By Astin Sokang, Universitas Kristen Krida Wacana, Indonesia; Triana Kesuma Dewi, Universitas Airlangga, Indonesia; Yuhang Zhu, Shandong Second Medical University, China; Gill ten Hoor, Maastricht University, The Netherlands
For many adults, COVID-19 causes only mild illness, such as fatigue, cough, or a slight fever. However, for people with certain health conditions, infection can lead to hospitalisation or severe complications. Early identification of these patients is therefore critical, because treatments are most effective when given soon after symptoms begin.
Recent numbers consistently show that the risk of severe COVID-19 increases with age and with underlying health conditions such as cardiovascular disease, diabetes, obesity, chronic lung disease, cancer, and immunosuppression. Older adults and people living with multiple health conditions are particularly vulnerable to severe outcomes.
While antiviral therapies are most effective at preventing severe outcomes when started within five days of symptom onset, rapid identification of high-risk patients remains essential, as delayed treatment may still benefit vulnerable groups with prolonged viral replication.
Why high-risk patients are sometimes overlooked
Despite clear clinical guidance, eligible patients are not always identified in time to receive early treatment. Clinicians often focus on symptom severity rather than underlying risk. Patients who present with mild symptoms may not immediately trigger further evaluation, even if they have risk factors that increase the likelihood of complications.
Additionally, risk often arises from multiple moderate factors rather than a single high-risk condition. Guidance emphasises that the number of underlying conditions significantly increases the risk of severe illness, highlighting the importance of assessing overall risk profiles, for example, old age, hypertension, and overweight, rather than individual conditions in isolation.
Time pressure in busy clinical environments can also play a role. Clinicians often need to make decisions based on limited information, such as incomplete patient histories or medical records that do not clearly flag relevant risk factors. As a result, important cues may be missed when risk factors are not immediately obvious.
Structural and behavioural barriers also affect who receives timely care. Research throughout the pandemic has shown that racial and ethnic minority groups, as well as socioeconomically disadvantaged populations, experienced higher rates of COVID-19 infection, hospitalisation, and death. These disparities are partly linked to differences in access to healthcare and treatment.
Patients themselves may also delay seeking care. Many people assume that mild symptoms mean low risk, or they may be unaware that treatments are most effective when started early. Without clear guidance from clinicians, these patients may present too late for treatment to be effective.
In addition, changes in risk perception over time may also play a role. Earlier in the pandemic, higher risk awareness led to more cautious practice. As the situation has improved, mild cases may seem less urgent, which can reduce motivation to assess risk systematically, among both patients and healthcare professionals.
How behavioural science can support better identification
At first glance, the challenge may appear purely clinical. However, behavioural science provides practical tools that can help clinicians consistently identify high-risk patients. Clinicians frequently work under high cognitive loads. Simplifying decision-making through prompts and checklists may help reduce reliance on memory and intuition by guiding clinicians through structured review of key risk factors. Electronic medical records (where available) can also support early identification. Automated alerts that flag patients with known risk factors, such as age, chronic disease, or immunosuppression, can prompt clinicians to assess treatment eligibility quickly.
Clear communication about risk and the importance of early treatment can support early identification. When patients understand their risk, they may be more likely to contact healthcare providers sooner after testing positive, rather than delaying care until symptoms become worse.
Additionally, asking targeted questions (e.g., “What might make it difficult for you to get treatment quickly?”) or expressing concern about access to care may help uncover hidden barriers. For example, a general prompt such as “You should consider seeing a doctor” is often less effective than actionable guidance like “You could book an appointment with your local clinic this week, and I can help you find one nearby if needed”, when encouraging health-seeking behaviour.
Reflective practice can also help address implicit bias. Simple prompts, such as asking whether the same advice would be given or treatment decisions would be made for a different patient with the same clinical profile, can reduce unintended discrepancies in care.
Key takeaways
Improving the identification of high-risk COVID-19 patients does not necessarily require major system changes. Often, small adjustments to clinical workflows, screening procedures, and communication practices can make a meaningful difference. By combining clinical guidance with behavioural insights, healthcare practitioners can ensure that high-risk patients are recognised promptly and receive timely assessment for treatment. In the context of COVID-19 and future infectious disease outbreaks, these small improvements in clinical practice can help to prevent severe illness and potentially save lives.
Practical recommendations
- Use a brief risk-screening checklist during COVID-19 consultations
During every (pre-)consultation with a patient who tests positive or shows symptoms, quickly assess common high-risk factors such as older age, cardiovascular disease, diabetes, obesity, chronic lung disease, cancer, or immunosuppression. This might reduce the risk of missing vulnerable patients, especially during busy clinical appointments. - Consider cumulative risk rather than single conditions
Patients often have several moderate risk factors rather than one obvious high-risk condition. When assessing antiviral treatment eligibility, consider the overall risk profile, including age, comorbidities, and clinical context, rather than focusing on a single diagnosis. - Prioritise rapid assessment within the treatment window
Early COVID-19 treatments are most effective when started soon after symptom onset. Establish clear workflows so that high-risk patients who test positive can be assessed quickly for treatment eligibility. This might include same-day clinical review, dedicated triage pathways, or automated alerts within electronic health records where available. - Communicate risk clearly and proactively to patients
Patients with chronic conditions may not know that they are at increased risk of severe COVID-19. Explain how specific health conditions influence risk and encourage patients to contact healthcare providers promptly if they test positive or develop symptoms. - Standardise treatment decisions
Standardise treatment decisions through algorithmic triage pathways and clinical scoring systems to remove subjective intuition and reliance on heuristics. Before deciding that a patient does not need further assessment or treatment, pause and reflect: “Would I make the same decision for another patient with the same medical profile?”. Structured reflection can help reduce unintended disparities in care and ensure that decisions are based on clinical need rather than assumptions.