 (4.7) | ||
| If advised for frequent examinations based on your condition, how often would you be able to come? | Weekly | 5 (8.6) a | 1 (1.7) a | 3 (5.2) a | 1 (1.7) a | 10 (4.3) | < 0.001 |
| Monthly | 19 (32.8) a | 9 (15.5) b | 29 (50.0) a | 27 (46.6) a | 84 (36.2) | ||
| Exam once in 3 months | 5 (8.6) a | 20 (34.5) b | 3 (5.2) a | 3 (5.2) a | 31 (13.4) | ||
| Exam once in 6 months | 2 (3.4) a | 12 (20.7) b | 3 (5.2) a | 2 (3.4) a | 19 (8.2) | ||
| Depends on lockdown relaxation | 19 (32.8) a | 3 (5.2) b | 12 (20.7) a | 19 (32.8) a | 53 (22.8) | ||
| I am not sure | 8 (13.8) a | 13 (22.4) a | 8 (13.8) a | 6 (10.3) a | 35 (15.1) | ||
| Do you have difficulty in the following? | Seeing even when wearing glasses | 0 a | 41 (70.7) b | 8 (13.8) c | 8 (13.8) c | 57 (24.6) | < 0.001 |
| Hearing | 1 (1.7) a | 4 (6.9) a | 8 (13.8) a | 7 (12.1) a | 20 (8.6) | 0.087 | |
| Concentrating, remembering, or making decisions | 1 (1.7) a | 10 (17.2) b | 2 (3.4) a | 3 (5.2) a | 16 (6.9) | 0.004 | |
| Walking or climbing stairs | 1 (1.7) a | 13 (22.4) b | 7 (12.1) b | 10 (17.2) b | 31 (13.4) | 0.008 | |
| Dressing or bathing | 0 a | 0 a | 0 a | 6 (10.3) b | 6 (2.6) | < 0.001 | |
| Doing errands alone such as doctor visits, shopping | 0 | 2 (3.4) | 0 | 2 (3.4) | 4 (1.7) | 0.254 | |
| Do not wish to answer | 2 (3.4) | 0 | 1 (1.7) | 0 | 3 (1.3) | 0.294 | |
| I don’t have any difficulty | 53 (91.4) a | 11 (19.0) b | 37 (63.8) c | 36 (62.1) c | 137 (59.1) | < 0.001 | |
| Over the past 12 months, has a doctor or health provider told you that you have any of the following? | Diabetes | 15 (25.9) | 25 (43.1) | 25 (43.1) | 20 (34.5) | 85 (36.6) | 0.164 |
| Heart disease | 0 | 3 (5.2) | 2 (3.4) | 4 (6.9) | 10 (4.3) | 0.554 | |
| Pulmonary disorder (asthma, COPD, etc.) | 0 | 0 | 4 (6.9) | 3 (5.2) | 7 (3.0) | 0.057 | |
| Hearing impairment | 0 a | 0 a | 5 (8.6) a | 8 (13.8) b | 13 (5.6) | 0.002 | |
| Epilepsy or neurologic disease | 0 | 0 | 0 | 0 | 0 | – | |
| Arthritis | 1 (1.7) | 1 (1.7) | 5 (8.6) | 6 (10.3) | 13 (5.6) | 0.080 | |
| Are overweight or underweight | 0 | 0 | 0 | 0 | 0 | – | |
| Psychiatric disorder | 0 | 0 | 0 | 0 | 0 | – | |
| Significant physical disability | 0 | 0 | 0 | 1 (1.7) | 1 (0.4) | 0.390 | |
| Developmental or intellectual disability | 0 | 0 | 0 | 0 | 0 | – | |
| Other | 10 (17.2) | 17 (29.3) | 12 (20.7) | 17 (29.3) | 56 (24.1) | 0.311 | |
| None of the above | 36 (62.1) a | 24 (41.4) b | 23 (39.7) b | 22 (37.9) b | 105 (45.3) | 0.030 | |
| If you have an underlying health condition, do you feel your condition makes you more likely to suffer from complications if you contract COVID-19? | Yes | 7 (31.8) | 5 (14.7) | 3 (8.6) | 3 (8.3) | 18 (14.2) | 0.111 |
| No | 15 (68.2) | 28 (82.4) | 32 (91.4) | 33 (91.7) | 108 (85.0) | ||
| I am not sure | 0 | 1 (2.9) | 0 | 0 | 1 (0.8) | ||
| Do you have concerns about the following? | Transportation | 34 (58.6) a | 50 (86.2) b | 42 (72.4) c | 43 (74.1) c | 169 (72.8) | 0.011 |
| Interacting with others in a social setting | 0 a | 8 (13.8) b | 7 (12.1) b | 3 (5.2) b | 18 (7.8) | 0.020 | |
| Access to healthcare | 10 (17.2) a | 7 (12.1) b | 10 (17.2) a | 33 (56.9) c | 60 (25.9) | < 0.001 | |
| Access to food and groceries | 6 (10.3) a | 0 b | 1 (1.7) b | 0 b | 7 (3.0) | 0.002 | |
| Maintaining your job or schooling | 1 (1.7) a | 0 a | 4 (6.9) b | 0 a | 5 (2.2) | 0.032 | |
| Access to accurate information about the virus | 0 | 0 | 0 | 0 | 0 | – | |
| I am not sure | 0 | 1 (1.7) | 0 | 0 | 1 (0.4) | 0.390 | |
| I have no concerns | 21 (36.2) a | 6 (10.3) b | 15 (25.9) a | 13 (22.4) a | 55 (23.7) | 0.012 | |
| Since COVID-19 began, have you had more anxiety, fear, concern about your health? | Yes | 8 (13.8) a | 14 (24.1) b | 4 (6.9) a | 5 (8.6) a | 31 (13.4) | 0.029 |
| If you developed COVID-19 symptoms (cough, sore throat, fever), would you seek medical care? | Yes | 58 (100) | 58 (100) | 57 (98.3) | 57 (98.3) | 230 (99.1) | 0.421 |
| No | 0 | 0 | 1 (1.7) | 0 | 1 (0.4) | ||
| I am not sure | 0 | 0 | 0 | 1 (1.7) | 1 (0.4) | ||
| Have you heard of telehealth or virtual care? | Yes | 11 (19.0) a | 5 (8.6) b | 2 (3.4) b | 4 (6.9) b | 22 (9.5) | 0.029 |
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