As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread across the world rapidly and extensively, it led to the worst pandemic of modern times, the coronavirus disease 2019 (COVID-19) pandemic.

Study: COPD and social distancing in the UK. Image Credit: Stock-Asso/Shutterstock

In an attempt to mute the spread of this highly infectious pathogen, most public health authorities insisted on people distancing themselves when outside of their own home space, restricted travel and gatherings, and closed down shops, offices, educational institutions, and other public places.

How much did ordinary people, who were at increased risk from the virus due to their medical condition, respond to these measures? A new preprint sought to answer this in part by looking at people with chronic obstructive pulmonary disease (COPD), known to be a high-risk factor for severe COVID-19.

Introduction

During the pandemic, there were a  range of official guidelines for social interaction, including a mandate to wear masks in public, limit public gatherings, and reduce contacts wherever possible. Handwashing became a social norm.

People with COPD were revealed to be at higher risk of mortality or severe illness from SARS-CoV-2 infection. This group of individuals was therefore advised to shield themselves away from the virus by restricting daily social interactions. In addition, such people themselves tended to self-isolate.

This could have increased the feeling of loneliness. In addition, earlier researchers have shown that fear was a dominant emotion during lockdowns. The pre-existing COPD added to the feeling of anxiety, as COVID-19 mainly affected the lungs in moderate to severe infections.

The current study, available as a preprint on the medRxiv* server, reports on the tendency among COPD patients in the UK to practice social distancing, compared to the public at large. The data came from weekly public surveys assessing social distancing and individual thoughts about the pandemic, including 13 pre-existing health conditions.

The questions included the readiness to use masks or other face coverings outside the home, willingness to go out, use public transport and visit stores.

Findings

The study included over 43,000 people aged 18 to 96 years. The median age was 48 years, and over half were employed full- or part-time. Less than 3% had a history of asymptomatic COVID-19, while just under half said they had none of the 13 health conditions.

The data shows that people with COPD tended to avoid gatherings of any size, avoided having guests, or going to work, avoided symptomatic people, did not go out to the stores, and wore face masks when outside the home, at higher rates than other people. They also ate alone more often, had separate bedrooms, and were more likely to clean often-touched objects like knobs and toilets, and to avoid touching public objects.

Handwashing and covering the mouth when sneezing were behaviours that were found with equal frequency in both groups.

In the spring of 2020, people were very willing to wear face coverings or masks outside, but COPD patients showed a higher level of readiness in the first part of the outbreak, over the first five months.

A significant difference was mapped over April-June 2020, but not thereafter. Interestingly, there was no difference between the groups in terms of using public transport, but COPD patients were more hesitant to visit shops during the pandemic.

The number of cases in the prior week did not, affect the level of compliance to each measure. When compensated for age (the mean age among COPD participants was 65 years compared to 48 for non-COVID-19 participants), and for the week of participation, the only significant risk factor for face mask use was COPD.

Implications

The results suggest that those with COPD were more willing to follow COVID-19 guidance and adhere to regulations than the general population for the large majority of recommended measures, especially those related to avoiding contact with other people and isolating socially.”, explained the researchers.

 A greater degree of compliance was observed among COPD vs others when infection levels rose.

Though COPD patients tended to be older than others, their medical condition also contributed significantly to their willingness to follow guidelines such as social distancing, in order to protect themselves against the infection. This was probably due to the information they received regarding their increased risk for complications with COVID-19.

The study shows how attitudes to public health restrictions vary with personal medical history, as well as over time. Further examination of why this occurs is warranted. In the current study, anxiety about infection-related complications is likely, with over half the COPD patients reporting that they avoided hospital visits during lockdowns, with over 70% switching to having others do the shopping for them during such periods, up from less than 25% before the lockdown was implemented.

The face mask compliance is surprising since many claim that masks hinder free-breathing, and since masks do less to protect the wearer than to protect others.

Overall, the study shows that,

 Those with COPD pursued greater self distancing measures, even before evidence that they were at greater risk of COVID-19 became available. Guidance provided by clinicians could well influence patient behaviors and have a positive effect on efforts to reinforce cautious behaviors.”

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.