Addressing the long-term effects of COVID-19

Woman and man with masks on to show Addressing the long-term effects of COVID-19

Johnny Skillicorn-Aston and Jeremy Hooper address the long-term effects of COVID-19 and preventing a negative legacy amongst the population.

Addressing the long-term impacts on sickness and disease as a consequence of the COVID-19 pandemic, both causal and additive, will be a continuing challenge for the healthcare sector as it moves through the recovery and restoration agenda.

We might understand the epidemiology of the Coronavirus more widely now, but we are less certain on its legacy. One thing is clear; smarter, quicker and larger-scale interventions and more acute models of scrutiny will be critical in lessening the enduring consequences of the pandemic for the nation’s health.

Unprecedented in the NHS’ history, it has raised the need to address some key issues. It is for others to determine hierarchy of approach but chief among the varied issues sits the correlation between economic status and poor health, health inequalities and the extra burden the pandemic has placed on this register, and concerns about what should be done to tackle both unmet and rising need.

Available data supports the view that people have largely behaved in accordance with the advice given and stayed at home; A&E attendances show a downturn of 50% on last year, while GP appointments show a similar decrease. It could be assumed that patients with symptoms of a minor illness nature might have chosen to just live with them, however, the figures for excess deaths illustrate that this was also the case for other conditions. It is unclear whether this group of people, had they engaged with healthcare professionals, would have had the same outcome.

Figure 1

“The key element is urgency to ensure that the longer-term impacts of the pandemic are not equally sustained”

Managing effective population health

An additional concern is the effect on the 2.2m patients asked to shield from wider society; around 20% have experienced a worsening of their condition and around 30% have been unable to access care. Getting services back on track is not an exact science, new practices in deep cleansing, establishing robust PPE practice and other infection control measures enlarge the challenge. The resumption of effective long-term condition management will help to reduce excess mortality in the coming winter.

Dr Anant Jani, Oxford Martin Fellow at the Oxford Martin School, University of Oxford, and population health specialist emphasises an approach that reflects the wider determinants in managing effective population health approaches.

“It is well established that social determinants of health (eg housing, education, transportation, access to jobs, nutritious food, clean air, clean water, support to prevent/recover from substance abuse, etc.) determine 70 to 80% of health outcomes. In the COVID-19 aftermath, we are going to see these factors become even more important and we will need to address them if we hope to maintain the health of our populations.

“It is well established that social determinants of health (eg housing, education, transportation, access to jobs, nutritious food, clean air, clean water, support to prevent/recover from substance abuse, etc.) determine 70 to 80% of health outcomes. In the COVID-19 aftermath, we are going to see these factors become even more important and we will need to address them if we hope to maintain the health of our populations.

Figure 2

 

“To promote population health, we must focus on shifting the population risk profile to the left to keep our populations healthy and also decrease the amount of avoidable spend on healthcare. Shifting the population risk profile to the left is even more important in light of the COVID-19 aftermath because many of our citizens will actively transition to states of poor health and once they are in poor health, the level of intervention needed for those individuals to bring them back to a healthy state will be much higher than if we intervened at a population level to control the incidence of their particular morbidity.”

Urgency

This signals a clarion call for earlier interventions that wrap a value-based approach within a population health methodology. Supporting mechanisms to address these factors, individually and collectively, will go far in preventing and/or reducing suffering among our citizens. It will also contribute to lowering the level of resource to address their needs now and in the future. Sustaining innovation within integrated health and care systems will restore services, however, the key element is urgency to ensure that the longer-term impacts of the pandemic are not equally sustained.

Johnny Skillicorn-Aston is Communications Specialist, and Jeremy Hooper is Health Economist at Conclusio. Go to www.conclusio.org.uk

References
Trend in Weekly Deaths 2020, ONS Weekly Mortality Data | Hood CM, Gennuso KP, Swain GR, Catlin BB. County Health Rankings: Relationships Between Determinant Factors and Health Outcomes. American Journal of Preventive Medicine. 2016 02; 50(2): 129-135 | Rose G. Sick individuals and sick populations. Int J Epidemiol 1985; 14: 32–38 | Rose, G. A., Khaw, K.-T., & Marmot, M. G. (2008). Rose’s strategy of preventive medicine: The complete original text. Oxford, UK: Oxford University Press | WHO. Social Determinants of Health: The Solid Facts, 2nd edn. Geneva: WHO, 2003.