The experiences of patients ill with COVID-19-like symptoms and the role of testing for SARS-CoV-2 in supporting them: A qualitative study in eight European countries during the first wave of the pandemic

Abstract

Background

Access to testing during the first wave of the COVID-19 pandemic was limited, impacting patients with COVID-19-like symptoms. Current qualitative studies have been limited to one country or were conducted outside Europe.

Objectives

To explore - in eight European countries - the experiences of patients consulting in primary care with COVID-19-like symptoms during the first wave of the pandemic.

Methods

Sixty-six semi-structured interviews, informed by a topic guide, were conducted by telephone or in person between April and July 2020. Patients with COVID-19-like symptoms were purposively recruited in primary care sites in eight countries and sampled based on age, gender, and symptom presentation. Deductive and inductive thematic analysis techniques were used to develop a framework representing data across settings. Data adequacy was attained by collecting rich data.

Results

Seven themes were identified, which described the experiences of patients consulting. Two themes are reported in this manuscript describing the role of COVID-19 testing in this experience. Patients described significant distress due to their symptoms, especially those at higher risk of complications from COVID-19, and those with severe symptoms. Patients wanted access to testing to identify the cause of their illness and minimise the burden of managing uncertainty. Some patients testing positive for COVID-19 assumed they would be immune from future infection.

Conclusion

Patients experiencing novel and severe symptoms, particularly those with comorbidities, experienced a significant emotional and psychological burden due to concerns about COVID-19. Testing provided reassurance over health status and helped patients identify which guidance to follow. Testing positive for SARS-CoV-2 led to some patients thinking they were immune from future infection, thus influencing subsequent behaviour.

Keywords:

• Qualitative research
• SARS-CoV-2
• patients
• primary care
• testing

Acknowledgements

We want to express our gratitude to all the patients who have participated in this study for sharing their experiences and to the primary care sites for their support.

Ethical approval

Ethical approval for the whole project was granted in England, by the South Central-Berkshire Research Ethics Committee (Ref. 20/SC/0175). The seven research sites outside of the UK also obtained ethical approval or waivers from their local ethical review committees. All methods were carried out per relevant guidelines and regulations. Informed consent was obtained from all patients and where patients are under 18, informed consent was obtained from a parent and/or legal guardian.

Author contributions

MEH, MW, STC, and SA had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: STC, SA, NG, HG, CCB, AVDV. Recruitment and acquisition of data: MW, MA, FB, SC, AC, KF, MNK, CL, LM, KR, IS, PDS, AV. Interpretation of data: MEH, MW, STA, SA, MA, FB, SC, AC, KF, MNK, JK, CL, LM, KR, IS, PDS, AV. Drafting of the manuscript: MEH, MW, STC, and SA. Critical revision of the manuscript for important intellectual content: All authors.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data availability statement

The datasets generated during the current study are not publicly available as the research programme is ongoing but are available from the corresponding author upon reasonable request.

Additional information

Funding

This work is supported by RECOVER (Rapid European COVID-19 Emergency research Response), which has received funding from the EU Horizon 2020 Research and Innovation programme [grant agreement number 101003589]. The funder had no role in the writing of the manuscript or the decision to submit for publication. STC was supported by the National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance [NIHR200915] at the University of Oxford in partnership with the UK Health Security Agency (UKHSA).