9 November 2021 

There were significant changes in the use of healthcare services for non-COVID conditions during the early stages of the COVID-19 pandemic, according to researchers from the UK Health Security Agency (UKHSA) and University of Bristol in a paper published in BMC Public Health. The researchers used syndromic surveillance data to describe the changes, which they say likely reflect changes both in the incidence of other conditions and in healthcare-seeking behaviour at the time.  

In England, a range of non-pharmaceutical interventions (NPIs) were introduced during the COVID-19 pandemic. In February 2020, a public health information campaign was launched to encourage frequent handwashing, followed by advice to use online or telephone health services, social restrictions, and then, at the end of March, the first national lockdown. These interventions likely resulted in a change in the incidence of other conditions (such as other infectious diseases) and a change in people’s healthcare-seeking behaviour.

The researchers used data from syndromic surveillance systems, which are collected during routine healthcare provision and can be used to detect changes in symptoms or preliminary diagnoses in near-real time. They described trends in healthcare usage and syndromic indicators during the peak pandemic period of the first national lockdown (Monday 23 March – Sunday 24 May 2020), compared to the same period in the previous year (Monday 25 March to Sunday 26 May 2019). 

The study found that the total number of NHS 111 calls, ambulance calls, and GP consultations increased in early March 2020, followed by a decrease in contacts with all services after the introduction of NPIs. For the peak pandemic period in 2020 compared to 2019, there was a 12% increase in the daily mean number of NHS 111 calls, an 11% decrease in GP out-of-hours consultations, and a 49% decrease in Emergency Department (ED) attendances. Ambulance calls varied markedly throughout the pandemic, increasing during the introduction of social distancing but decreasing during lockdown.

The researchers described the impact of the pandemic on healthcare-seeking for infectious disease, which was likely affected by handwashing and social distancing measures. They observed a 64% decrease in GP in-hours consultations for conjunctivitis in the peak pandemic period in 2020 compared to 2019, possibly due to increased handwashing reducing the spread of infective conjunctivitis. There was also a 31% decrease in GP in-hours consultations for mumps, after high activity early in 2020, following the implementation of social distancing measures.

The study explored conditions affected by changes to daily activities in the pandemic. ED attendances for fractures decreased by 47% overall, showing a sharp decrease after the introduction of social restrictions and there was also no longer a weekend increase in fracture attendances at ED. This could reflect a decrease in accidents related to commuting to work, team sports, or the night-time economy.

The researchers also described conditions which might indicate changes in individual’s healthcare-seeking behaviour. For example, herpes zoster (shingles) is a condition whose incidence was likely unchanged by the pandemic. GP in-hours consultations for herpes zoster decreased by 27%, likely reflecting reduced contact with health services. A reduction in attendance was also observed for more severe cardiac conditions, with a 35% decrease in ED attendances for myocardial ischaemia.

Dr Claire Ferraro, Specialist Registrar in Public Health in the South West and lead author of the study, said: “This data analysis is a stark reminder of what an exceptional time we experienced at the peak of the pandemic last year, when we saw dramatic changes to health-seeking behaviour and variation in the number and/or types of conditions presenting across the spectrum of NHS services.”

Professor Gillian Smith, co-author and Consultant Epidemiologist from the Real-time Syndromic Surveillance Team, UKHSA, said “This study highlights the indirect effects of the pandemic on consulting behaviour for a range of conditions. It’s important that we take account of this when planning for the future.” 

Paper: Describing the indirect impact of COVID-19 on healthcare utilisation using syndromic surveillance systems by Claire Ferraro, Lucy Findlater, Roger Morbey, Helen Hughes, Sally Harcourt, Thomas Hughes, Alex Elliot, Isabel Oliver and Gillian Smith. Published in BMC Public Health. November 2021.


Further information

About the NIHR Health Protection Research Unit [HPRU] in Behavioural Science and Evaluation at the University of Bristol 

The NIHR HPRU in Behavioural Science and Evaluation at University of Bristol is one of 14 HPRUs across England, part of a £58.7 million investment by the NIHR to protect the health of the nation. 

The NIHR HPRU in Behavioural Science and Evaluation is a partnership between the UK Health Security Agency (UKHSA) and University of Bristol, in collaboration with MRC Biostatistics Research Unit at the University of Cambridge and University of the West of England. 

Each NIHR HPRU undertakes high quality research that is used by UKHSA to keep the public safe from current and emerging public health threats.

About the NIHR 

The mission of the National Institute for Health Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

  • Funding high quality, timely research that benefits the NHS, public health and social care;
  • Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
  • Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
  • Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
  • Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
  • Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.
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