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      Assessing the indirect effects of COVID-19 on healthcare delivery, utilization and health outcomes: a scoping review

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          Abstract

          Background

          The COVID-19 pandemic and global efforts to contain its spread, such as stay-at-home orders and transportation shutdowns, have created new barriers to accessing healthcare, resulting in changes in service delivery and utilization globally. The purpose of this study is to provide an overview of the literature published thus far on the indirect health effects of COVID-19 and to explore the data sources and methodologies being used to assess indirect health effects.

          Methods

          A scoping review of peer-reviewed literature using three search engines was performed.

          Results

          One hundred and seventy studies were included in the final analysis. Nearly half (46.5%) of included studies focused on cardiovascular health outcomes. The main methodologies used were observational analytic and surveys. Data were drawn from individual health facilities, multicentre networks, regional registries, and national health information systems. Most studies were conducted in high-income countries with only 35.4% of studies representing low- and middle-income countries (LMICs).

          Conclusion

          Healthcare utilization for non-COVID-19 conditions has decreased almost universally, across both high- and lower-income countries. The pandemic’s impact on non-COVID-19 health outcomes, particularly for chronic diseases, may take years to fully manifest and should be a topic of ongoing study. Future research should be tied to system improvement and the promotion of health equity, with researchers identifying potentially actionable findings for national, regional and local health leadership. Public health professionals must also seek to address the disparity in published data from LMICs as compared with high-income countries.

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          Most cited references31

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          Scoping studies: towards a methodological framework

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            Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe

            Following the detection of the new coronavirus1 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its spread outside of China, Europe has experienced large epidemics of coronavirus disease 2019 (COVID-19). In response, many European countries have implemented non-pharmaceutical interventions, such as the closure of schools and national lockdowns. Here we study the effect of major interventions across 11 European countries for the period from the start of the COVID-19 epidemics in February 2020 until 4 May 2020, when lockdowns started to be lifted. Our model calculates backwards from observed deaths to estimate transmission that occurred several weeks previously, allowing for the time lag between infection and death. We use partial pooling of information between countries, with both individual and shared effects on the time-varying reproduction number (Rt). Pooling allows for more information to be used, helps to overcome idiosyncrasies in the data and enables more-timely estimates. Our model relies on fixed estimates of some epidemiological parameters (such as the infection fatality rate), does not include importation or subnational variation and assumes that changes in Rt are an immediate response to interventions rather than gradual changes in behaviour. Amidst the ongoing pandemic, we rely on death data that are incomplete, show systematic biases in reporting and are subject to future consolidation. We estimate that-for all of the countries we consider here-current interventions have been sufficient to drive Rt below 1 (probability Rt < 1.0 is greater than 99%) and achieve control of the epidemic. We estimate that across all 11 countries combined, between 12 and 15 million individuals were infected with SARS-CoV-2 up to 4 May 2020, representing between 3.2% and 4.0% of the population. Our results show that major non-pharmaceutical interventions-and lockdowns in particular-have had a large effect on reducing transmission. Continued intervention should be considered to keep transmission of SARS-CoV-2 under control.
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              COVID-19 and Racial/Ethnic Disparities

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                Author and article information

                Journal
                Eur J Public Health
                Eur J Public Health
                eurpub
                The European Journal of Public Health
                Oxford University Press
                1101-1262
                1464-360X
                23 March 2021
                : ckab047
                Affiliations
                [1 ] Department of Emergency Medicine, Columbia University Irving Medical Center , New York, NY, USA
                [2 ] Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University , New York, NY, USA
                [3 ] Vagelos College of Physicians and Surgeons, Columbia University , New York, NY, USA
                Author notes
                Correspondence: Charlotte M. Roy, Department of Emergency Medicine, Columbia University Irving Medical Center, 622 W 168th Street, VC-260, New York, NY 10032, USA, Tel: +1-212-305-8536, e-mail: charlotteroy.md@ 123456gmail.com
                Author information
                https://orcid.org/0000-0002-1481-3905
                https://orcid.org/0000-0002-2132-6435
                Article
                ckab047
                10.1093/eurpub/ckab047
                8083627
                33755130
                fc523594-fc3d-4f98-8991-3a0eb802155e
                © The Author(s) 2021. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

                History
                Page count
                Pages: 7
                Categories
                Original Manuscript
                AcademicSubjects/MED00860
                AcademicSubjects/SOC01210
                AcademicSubjects/SOC02610
                Custom metadata
                corrected-proof
                PAP

                Public health
                Public health

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