key: cord-0938495-ba311p2a authors: Chang, Wen-Han title: The influences of the COVID-19 pandemic on medical service behaviors date: 2020-09-11 journal: Taiwan J Obstet Gynecol DOI: 10.1016/j.tjog.2020.09.007 sha: f8b4f9521738ed6d2e8d55475c8aa58aab5064e3 doc_id: 938495 cord_uid: ba311p2a The outbreak of the novel coronavirus (COVID-19) has greatly impacted medical services worldwide. In addition to changing the processes used by hospital medical services, it has also changed the behaviors of medical staff, resulting in a completely different appearance. Fear of being infected with COVID-19 makes patients fear entering hospitals, and hospitals must repeatedly screen patients prior to entry in order to confirm that they are not infected. Patients are then separated according to their symptoms and travel, occupation, contact and cluster histories (TOCC), which seriously affects them. In addition, hospitals have invested a lot of money into the whole visiting process and into the equipment required to prevent the spread or lessen the impact of COVID-19. There is some potential that medical staff will have too much anxiety over the risk of COVID-19 infection, despite wearing heavy protective equipment [31] [32] [33] . Lacking of medical attended caring with warmth, keeping of interpersonal social distancing measures, and wearing-no-taking-off protective equipment in necessary have resulted in the change of overall medical behaviors [34, 35] . It is possible that, even after COVID-19 is contained, pandemic prevention measures will still be carried out. This would directly cause pandemic prevented medical behaviors (such changes as wearing a mask to see a doctor, disinfecting and washing hands frequently, being continue to ask patients about their contact history, and maintaining proper social distance) to be maintained naturally. Patients may also change their behaviors in relation to seeing a doctor. For instance, patients may avoid walking around the hospital as a main activity or try to avoid going to the hospital altogether [36] . At the same time, they may instead try to inquire about relevant health issues by phone and only attempt to see a doctor in the event of a serious illness [37] . Due to complicated pandemic prevention processes, the wait time to see a doctor could increase, making the patient's stay time longer [38] . All of this would affect the overall quality of medical treatment. Indeed, COVID-19 has brought great changes to the relationships between medical staff and patients [39, 40] . J o u r n a l P r e -p r o o f However, through this change, we can make medical treatment more transparent and shift the use of medical services toward urgent and critical needs. In order to reduce the risk of exposure, almost all hospitals have set up outdoor fever-screening stations and viewing areas outside the emergency room to separate patients who are potentially infected with COVID-19 from the general patient area [41, 42] . However, the medical staff in the emergency room is still responsible for the treatment of all patients, which includes performing consultations, providing examinations, and prescribing medicine. In response to this information, emergency physician Xiao Yawen said, "It takes a lot of time to see a suspected case because the emergency doctors and nurses must immediately put down their emergency work, and then dress from head to foot (head covers, eye masks, masks, protective clothing)... to help patients, take X-rays, take tests, and finally return to the emergency department to continue their work." "In a designated emergency hospital, medical From November 2019 to June 2020, COVID-19 has caused a global pandemic during which more than 6.3 million people have been infected, and more than 360,000 people have died. This has had a profound impact on people's mental health [54] . The psychological effects of being infected with COVID-19 could seriously interfere with daily behaviors, which may also extend the negative impacts of this situation into the future, causing further complications [55] . Psychiatrists and psychologists have emphasized the need to start research on the mental stress caused by COVID-19 as soon as possible [56] [57] [58] [59] [60] . A psychiatrist published in The Lancet Psychiatry said that using smartphones helps instantly monitor the mental health of isolated patients. She also emphasized the need to develop assistance specific to different groups of people, such as children and frontline medical staff, to address the complexities involved [61, 62] . Surveys have shown that during the spread of COVID-19, suspicion, anxiety, and isolation have had a profound impact on the public [63] . Mind, a mental health charity based in England and Wales, has warned the public that they will face many difficulties in obtaining the resources they need during this pandemic situation [64] . Twenty-four top mental health experts want to be able to monitor the mental health of the public at all times in order to J o u r n a l P r e -p r o o f design effective tools and support methods as soon as possible to support people who dare not go out or who are isolating themselves at home [65] [66] [67] . Professor Rory O'Connor has pointed out that increased social isolation, loneliness, anxiety, and stress, along with a poor economy, may deprive people of their mental health and happiness [62, 68] . The literature mentions that if people do nothing, they risk an increase in anxiety and depression and are more likely to drink, use drugs, or become hooked on gambling. Such behaviors could lead to negative consequences, such as fighting with others and homelessness. The author believes that it is imperative to monitor those at risk for anxiety, depression, self-mutilation, suicide, and other mental health issues in advance in order to provide appropriate support immediately [69, 70] . Two online surveys conducted by the Academy of Medical Sciences in March present a picture of people's current mental health. One of them, conducted by the British charity MQ, studied the mental health of more than 2,100 people and discovered that they were worried about the deterioration of the support and services needed for life during the global pandemic. Additionally, it showed that the subjects of the survey were afraid of their health issues becoming worse [71] . Studies have shown that the COVID-19 pandemic will cause changes in ethnic behavior. A previous study lists several categories of people whose behaviors changed after the start of the pandemic [72, 73] . The study suggests that the pressures of the global pandemic may be different for the following groups compared to the general public: 1. Children, young people, and families (due to school closures, domestic violence, lack of free school meals, etc.) 2. Seniors and people with potential health issues (due to isolation, loneliness, bereavement, etc.) 3. People who already have mental health issues (due to loss of support services, relapses in depression or anxiety, etc.) 4. Frontline medical staff and emergency medical technicians (due to fear of infection, work pressure, etc.) 5. People with learning difficulties (due to changes in schedule and support methods) 6. Low-income people (due to work and financial instability) 7. Prisoners, homeless people, and refugees (due to social isolation) 8 . People with difficulties in social care, patients living alone, and foreign workers (due to charities being unable to meet demands because more people are relying on distributed food) J o u r n a l P r e -p r o o f The spread of COVID-19 has caused psychological fears among medical staff, which can cause the following changes in behavior: [74, 75] 1. Physicians may be more cautious when examining patients, avoiding close proximity and prolonged contact. 12. After treating a patient, disinfection of the space may be more intense, and the patients may be divided into infected and non-infected groups. In conclusion, the pandemic has had a considerable impact on the medical system, patient care, and the biomedical industry. We are likely to see more digitization of the industry, and there will be three significant changes in the future: [76, 77] 1. Changes in communication: Due to the cancellation of large gatherings, events, education, and training have been converted into online formats. Medical discussions J o u r n a l P r e -p r o o f will follow suit and be carried out online. This remote mode of acceleration will be applied everywhere in medical treatment [78] . 2. Changes in medical behavior: Due to home isolation periods, information technology (IT) departments will focus on developing remote diagnosis programs, digitalizing data to classify images, developing programs to prescribe and deliver medications, and creating payment methods for medical expenses. The establishment of relevant medical regulations and systems will be a major future focus in the health care industry [79,80]. The health care industry will work to establish a link between medical data and industrial information through the combination of online and hospital entities using mobile devices and the Internet to establish an intelligent model of medical precision, operation, and innovation [81] . 4 . Enhancement of medical support behavior: Neighboring countries will be encouraged to exchange technology with each other, since some countries may lack key technologies that would allow them to implement proper pandemic prevention protocols [82] . Exchanging and sharing technology for the good of humanity will allow countries to benefit from each other and to solve the problems they share. It is vital that more people and countries contribute to a win-win situation during this pandemic [83] . The pandemic situation caused by COVID-19 is a common topic for people worldwide. Everyone must apply the concepts of sharing information with each other and thinking about countermeasures to deal with common enemies [84] . Each participating country publishes research on COVID-19, which allows medical staff to immediately see outbreak-related information on Internet media platforms so they can learn about each other's content to jointly fight the spread of the virus. Due to the sharing between different societies, a large amount of new coronavirus information is presented every day, which enables considerable changes to medical approaches related to COVID-19. A lot of affirmation is given to the success of individual countries' pandemic prevention research, and successful results is also provided through various channels to countries with severe outbreaks [85] . These sharing behaviors have had the greatest overall effect on pandemic prevention. Countries around the world are realizing at this time that COVID-19 is a common problem, and everyone needs to work together to stop the spread of the virus. Any country that fails to adopt prevention measures will cause crises and disasters in the world [86] . Although it is too early to see what the impact will be, it is already very difficult for many public welfare organizations to obtain the support they need. The development of the pandemic has reduced the behavior of many public welfare organizations and has also caused many people who rely on public welfare organizations to lose access to needed resources, resulting in increased difficulties in life [87] . Paul Farmer, the CEO of Mind, mentioned that some people are no longer able to get mental health services from the NHS, and appointments with children's and adolescents' mental health services and psychotherapy have been forced to cancel. "Governments and service organizations need to know not only how to support others correctly but also what the long-term impact will be to help people rebuild their lives." [88, 89] The longer someone does not receive treatment and support, the more stressful life can become for that person, leading to a decrease in quality of life. If the pandemic continues without improvement, the expected result will eventually be self-harm and suicide attempt for these vulnerable groups [90] [91] [92] . solve the problem of inconsistent information processing. This will help reduce the abuse of emergency resources due to fear of infection and reduce the chance of cluster infections in the emergency room. Through the function of AI, instant information can be obtained, and various rumors and false information can be refuted immediately to avoid panic and irrational behavior caused by people's fear, which often leads to the hoarding of important resources and even ethnic antagonism and hatred. In addition, the real role of digital medicine has always been to reduce people's workload. In some countries, AI may not be able to meet the needs of pandemic prevention, but in terms of log-in data identification and tracking, it helps pandemic investigation very much. Due to the use of health insurance cards in Taiwan, there is automatic tracking of all travel contact history, which can also be used as a basis for communities to receive materials, such as masks [102] . In the 21st century, people's work has been greatly increased, but infectious diseases such as COVID-19 have increased social distance, decreased contact frequency between people, and changed people's consumption behaviors. Even after the pandemic, people will not return to J o u r n a l P r e -p r o o f their original behaviors [103] . COVID-19 has indeed changed the behavior modes of human interactions with the surrounding environment, resulting in new behaviors toward things such as on-line learning [104, 105] . Taiwan's medical experience shows that cross infection in hospitals is often caused by the flow of manpower between different units, so if we consider this flow of manpower and use more robots and smart beds, it will effectively reduce cross infection [106, 107] . COVID-19 is a highly infectious disease that challenges the human response to its diffusion ability. Taking the point of view of medical behaviors into consideration, we can set strict pandemic prevention protocols to avoid the spread of COVID-19 and cultivate good pandemic prevention behaviors. We should pay attention to the differences between COVID-19 and past diseases, especially in order to clearly evaluate its impact and to develop good pandemic prevention habits. To establish a complete pandemic prevention management system, formulate good pandemic prevention policies, popularize the telemedicine license system, and maintain the safety of vulnerable groups in society, we should make preparations in advance while considering what may continue to occur in the future. In the face of severe pandemic situations, whether it is the handling of pandemic information or the sharing of human resources, joint efforts integrated, the pursuit of win-win behavior, and global health diplomacy will be the primary reasons we concern this pandemic from spreading. Some of the cited part in this article from web-sites has not been peer-reviewed; it cannot replace the expert's clinical judgment, nor has it examined the credibility of its cited source in detail. The authors have no conflicts of interest relevant to this article. 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