Beyond Infection: The Wider Impact of COVID-19 on Population Health
Greta Economides, University College
It is clear that COVID-19 has had an enormous effect on all of our lives. Major impacts on our health and our healthcare include widening health inequalities, effects on mental health, and an NHS under ever-more pressure. We must consider, and address, these issues if the country is to fully recover and thrive after this pandemic is over.
One domain in which the COVID-19 pandemic has affected wider population health is its impact on mental health. Early in the pandemic, concerns1 were raised about the possible impact of lockdown on mental health. This extended to patients with pre-existing diagnoses, and to those without. While the full effects on the nation’s mental health are still being explored, it is already clear that stress surrounding COVID19 and lockdown has had an effect. Figures from the he Office of National Statistics (ONS) published in June2 show that the number of adults self-reporting depression doubled in comparison to pre-lockdown levels. The ONS also reported a rise in anxiety, which has begun to fall since lockdown ended, but has not fully returned to baseline. Regarding urgent mental health crises, 43% of psychiatrists saw an increase in the number of urgent or emergency referrals during lockdown, according to the Royal College of Psychiatrists3. It is interesting to note that these changes have affected different sections of society differently. Longitudinal data from the Institute for Fiscal Studies4 indicates that young women, those with pre-existing mental health conditions, and those who experienced a fall in household income were most affected. What is not yet known are the long-term consequences on mental health. The pandemic is not yet over, and mental health resources are already scarce. What is clear is that the government need to urgently invest in mental health, to ensure that this ever-growing issue does not get worse.
It is also clear that COVID-19 has had a major effect on all medical specialties, in both primary and secondary care. The NHS is now beginning to address the long-term implications of holds placed on routine referrals, reduced numbers of consultations (particularly face-to-face consultations), and reduced visits to A&E during lockdown. This has led to significant delays in diagnosis. One study in Greater Manchester5 reported that diagnosis of ‘common conditions’ (for example, heart failure and type 2 diabetes) halved during lockdown. As well as this delay in diagnosis, patients are now faced with ever-increasing waiting times, due to the backlog which has developed within secondary care. This is largely due to the halting of elective surgery in April, but also due to patients holding back from seeking medical care. An example which illustrates both of these factors is cancer diagnosis. It has been reported that during lockdown half the number of patients were referred through the ‘two-week wait’ system compared to pre-lockdown rates6. Cancer Research UK7 reported that 2 million people with cancer will be affected by backlogs within the NHS. Furthermore, Maringe et al report in the Lancet8 that there has been a significant increase in the number of avoidable deaths from cancer. Cancer is just one speciality which has been affected by the COVID-19 pandemic, and its referral rate is showing one of the fastest recovery times. Increased wait times for both urgent and routine referrals are having a significant effect on mortality and quality of life.
The COVID-19 pandemic has had specific effects on all medical specialities which need to be urgently addressed. However, it is also likely that there will be effects on the nation’s health in a broader sense. For example, one third of the population have reported doing more exercise over the course of the lockdown, while one third reported doing less9. Similarly, people under 35 were more likely to decrease alcohol consumption, while people between 35 and 54 were more likely to increase9 consumption. It will be interesting to see how these trends develop in the long-term. For example, it is unclear whether people have retained their lockdown habits regarding exercise, or have returned to their pre-lockdown levels. The coming months will reveal what effect these lifestyle changes have on the health of the population, if any.
Some trends in health and lifestyle are unpredictable. However, since the beginning of the pandemic, concerns were raised10 about the possibility that health inequality will worsen due to both the effect of restrictions, and government policy. It is already widely accepted that health is divided sharply along socio-economic lines. In 2019, the King’s Fund11 reported that males in the least deprived 10% of areas in England would on average live 10 years longer than those in the most deprived 10%. Those hit hardest by the pandemic are those who live in the most deprived areas of the country, both in terms of personal finances and quality of life. Data from Maynou and Saez12 showed a sharp increase in healthcare inequality in the EU following the 2008 financial crisis, and following the introduction of austerity in 2010. There is a distinct possibility that we will see a repeat of this in the financial aftermath of the pandemic.
Edition: 69 (2020-2021)
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BMJ, 2020, Covid-19: Mental health services must be boosted to deal with “tsunami” of cases after lockdown. Retrieved from: https://www.bmj.com/content/369/bmj.m1994. Last accessed: 14/10/2020
Office for National Statistics, Coronavirus and depression in adults, Great Britain: June 2020. Retrieved from: https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/coronavirusanddepressioninadultsgreatbritain/june2020. Last accessed: 14/10/2020
Royal College of Psychiatrists’ briefing, May 2020, Analysis of second COVID-19 RCPsych member survey – indirect harms. https://www.rcpsych.ac.uk/docs/default-source/about-us/covid-19/second-rcpsych-covid-member-survey-summary---indirect-harms.pdf?sfvrsn=13a88d7d_4. Last accessed: 14/10/2020
Institute for Fiscal Studies, June 2020. The mental health effects of the first two months of lockdown and social distancing during the Covid-19 pandemic in the UK. Retrieved from: https://www.ifs.org.uk/publications/14874. Last accessed: 14/10/2020
BMJ, 2020, Covid-19: Diagnosis of common conditions in general practice halved during lockdown, study finds. Retrieved from: https://www.bmj.com/content/370/bmj.m3732. Last accessed: 18/10/2020
The Health Foundation, September 2020, Use of primary care during the COVID-19 pandemic. Retrieved from: https://www.health.org.uk/news-and-comment/charts-and-infographics/use-of-primary-care-during-the-covid-19-pandemic. Last accessed: 14/10/2020
Cancer Research UK, June 2020, Over 2 million people waiting for cancer screening, tests and treatments. Retrieved from: https://scienceblog.cancerresearchuk.org/2020/06/01/impact-of-coronavirus-on-cancer-services-revealed-over-2-million-people-waiting-for-screening-tests-and-treatments/. Last accessed: 14/10/2020
Maringe et al, 2020, The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study, The Lancet, volume 21, issue 8, p1023-1024
Public Health England, October 2020, Wider impacts of COVID-19 on health: summary. Retrieved from: https://www.gov.uk/government/publications/wider-impacts-of-covid-19-on-health-monitoring-tool/wider-impacts-of-covid-19-on-health-summary. Last accessed: 14/10/2020
BMJ, April 2020, Mitigating the wider health effects of covid-19 pandemic response. Retrieved from: https://www.bmj.com/content/369/bmj.m1557. Last accessed: 14/10/2020
The King’s Fund, June 2020, What is happening to life expectancy in the UK? Retrieved from: https://www.kingsfund.org.uk/publications/whats-happening-life-expectancy-uk. Last accessed: 14/10/2020
Maynou & Saez, 2016, Economic crisis and health inequalities: evidence from the European Union