The UK has been profoundly shocked by the coronavirus (COVID-19) pandemic. The measures that have been taken to help control the spread of this virus have deeply impacted our lives, affecting our social contacts, job security, and income – which are all factors that are essential to leading healthy lives.
The local government and public health workforce have altered their work to protect those who are most vulnerable and to help contain the infection. However, this is occurring following budget reductions in successive years. The NHS was radically mobilised in order to respond to the acute needs of those who have been infected with the coronavirus while scaling back on non-COVID-19 healthcare at the same time. Social care, which has been weakened by years of rising demand and declines in real-term public funding, is reeling from the impact made by the virus. It has left many staff members and users unprotected and fatally vulnerable. Until now, the official data has poorly accounted for this.
On a daily basis, most eyes are focused on the harshest part of his crisis: the increased toll from COVID-19 as seen in the high numbers of hospitalisations and confirmed deaths. However, each week sees a steady release of sources of data that are more complete, with a one-month or longer time lag. They are not perfect sources – there are some blind spots in home social care or community services. However, they are beginning to shine a light on the contours of this infection since it started to take hold in March.
The Health Foundation over the next couple of weeks is going to be publishing a series of brief commentaries and charts, in an attempt to describe the various dimensions of COVID-19’s impact as they continue to unfold, ranging from people’s daily lives to the healthcare system. There are four dimensions of impact at least, with distribution and depth that are yet unknown.
COVID-19’s Direct Impact
The direct impact made by the virus is the first dimension, in terms of serious illness and death. The early evidence coming out of China (followed by Italy) suggests that it was more likely that the virus would kill people who were older, those with underlying conditions (especially ischaemic heart disease, diabetes, and hypertension), and men. The patterns in Northern Ireland, Wales, and England are the same for COVID-19 patients who need intensive care services.
Impact on Acute Care
The indirect impact on individuals with non-related COVID-19 acute conditions is the second dimension. NHS trusts during the month of March quickly re-designed their services on a broad scale in order to release capacity to treat patients who have COVID-10. It included redeploying staff, shifting appointments online wherever possible, postponing planned treatment, and discharging thousands of patients to free up beds. The media widely covered the process. NHS England published over 50 guidance sets to hospital specialists for treating non-COVID-19 patients during this pandemic.
General Practice and Other Non-Acute Care
The third dimension affects and disrupts individuals with chronic conditions, or individuals who need less urgent care which might have been interrupted. A lot of the work involved in managing patients who have chronic conditions is done by general practice. How general practice works has significantly changed since mid-March. The guidance states that all practices should be moved into remote triage. Patients are assessed online or by phone before they are provided with access to a GP or another health professional. In order to free up capacity, the option was given to GP practices to defer some of their routine activities, which includes routine medication reviews and health checks for individuals 75 years and older. Other activities, like child immunisations, should be continued. The public, at the same time, was given instructions on how to access NHS 111 instead of their GP if they have any COVID-19 symptoms.
Social Distancing and the Lockdown
The fourth dimension is the long and medium-term impact on health due to government inventions such as restricting movement in order to curb COVID-19 transmission. There can be a profound direct impact caused by the lockdown. For example, it can result in hardship, neglect, domestic abuse, unemployment, and bankruptcies. Services like sports massage therapy are also impacted.