It has been estimated that at least 5 million people died worldwide between early 2020 and early 2022 as a direct result of the covid-19 pandemic, and millions of others developed long covid (1,2). In addition, measures to combat the pandemic reduced the quality of care provided for other diseases.

In France, the number of hospital stays for conditions other than covid-19 fell by 13% between 2019 and 2020, especially in those regions most affected by the pandemic. Part of this reduction, in diseases involving the ears, nose, throat, lungs and infections, is probably a positive consequence of covid-19-related social distancing, and hygiene and lockdown measures. However, there was also a reduction in hospitalisations for cardiovascular diseases, including stroke and myocardial infarction (3).

An even greater reduction was seen in hospital stays for surgery: around 15% between 2019 and 2020 (3). A study based on French national health insurance data showed a marked reduction in surgical interventions involving implantable medical devices in 2020 and between January and April 2021, compared with the number expected for these two periods. In the case of arthroplasty with knee replacement, there were 25% fewer surgeries than expected during the first period and 19% fewer during the second; for cataract surgery, 22% and 3% fewer respectively; for arthroplasty with hip replacement, 13% and 75% fewer; and for coronary angioplasty, 11% and 6% fewer (4). Multiple reasons were cited: difficulty travelling during lockdowns; patients' fear of becoming infected in hospital, cancelled operations, bed shortages, drug shortages (neuromuscular blocking agents), and exhaustion among healthcare  (4).

The same phenomenon has been observed in many other countries, and in some cases, the consequences are even more disturbing. A review of dozens of studies showed reductions in cancer diagnoses and cancer surgery, for example, between 2019 and 2020 (1,5).

The pandemic has clearly had a negative impact on many people's mental health, while at the same time reducing the availability of mental health care in many countries (1).

Disruption to tuberculosis, HIV, malaria and child-immunisation programmes in some low-income countries is likely to cause significant harm in the medium term (6).

Life expectancy at birth fell in many countries in 2020: by more than two years in the United States and Russia, and by about 6 months in France. In contrast, shorter life expectancy was not observed in a few countries: South Korea, Norway, New Zealand and Taiwan (7,8).

In 2020 and 2021, over 5 million deaths were directly attributed to the covid-19 pandemic. However, the estimated number of deaths doubles to quadruples when unrecorded cases and indirect deaths due to the impact of the pandemic on other healthcare services are taken into account. In May 2022 the World Health Organization (WHO) estimated the total death toll at appproximately 14.9 million (2,9).

The prevention of indirect deaths is yet another argument in favour of hygiene measures, and large-scale vaccination against covid-19. 

©Prescrire 1 July 2022

References  
1- OECD "Health at a glance 2021" 2021: 274 pages. 
2- Adam D "The effort to count the pandemic's global death toll" Nature 2022; 601: 312-315. 
3- Naouri D "En 2020, le nombre de séjours hospitaliers hors Covid-19 a diminué de 13% par rapport à 2019" Études & Résultats 2021; (1204): 8 pages. 
4- Dufour E et al. "État des lieux de cinq interventions courantes impliquant des dispositifs médicaux implantables: conséquences liées au Covid-19 en France en 2020 et de janvier à avril 2021" Épi-Phare 29 September 2021: 114 pages. 
5- Hanna TP et al. "Counting the invisible costs of covid-19: the cancer pandemic" BMJ blog 5 November 2020: 3 pages. 
6- Hrynick TA et al. "COVID-19 response: mitigating negative impacts on other areas of health" BMJ Global Health 2021; 6: e004110: 11 pages. 
7- Islam N et al. "Effects of covid-19 pandemic on life expectancy and premature mortality in 2020: time series analysis in 37 countries" BMJ Global Health 2021; 375: e066768: 14 pages. 
8- Insee "France, portrait social" 2021: 243 pages. 
9- "14.9 million excess deaths associated with the COVID-19 pandemic in 2020 and 2021" 5 May 2022. www.who.int accessed 1 June 2022: 2 pages.

Source: "Covid-19: delays in other types of health care " Prescrire International 2022; 31 (239): 171. Free

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