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Why is dealing with COVID important beyond the infection itself? The Indirect Impact of COVID on Health Outcomes.

A lot has happened in the last nine months since the first novel coronavirus case was reported in China back in mid-November last year. Within four months, on 11 March, the World Health Organization (WHO) declared a global pandemic with the US following suit, declaring a national emergency two days later. As of 19 August, WHO reported over 22m confirmed COVID-19 cases globally with, sadly, over 781k people dying from the infection.

Over recent weeks, several reports have emerged about the magnitude of the indirect effects of the pandemic on health behaviors and outcomes. These indirect effects are different than the consequences of being infected by the virus itself but relate more to the impact of the pandemic on the population which is likely to have a longer-term bearing on health outcomes. Interestingly, an analysis of the 2014 outbreak of Ebola virus in west Africa showed that the indirect consequences of that outbreak were more severe than the outbreak itself.

I want to highlight two examples where considering the indirect effects of the pandemic on health outcomes is important. They are reductions in emergency attendances and delays in cancer care that have resulted because of the pandemic.

Public health systems around the world responded primarily by large-scale repurposing of exiting health facilities to create capacity for patients with COVID-19 whilst the public were requested to stay away unless for an emergency. Research shows that people did stay away and, in some cases, when suffering from potentially life-threatening conditions. In June, the CDC in US reported that in the 10 weeks following the emergency declaration, emergency visits reduced by 23% for heart attacks and 20% for stroke, compared with the preceding 10-week period. This trend has been seen in many countries around the world and will, undoubtedly, lead to an adverse outcome in many cases.

In many countries, cancer screening was suspended, and routine treatments postponed due to the pandemic. In addition, people are frightened to visit health facilities to seek care due to the risk of exposure to COVID19. This has led to delayed or undiagnosed cancer and an adverse impact on the prognosis and life-expectancy. In July, the Lancet reported an estimated 16% increase in deaths due to bowel cancer and almost 10% rise due to breast cancer up to five years after diagnosis in the UK compared with pre-pandemic rates. Again, this trend has been seen in several other countries too.

Other than these, there are several other indirect effects beginning to emerge. Reports have indicated a rise in infectious diseases in Africa, such as malaria and HIV, a rise in maternal and child deaths in low and middle-income countries and rise in mental illness, particularly anxiety and depression in many countries across the world.

In summary, we must be vigilant in monitoring these, and other, indirect effects of the pandemic on our members and, wherever possible, encourage them to seek medical advice early when needed. They should take advantage of telemedicine, like the vHealth service, and well-being resources like Wysa — our confidential and anonymous mental well-being app offered to Aetna International members.

Dr Hemal Desai
Senior Medical Director, Aetna International

20 August 2020

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