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27 April 2020

The effect of Covid-19 on other health outcomes

Dr Sotiris Vandoros, Senior Lecturer in Health Economics

The consequences for our health services won't end with the virus

Looking down at the feet of someone standing on a set of weighing scales
Inactivity associated with Covid-19 lock-downs may result in more obesity and obesity-related illnesses. Photo by i yunmai on Unsplash

The Covid-19 pandemic has now claimed over 120,000 lives globally, including over 12,000  in the United Kingdom.  In countries where health services have been overwhelmed, the virus may have claimed many indirect victims too, who have been unable to access the critical care they needed.  Even when the virus is contained, there will be lasting consequences that health services around the world will have to plan and prepare for.

One of the most visible and immediate problems will be treating those whose non-urgent operations were postponed to free up capacity and resources to treat COVID-19 patients. Others might have avoided seeking the medical attention they needed, or cancelled planned check-ups or screening in order to avoid being exposed to the virus, potentially creating larger health problems as their illnesses go undiagnosed and untreated.

In addition to the consequences of the virus itself, the measures that are currently necessary to manage it will also have a significant impact by limiting economic and physical activity. 

The level of the Economic Policy Uncertainty index in the UK is currently higher than that at the peak of the financial crisis of 2008, and many are predicting a deep economic recession.  While some people are already suffering financial hardship, even those who are not yet affected are facing uncertainty about their finances, something that is shown can be detrimental to mental and physical health. People in industries that face a higher likelihood of job cuts, or those on temporary contracts may be worst affected and their household members may be impacted too.

My research has shown that higher levels of economic uncertainty are associated with more suicides, as a result of stress and anxiety. At the moment, uncertainty is combined with feelings of isolation as people practice social distancing during the lockdown, making it doubly important to have the right mechanisms in place to support mental health.

Uncertainty is also associated with an increased risk of car crashes because more drivers are distracted, frustrated, and often sleep deprived. While the lockdown means fewer cars on the roads, which would usually mean fewer car crashes, evidence of increased speeding on empty roads is starting to emerge, which would make those accidents that do happen more severe.  Moreover, it is likely that feelings of economic uncertainty will continue after the present lock-down is ended and continue to have an impact when traffic starts to return to more normal levels.

Behaviours affecting our physical health, such as alcohol, diet, exercise and smoking can be affected by recessions. Evidence from earlier economic recessions suggested that they may have led to an improvement in physical health, possibly due to reduced work-related stress and the relative unaffordability of unhealthy behaviours such as smoking, excessive drinking and drink driving. However,  more recent crises have been measurably damaging for physical health. For example, one of our recent studies found a decrease in fruit intake and an increase in obesity and the likelihood of suffering from diabetes in England following the great recession of the late 2000s.

In the case of the post-Covid-19 recession, the negative health impacts of the recession will be given a headstart by the lockdown.  The lockdown is necessary to prevent the spread of Covid-19, but it can have spillover effects. Being less active can lead to higher levels of obesity, which is associated with numerous diseases. The psychological impact of reduced social contact should also be considered, as must reports of an increase in domestic violence.

However, the quarantine may have some positive impact if we are able to maintain new behaviours.  We may see fewer car crashes and less air pollution if there is a permanent switch to working from home and less commuting. Pollution is a serious health risk factor that claims about 40,000 deaths a year in the UK, while over 1,700 people lose their lives per year in car crashes. Reports that smokers are more likely to experience severe symptoms of Covid-19 may, in combination with the curtailment of opportunities to socialise, contribute to lower smoking rates. Finally, the current pandemic has raised awareness about how to avoid spreading viruses, and this may help reduce the prevalence of flu and its toll next year.

After the Covid-19 pandemic is over, the NHS is likely to face an aftershock, stemming mainly from the effects of lack of activity, undiagnosed diseases and mental health issues. Any spillover effects have to be taken into account in designing the future of health services, as should the opportunity to encourage healthier new habits.   This is vital information that will help us plan not just for future waves of Covid-19 and any other pandemic, but also for the eventual recovery.