We read with great interest about the work by Jiang et al, which connects our findings from a large administrative database [
[1]
] to data from a patient forum on kidney stones [[2]
]. Their study provides a plausible explanation for our findings and helps in understanding the various factors underpinning the decrease in urologic care observed across all US geographic regions in the early stages of the COVID-19 pandemic. Investigating epidemiologic phenomena using a variety of different sources, from “big data” analyses to patient reports and single-institution experiences, improves our ability to refine hypotheses, with the referenced work as a strong example.Jiang T, Osadchiy V, Weinberger JM, et al. Impact of the COVID-19 pandemic on patient preferences and decision making for symptomatic urolithiasis. J Endourol. In press. https://doi.org/10.1089/end.2020.1141.
Jiang et al have built on earlier studies looking at social media use amongst urology patients [
3
, 4
], in this case in the unique setting of the COVID-19 pandemic. Natural language analysis of user comments on Reddit, the second most visited social media website in the USA [[5]
], allowed the group to study the possible misconceptions, fears, and responses that may be magnified through such websites—a process further amplified during the early stages of the COVID-19 outbreak. Research that centers on the intersection of information engagement and modern social media platforms is key to understanding how patients explore and act on health-related data [Amazon. Alexa traffic ranks by country 2021. www.alexa.com/topsites/countries/US.
[6]
]. Again, the pandemic serves as the most prominent health care–related example of patients relying on social media for information and exploring and acting on these data on their own, which may represent a source of misinformation in spite of potential benefits [[7]
].The work by Jiang et al suggests that patient concerns and anxiety related to in-person encounters, procedures, and emergency room visits may be responsible for the decrease in urology encounter volume observed in our data, particularly given that the observations seemed to be independent of the geographic spread of the COVID-19 pandemic. While we suspect that this trend would generalize to subspecialties within urology, we would be curious to know to what extent patient anxiety was responsible for observed changes in, for example, urologic oncology, where intervention may be more imperative but symptoms less immediately impactful. Social media data may also allow us to understand the influence of rapidly expanding telemedicine on patient behavior during this time [
[8]
].Chao GF, Li KY, Zhu Z, et al. Use of telehealth by surgical specialties during the COVID-19 pandemic. JAMA Surg. In press. https://doi.org/10.1001/jamasurg.2021.0979.
Several questions remain with respect to the impact of the COVID-19 pandemic on urology. Importantly, how effective was the triage of urologic conditions? Did harm reach patients because of over- or under-triaging? Will COVID-19 cause long-lasting changes in the structure of urology practice? Data from the months and years following the early stages of the pandemic will be necessary to fully answer these and other questions. In the meantime, impactful work such as that presented here helps us to understand shortcomings and points for improvement not just for future disaster management but also for patient-centered care as a whole.
Conflicts of interest: The authors have nothing to disclose.
Acknowledgments: Jonathan E. Shoag is supported by the Frederick J. and Theresa Dow Foundation of the New York Community Trust and a Damon Runyon Cancer Research Foundation Physician Scientist Training Award. Jim C. Hu is supported by the Frederick J. and Theresa Dow Foundation of the New York Community Trust, and PCORI (CER-2019C1-15682, CER-2019C2-17372) and NCI (R01 CA241758) grants. The sponsors played no direct role in the study.
References
- Estimating the impact of COVID-19 on urology: data from a large nationwide cohort.Eur Urol Open Sci. 2021; 25: 52-56
Jiang T, Osadchiy V, Weinberger JM, et al. Impact of the COVID-19 pandemic on patient preferences and decision making for symptomatic urolithiasis. J Endourol. In press. https://doi.org/10.1089/end.2020.1141.
- Prostate cancer and social media.Nat Rev Urol. 2018; 15: 422-429https://doi.org/10.1038/s41585-018-0006-0
- ‘Fake news’ in urology: evaluating the accuracy of articles shared on social media in genitourinary malignancies.BJU Int. 2019; 124: 701-706https://doi.org/10.1111/bju.14787
Amazon. Alexa traffic ranks by country 2021. www.alexa.com/topsites/countries/US.
- Social media analytics: what you need to know as a urologist.Eur Urol Focus. 2020; 6: 434-436https://doi.org/10.1016/j.euf.2019.08.005
- What social media told us in the time of COVID-19: a scoping review.Lancet Digital Health. 2021; 3: E175-94https://doi.org/10.1016/S2589-7500(20)30315-0
Chao GF, Li KY, Zhu Z, et al. Use of telehealth by surgical specialties during the COVID-19 pandemic. JAMA Surg. In press. https://doi.org/10.1001/jamasurg.2021.0979.
Article info
Publication history
Published online: May 26, 2021
Accepted:
May 6,
2021
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- Estimating the Impact of COVID-19 on Urology: Data from a Large Nationwide CohortEuropean Urology Open ScienceVol. 25
- PreviewThe impact of the coronavirus disease 2019 (COVID-19) pandemic on urology worldwide has been the subject of frequent speculation, but population-level estimates on changes in urology care are sparsely reported. Here, we use newly released data from a large USA-based cohort to provide further insight into the impact of the pandemic on our field. For a final cohort of 900,900 patient encounters in 418 hospitals, we describe an approximately 20% decrease in urology-specific emergency room (ER) visits (19.4%, 95% confidence interval [CI] 17.4–21.5%), admissions to a urology service (19.3%, 95% CI 13.7–24.9%), and ambulatory urology surgeries (22.9%, 95% CI 13.2–32.6%) during March 2020 relative to baseline.
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- Re: Patrick Lewicki, Spyridon P. Basourakos, Bashir Al Hussein Al Awamlh, et al. Estimating the Impact of COVID-19 on Urology: Data from a Large Nationwide Cohort. Eur Urol Open Sci 2021;25:52–6: Impact of the COVID-19 Pandemic on Kidney Stones: Matching Online Discussions to Real World DataEuropean Urology Open ScienceVol. 29
- PreviewWe read with great interest the data presented by Lewicki et al [1] regarding shifts in urology care during the COVID-19 pandemic. The authors report a nearly 20% decrease in urology emergency room visits during March 2020, with an estimated 23% decrease in volume for nonobstructing stones. They note that there were no significant predictors of change in inpatient volume, even when correcting for hospital academic status, urban/rural status, or insurance makeup, perhaps suggesting that patient-specific factors related to the pandemic are driving the changes in volume observed.
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- Preview
