As the first wave of COVID-19 subsides across most of Europe, many will breathe a sigh of relief. Yet, for health services, the battle to convince the public to access healthcare is only just beginning.

During the pandemic, the public were encouraged not to use health services unless they absolutely needed to and, across Europe, this message hit home: people were scared of the risk of infection and anxious not to overburden services that they were warned were on the brink of collapse.

Attention is now turning to ‘restarting’ routine health services but these attitudes endure. There is a risk that they could cause a second wave of COVID-related harm, this time related not to the virus itself, but to the changes in behaviour it has engendered.

This lingering fear is revealed in polling for Incisive Health, undertaken across France, Germany, Italy, Spain and the UK. Just under half (49%) of respondents are “scared” to use an A&E department, whilst 4 out of 10 (39%) are concerned about using an ambulance for the same reason. The figures are even starker for those countries whose hospital services were hit hardest by the pandemic. Six out of ten (61%) of respondents from Spain and 56% of respondents from Italy report fear of using A&E departments due to risk of catching COVID-19. By contrast, in Germany the figure was just over a third (38%).

Anxiety over COVID-19 affects those who are already unwell with serious health conditions. As one oncologist described it to me: “many of my patients are more afraid of COVID-19 than they are of their cancer.”

Fear is accompanied by a reluctance to cause more pressure on health services. Two thirds of respondents in Spain are reluctant to use an A&E service because they don’t want to take up time or capacity. The figures are 60% for Italy, 56% for France and 52% for the UK. This reticence does not just affect hospital services. 57% of respondents from Spain and 48% respondents from the UK report that they are reluctant to visit their GP for the same reason.

As services across Europe reopen, they may find many fewer people willing to use them. This matters because there is a growing bubble of untreated health need. Non-COVID-related health activity has plummeted, from A&E attendances to routine operations. Two million people in the UK alone are now waiting for a cancer screening test, diagnosis or treatment. These people have not suddenly got better or found ways of self-managing. The danger is that their condition is worsening as they wait.

A reluctance to seek help for the signs and symptoms of ill-health, combined with longer waits for those who do, is not a recipe for a healthy recovery. In a world where Wave 1 may have subsided but COVID-19 is still likely to be endemic, health systems have a bigger job on their hands than simply reopening services. They need to convince people that accessing healthcare is not only safe, but also the right thing to do.

To find out more about the polling results, please access a briefing here.

The survey was conducted by Censuswide between 29 May 2020 and 03 June 2020. The survey included 2,000 adults per country from France, Germany, Italy, Spain and the UK, nationally representative in terms of gender and age. Censuswide abide by and employ members of the Market Research Society which is based on the ESOMAR principles.