After reading this, seems many Scots stopped going to the hospital on their own you guys had a full lock down In BC where I live we did not.
We found substantial impact on healthcare provision after the first UK-wide lockdown in March 2020 in England, Scotland, and Wales with admission rates due to cancer, cardiovascular-related conditions, and respiratory-causes (excluding COVID) falling substantially in 2020 compared to pre-pandemic levels. This reduction was observed for both males and females, all ethnicities, and across all socioeconomic groups. Compared to cardiovascular-related and respiratory-related causes, cancer-related admissions fell more throughout Great Britain (driven largely by a reduction in scheduled admissions). Further, unscheduled admissions in quintile 1 (most deprived) faced bigger impact compared to quintile 5 (least deprived) in the three nations. Some ethnic minorities in England (Black, Mixed, Other) and Scotland (non-White) faced bigger impacts compared to White. Despite gradual easing of lockdown restrictions over six months after the first lockdown, the admission rates due to cancer, cardiovascular-related, and respiratory-related causes remained considerably lower than pre-pandemic times suggesting sustained impact on healthcare provision. To our knowledge, this is the largest study investigating the impact of COVID-19 on healthcare provision covering 99.9% of the Scottish and Welsh population, and around 42% of the English population. The key strength of this paper includes a long follow-up, covering a large geographic area, studying different healthcare conditions, being able to distinguish between scheduled and unscheduled care, being able to stratify by sex, ethnicity, and socioeconomic position, and using routine hospital records thereby mitigating the risks of both selection bias and information bias often associated with observational studies. There are some limitations to note. While the most plausible explanation for the majority of the reduced admissions is likely due to the cancellation of many routine services usually offered by the National Health Services (NHS) to redirect staff and resources to COVID-19 patients, it is also likely that to some extent, behavior change and improved self-management may have led to a genuine reduction in healthcare need; for example patients were encouraged not to present with more minor conditions to avoid exposure to the virus and putting pressure on health services unnecessarily. Diagnostic and screening services were also severely reduced, meaning that fewer people would be attending hospital for newly diagnosed conditions. We have not measured GP appointments, outpatient services, care-at-home services or other provisions that may have in some cases adapted to provide additional services for patients who would otherwise have attended hospital. There is some evidence to suggest that respiratory-related admission reduced during the pandemic possibly due to pandemic-related non-pharmacological interventions. 18, 19 However, we cannot separate out any genuine reduction in demand due to improved health from a reduction due to disruption in this study. Further, a patient can have multiple diagnoses during a single admission episode. We have, however, considered only the “primary” cause of admission when estimating admission rates. In addition, the start of the follow-up period from
OpenSAFELY was from January 1, 2020, but it was January 1, 2016, for data from Scotland and Wales. The ITS model we have used consisted of linear terms only and it will not account for any non-linear changes over time, other than autoregression type relationships that are separately accounted for. Lastly, the ITS analysis is ideally suited to assess the impact of an intervention (such as imposition of lockdown) introduced at a specific time. It is likely that healthcare provision was impacted to some extent due to escalating infection rates themselves (which then led to lockdown restrictions in the UK). In this study, however, we are not able to distinguish between the impact of uncontrolled infections and the effects of lockdown itself on healthcare provision.
The substantial impact on healthcare provision we found after the first lockdown has been corroborated by additional UK studies. Wyatt et al. found a 51% reduction in attendance to emergency department in England after the first lockdown. 20 Mulholland et al. looking at any-cause
hospital attendance and admissions in Scotland during the first lockdown found a 41% reduction in visits, 26% reduction in unscheduled and 61% reduction in scheduled admissions. 4 Unlike our study, the aforementioned studies only looked at the immediate impact of the first lockdown. Further, we were also able to stratify the analyses by several demographic categories and assess healthcare inequalities.
Substantial impact on secondary care due to COVID-19 pandemic have also been reported in other countries including Belgium, 21 South Africa, 22 China, 23 and South Korea. 24 Most of these studies looked at hospital admissions for any cause and undertook controlled ITS analysis comparing pre-pandemic and pandemic periods. These studies were relatively small and often from a single hospital. Likely explanations provided for the significant impact during the pandemic were a change in health-seeking behaviours, 18 improved self-management, 25 lifestyle, 26 improved air-quality, 25 and increasing emergency capacity to treat COVID-19 at the expense of other services.
The uneven impact across socioeconomic position and ethnicity adds to existing evidence base and aligns with findings from UK-wide survey-based studies during the COVID-19 pandemic, 11 and other studies that have reported that past pandemics exacerbate existing healthcare provision disparities. 27
Our study has important implications for policy. While further research is needed to better characterize which clinical specialties and demographic groups have been most affected, an urgent response is required now. Although lockdown measures are becoming less common in many countries as vaccination programmes are being successfully rolled out, the removal of lockdown measures may not necessarily be accompanied by improved delivery and/or uptake of health services. Consequently, there is an urgent need to identify the most vulnerable groups, so that accessibility of healthcare services is maximized and therefore further adverse knock-on effects are mitigated.
The substantial impact on non-COVID-19 healthcare services and, at best, partial recovery despite easing of restrictions is alarming. This will likely have a knock-on impact on both medium-term and long-term health outcomes. Preliminary studies have already reported excess cardiovascular-related 28 and cancer-related 29 deaths due to impact on healthcare provision. Our study further adds to previous evidence base suggesting lack of healthcare systems resilience during a pandemic 30 and underscores the need for it to ensure unimpeded, equitable provision of essential services during any future pandemic or climate emergency-related stresses. 31
In summary, we conducted the largest study to date assessing the impact of the pandemic on non-COVID health service provision. There was a substantial reduction in hospital care for non-COVID diseases across England, Scotland, and Wales immediately after the first lockdown. This impact on healthcare provision persisted more than six months later despite easing of restrictions. The impact on healthcare provision was not uniform with the most deprived and some ethnic minorities the most affected. This will likely have a knock-on effect on healthcare outcomes. There is therefore an urgent need to minimize impact on non-COVID healthcare services and provide targeted support to more socially disadvantaged groups to mitigate healthcare inequalities. |
