One out of seven adults (14%) in the U.S. would not seek healthcare for themselves or a member of their household for a fever or dry cough due to cost. When adjusted to include fear of contracting COVID-19, findings suggest that 9% would still choose to avoid seeking care.

“Unwillingness to seek out care due to concerns over cost is related to familiar socioeconomic distinctions,” wrote the Gallup and West Health poll conductors in a blog post. “Hispanics and blacks are less likely to have health insurance than are non-Hispanic whites, and those in lower-income households are far more likely to be influenced by cost when considering if they will follow recommended medicine or procedures from their doctors. Mentioning coronavirus by name reduces the percentage of people who would not seek treatment by roughly one-third, suggesting that lack of clarity regarding the common symptoms of COVID-19 could be a factor in not pursuing it beyond household economics or basic access.”

Non-white adults under 30 with a high school education or less and in households that earn less than $40,000 annually were most likely to indicate an avoidance of medical care.

In addition to cost, 6% of respondents — representing about 15 million adults — said they or a family member have been denied care due to providers facing large volumes of COVID-19 patients. Such denials reflect geographical differences in COVID-19 diagnoses and associated hospitalizations, especially in hard hit areas like the Northeast, where 11% report being denied care. This is followed by 8% in the West, 5% in the South and 3% in the Midwest.

While race does not strongly correlate with denial of care, income level does, with 11% of those in households that make under $40,000 experiencing this scenario compared to 3% with annual incomes that exceed $100,000, reports the study.

Seeking care when exhibiting a fever or dry cough is critical to combating the pandemic. Greater testing is required for the eventual reopening of the economy, with experts estimating that testing has to at least triple beyond current levels for a safe reopening, reports The New York Times. Though hard-hit places like New York are beginning to see declines in COVID-19 patient numbers, a national plateau in cases in still unclear due to current levels of testing and many states still experiencing rising infection rates.

Opting not to seek care when exhibiting these symptoms, however, is not surprising to the authors, who say that the risk of contracting the infection combined with furloughs and permanent layoffs worldwide are large drivers for this reasoning.

Another is the cost of healthcare. While the government has made testing free of charge under the Families First Coronavirus Response Act, trips to the hospital alone can cost thousands in out-of-pocket fees, especially if a doctor deems a test unnecessary, if the provider is out-of-network or if the treatment for unrelated conditions is required.

“Greater clarity regarding these issues for the public is advisable,” said the blog. “It would likely be prudent for leaders and public health officials to not assume that the main symptoms of COVID-19 are universally known and to continuously provide updated information for where to go for local testing, cost expectations for treatment, and patient capacity at local hospitals.”

The findings are part of an ongoing, two-part special study conducted by Gallup and West Health to evaluate public opinion on the cost of U.S. healthcare. The first part was conducted between April 1 and 14.