High percentages of Vermonters agree with the social distancing measures put in place by the state in response to the coronavirus pandemic and have complied with them, according to a new survey. But their attitudes and actions, while protecting their health, have come at a significant economic cost, especially for low income Vermonters, one of several ways in which poorer Vermonters have been disproportionately affected by the pandemic.
Vermonters overwhelmingly supported the state's social distancing guidelines, according to the survey, conducted by faculty in the University of Vermont's Larner College of Medicine between April 30 and May 13. Nearly 90% strongly agreed or agreed with the current approaches to social distancing, from closing schools (91%) to closing bars and restaurants (91%) to limiting mobility outside the home (93%) to forbidding mass gatherings (95.4%) to being required to wear a mask outside the home (85%).
While the positive attitudes translated to significantly fewer contacts overall, the survey showed, not all groups benefited equally.
Those living in apartments and mobile homes and at the lower end of the income scale had more contact with other adults, seniors and children after the lockdown than those living in single family homes and condos and higher income Vermonters, who could often work from home.
"For the less well-off and especially those on the margins, the pandemic presented much more of a health risk than for more affluent Vermonters," said Eline van den Broek-Altenburg, an assistant professor and vice chair for Population Health Science in the Department of Radiology at the Larner College of Medicine's and the survey's principal investigator.
Heavy Economic Toll
The social distancing measures played a role Vermont's comparatively low infection rate but took a heavy economic toll, the survey found. Ten percent of Vermonters lost their jobs, and 28% saw their income reduced after social distancing guidelines were put in place. Sixteen percent of respondents were concerned about their ability to pay for basic necessities like food and rent, 19% used savings to cover monthly spending, and 10% said they had reduced ability to buy fresh fruit and vegetables.
As with social distancing, the economic impact was not felt equally, van den Broek-Altenburg said.
"Lower income Vermonters are being hit disproportionately," she said. "That's largely because those in higher income groups tend to have jobs where they can tele-work from home. That's not an option for most low-income workers, so many lost their jobs and their income."
Lower Income Vermonters More Likely to Defer Medical Care
The survey also asked respondents if they deferred medical care during the pandemic.
Nearly half the population deferred care, according the survey, and nearly one-third were concerned about the consequent health impacts. The mostly commonly deferred areas of care were dental services (27%) and primary care (23%).
Reasons given for deferring care included having a newly developed problem that could be treated later to the care being preventative to the health issue being ongoing. But income level and job loss were also strongly correlated with those deferring all kinds of care, said van den Broek-Altenburg.
"Those in disadvantaged populations are also being hit harder when it comes to necessarily healthcare needs or chronic conditions," she said.
Telemedicine may provide a solution for some.
The survey found that, while those who were deferring care were less likely to use telemedicine than those who were not, older respondents were more likely to use the service, as were those with chronic conditions. Those who deferred mental health services were also significantly more likely to use telemedicine.
Light Impact in Vermont Largely Due to Population Density
The Vermont survey was done in conjunction with similar surveys in Italy, the United Kingdom, France and China, and in other states.
The comparative data make clear that the pandemic's relatively light impact in Vermont has less to do with state residents' compliance with social distancing guidelines, although their behaviors helped, than with population density.
China's Hubei Province, where the pandemic's epicenter, Wuhan, is located, has 310 people per square mile; Italy has an average of 201 people per square; Vermont has just 26 and Burlington 98.
The key takeaway from the survey, van den Broek-Altenburg said, is that Vermonters have been affected disproportionately the pandemic across the board.
"In the future we need policies that are differentiated and much more targeted towards particular age groups, particularly income groups and particular professions," she said. "There is no one-size-fits-all solution."
The survey sample is a representative group drawn from primary care patients in the University of Vermont Medical Center's Vermont hospital service area. Researchers used census data to weight the sample so it was representative of the Vermont population.
The study's authors, in addition to van den Broek-Altenburg, include Adam Atherly, director of the Health Services Research Center and professor of medicine; Jan Carney, associate dean for public health and health policy and senior advisor to the dean; Victoria Hart, an assistant professor of public health; and Kelsey Gleason, assistant professor of public health. All work in UVM's Larner College of Medicine.
They authors are currently recruiting participants for a follow-up study that includes a serologic (antibody) test and PCR (swab/nasal) test from the survey population. By linking testing data to the survey results they will be able to draw better conclusions about factors affecting the spread of the disease as well as the underlying prevalence in the population and the hospitalization rate - all important data inputs for predictive modelling.
The survey authors also invite other researchers to access the extensive data they gathered for the survey for their own analysis.