Wider Impacts of COVID-19 on Health (WICH) summary, 20 May 2021

This Public Health England (PHE) monitoring tool looks at the wider impacts of the coronavirus (COVID-19) pandemic on population health. This report briefly highlights the main findings.

This resource will be updated monthly with new time point data for existing metrics and new metrics covering relevant themes where data become available. In some cases, a metric is from a single time point data collection and therefore figures will remain unchanged week on week. This will be continually reviewed, and the resource will be updated as appropriate for relevance and timeliness.

Overview

Areas of daily life in England have all seen some noticeable changes since the start of the COVID-19 pandemic.

The beginning of the first national lockdown in England was 23 March. Easing of lockdown began on 10 May. At this time, people who could not work from home were encouraged to return, avoiding public transport where possible, and were allowed to take unlimited outdoor exercise.

Further easing took place in the first half of June, allowing up to 6 people to meet outdoors, and outdoor sports amenities and outdoor non-food markets to open. More significant lifting of restrictions took place on 15 June. This permitted reopening of retail shops and some other public-facing businesses. On 4 July pubs, restaurants, hotels and hairdressers were permitted to open with the implementation of social distancing measures.

Since the easing of national restrictions, a series of local measures have been introduced. On 14 October the government introduced a 3-tier system and those areas in the highest tier were subject to the tightest restrictions. This was followed by a second national lockdown on 5 November until 2 December when the 3-tier system was reinstated. A Tier 4 was implemented for areas in London, East and the South East of England on 20 December and was extended to a number of other areas on 26 December. A third national lockdown came into effect on the 6 January 2021.

On the 8 March children started to return to school, the first step in the England road map to exit lockdown. Easing has continued from the 29 March 2021, allowing 6 people or 2 households to meet outdoors including private gardens. From 12 April 2021 non-essential retail, pubs and other hospitality venues, personal care premises such as hairdressers, as well as libraries and community centres were allowed to open. Further easing is expected from the 17 May 2021 and 21 June.

New metrics

A&E attendances

The rate of A&E attendance recorded decreased in quarters 1 (beginning April 2020), 2 and 3 in every age group, compared with the equivalent months in 2018 and 2019 combined. The attendances significantly decreased in the period April to June 2020 by 38.1% compared with the equivalent months in 2018 and 2019; by 15.8% in quarter 2; and by 23.8% in quarter 3 for all ages.

Outpatient attendances

The rate of outpatient attendances decreased in quarters 1 (beginning April 2020), 2 and 3 in every age group, compared with the equivalent months in 2018 and 2019 combined. The attendances significantly decreased in the period April to June 2020 by 39.1% compared with the equivalent months in 2018 and 2019; by 17.7% in quarter 2; and by 11.7% in quarter 3 for all ages.

Sexual health testing and diagnosis

The number of tests for chlamydia decreased in March, April and May 2020 compared with the equivalent months in 2019. Chlamydia testing began to increase in June and July 2020 levelling off until September 2020 but did not reach the numbers during the equivalent months in 2019. There was a similar pattern of a decreased number of Hepatitis C tests and Gonorrhoea tests from March 2020 to September 2020 compared to the equivalent months in 2019. For each disease, the starkest difference between 2020 and baseline can be seen in April during the first lockdown.

Updated metrics

Mental health and wellbeing

Self-reported mental health and wellbeing worsened during the pandemic. Adults experienced high anxiety levels and low happiness levels in the week immediately preceding the first national lockdown and the 2 following weeks. Prevalence for both indicators was more than double the average for 2019. Prevalence for both these has since declined but has generally remained above 2019 levels up to the week of the 18 April 2021. Data from 23 March 2020 to 12 April 2021 show that trends in a range of other mental health metrics such as loneliness, abuse, self-harm and suicide and major stress have fluctuated over the course of the pandemic. Further detail on this topic is available in the COVID-19: mental health and wellbeing surveillance report.

Dementia

Numbers of people with dementia and Alzheimer’s have fallen during the pandemic, partly due to patients not accessing services where assessment and diagnosis would take place. Prevalence of these diseases in adults aged 65 and over was lower in the months from April to December 2020 than in the averages of the same months from 2017 to 2019. The estimated diagnosis rate in adults aged 65 and over was also lower from April to December in 2020 than in 2019 and referral to a memory clinic was lower in the months from April to December 2020 than in the same months in 2018 to 2019. This pattern has continued in the most recent data (March 2021) with the rate remaining below the baseline for both measures.

Community support (social capital)

In general, data up to 2 August show that people have felt supported during the pandemic. Similarly, the majority of people felt that people were helping others more than before. These patterns were seen across income, age, sex, and ethnic groups.

Homeschooling

From 23 March 2020 until the start of the 2020 autumn term, most schools in England were closed to children other than those with parents who were keyworkers or who were classed as vulnerable. In the 4-week period up to 7 June, around 70% of parents reported homeschooling their children.

In the 6 week period up to 17 May 2020 29.3% of parents or guardians felt that homeschooling was having a negative effect on their wellbeing, with numbers significantly higher among women (35.2%) compared with men (21.8%)

Schools remained open during the second national lockdown and for the remainder of the term but were closed again at the start of the third national lockdown in January 2021.

Travel, access to outdoor space and time spent on activities

Mobility patterns changed visibly during the pandemic. The initial message to ‘stay at home’ during the first national lockdown showed high levels of compliance and all transport use saw a steep decline in the following 2 weeks.

Once restrictions eased, public transport use steadily increased whilst remaining below pre-pandemic levels. There was a slight decline in use of National Rail services from the end of September to the end of October 2020, perhaps reflecting the announcement on 23 September for people to work from home if they could and the introduction of local lockdowns. At the beginning of the second national lockdown there was a steep decline in all public transport and car use, rising gradually from the end of November up to Christmas and then falling steeply over the Christmas Bank Holiday period. Public transport use remained steady throughout the third national lockdown, at a lower level than the second but higher than the first national lockdown. All forms of transport have increased as some of the lockdown 3 measures have been relaxed.

After an initial decline following the first national lockdown, trips in light goods vehicles and heavy goods vehicles gradually increased and were back to normal levels from July 2020. Trips in light goods vehicles declined steeply again following the second national lockdown, and gradually increased from the end of November 2020 leading up to Christmas and then declined steeply over the Christmas Bank Holiday period. During the third national lockdown, these indicators showed gradual increases, but were consistently at a lower level than seen in the second national lockdown, but a higher level than during the first national lockdown.

Visits to parks, whilst down at first, were above pre-pandemic levels from 25 May until 30 September, perhaps reflecting the warmer summer and early autumn weather.

Access to green space and outdoor space is important for health and wellbeing. Those living in the London region have the lowest level of access to private outdoor space but also the shortest distance to travel to access public green spaces. Those in higher income groups have greater access to private garden space as do those from a White ethnic background and those in age bands 45 years and over.

Restrictions in place during lockdown and subsequently have had an impact on how people were able to use their time. Comparisons with data from 2014 to 2015 show that during March and April 2020 people were spending less time travelling, studying, doing housework and on personal care and more time sleeping and resting, entertaining and socialising, gardening and DIY, and working from home.

Air quality

Air quality data is available for London, Manchester and Birmingham. Improvements in air quality since the introduction of initial lockdown in March are mainly due to reductions in the concentration of the nitrogen oxide (NO2) in the environment. Data for NO2 up to the end of November show that these values are generally lower than the same period in 2019.

Grocery purchasing and food usage

The volume of grocery purchases rose sharply just before the first lockdown on 23 March 2020. Volume sales remained higher up to and including the week ending 14 February 2021 than at the same point in the previous year. Since the first lockdown began and up to the week ending 14 February 2021. During this time shoppers made fewer trips but bought more items per trip than in the same period in the previous year.

Leading up to and during the second national lockdown there was an increase in grocery purchases compared with the same period in the previous year, but not to the same level seen in March 2020. A similar pattern emerged for the third national lockdown, with volume of grocery purchases being comparable to those of the second national lockdown. These patterns are seen across all socioeconomic groups.

Changes in food use behaviours were most visible among the younger age groups, households with children and those who were self-isolating. About half of 16- to 34-year-olds changed their food use patterns between April and June while the habits of most of the older age groups remained consistent. There was a shift towards cooking more from scratch, eating together with the family and eating healthy meals, but also a marked increase in snacking, especially in April and May.

A more detailed analysis of the impact of COVID-19 pandemic on grocery shopping behaviours was published on 5 November.

Alcohol

Alcohol intake across the population as a whole remained about the same during the first national lockdown, with almost half reporting that they had neither increased nor decreased their drinking, and this pattern continued as restrictions were eased. Data up to 26 September 2020 show that those aged 18 to 34 were more likely to report consuming less alcohol than before, during all phases of social restrictions, and those aged 35 to 54 were more likely to report an increase. There was an increase in the proportion of ‘increasing and higher risk’ drinkers in April 2020. Since then, rates have been declining but are still consistently higher compared with 2019. Alcohol purchasing rose sharply before the first national lockdown and has remained higher up to 14 February 2021 than in the same weeks in 2019. This pattern is observed across all life stages and social classes. There was an increase in alcohol purchasing in the 2 weeks preceding the start of the second national lockdown which began on 5 November and a further increase in the last 2 weeks of November.

Rates of emergency hospital admissions for all alcohol-specific conditions in England were lower in March, April and May 2020, than in the same months at baseline (rates for 2018 and 2019 combined). They then increased above baseline levels for months June to September 2020 and then fell below the baseline for the months October 2020, to January 2021. This pattern was seen for men and women.

Mortality rates for alcohol-specific conditions were higher for all months from May 2020 to January 2021 than in the same months at baseline (rates for 2018 and 2019 combined). For both sexes, rates were increased in the second, third and fourth quarters of the year (April to June 2020, July to September 2020 and October to December respectively) compared to the equivalent quarters at baseline (2018 and 2019 combined). These trends were also observed for alcoholic liver disease, which accounts for most alcohol-related deaths, while the trend was less clear for other alcohol-specific causes. Regional differences are seen for alcohol related deaths, four regions had increased rates in the second quarter of 2020 compared to baseline. Five regions had increased rates in the third quarter of 2020 compared to baseline. Seven regions had increased rates in the fourth quarter of 2020.

Smoking

Smoking prevalence in the 4-week period ending 7 March 2021 was lower than the 2019 baseline. There has been an increase in the number of people attempting to quit smoking during the pandemic with almost two-fifths of smokers attempting to quit in the 3 months up to March 2021. Over-the-counter nicotine replacement therapy (NRT) and e-cigarettes remain the most commonly used aids to quitting. However, during the pandemic there has been a reduction in their use and a corresponding increase in people attempting to quit unaided.

Gambling

The proportion of adults reporting engaging in and spending money on all types of gambling, including betting and the lottery, decreased during the first national lockdown compared with before. This was seen across all age groups and both sexes. Gambling behaviour then increased once sports events and bookmakers reopened and by the start of the second national lockdown rates had returned to the levels seen before the first and remained similar since.

Physical activity

In April and May 2020, about one-third of adults reported doing at least 30 minutes of physical activity on 5 or more days in the previous week. This has since declined, with just under a quarter of adults reporting this level of physical activity up to the 30 November 2020.

Around one-third of adults reported doing more physical activity than usual during the lockdown period between 3 April and 11 May 2020, while over one-third said they were doing less. Similarly, just under a third of parents reported that their children were doing more physical activity compared with before the initial lockdown, although just over one-third said they were doing less.

Crime and anti-social behaviour

There was a reduction in many types of police-recorded crime during the first national lockdown, March 2020 to May 2020, compared with the same months in 2019. An exception to this pattern was drug offences, where levels increased, the rate in May 2020 was over two-fifths higher than in May 2019.

During the period April to May, when asked about their perception of national crime and crime in their local area ‘since the virus outbreak’, over half perceived that national crime had gone down, whereas just under a half perceived that there had been no change in levels of crime in their local area.

About 8 in 10 adults reported that there had been no change in how much they worried about crime in general since the virus outbreak.

Around a fifth of adults perceived anti-social behaviour levels in their local area to have decreased during the pandemic period and a similar proportion reported experiencing or witnessing anti-social behaviour in the last 3 months.

Online activity

During May and June 2020 over half of parents reported that their child aged 10 to 15 years was spending 5 or more hours per day online, with 12.2% spending 9 or more hours online. Over a tenth of parents reported that their child had encountered one or more negative online experiences in the last month.

Impact on employment and businesses

The rate of people per 1,000 employees who had been made redundant or took voluntary redundancy more than tripled from the quarter March to May 2020 to September to November 2020. Since then, from December 2020 to February 2021, the rate of redundancies halved from this peak level. The proportion of those claiming unemployment benefits more than doubled between March 2020 and May 2020 and has remained at a similar level since then up to the latest available data for March 2021. These figures may not yet reflect the true impact of the pandemic.

Lockdown meant significant impacts on businesses in terms of turnover and impact on the workforce. In the 2-week period ending 31 May employers were reporting that just over a fifth of the UK workforce was on furlough and just under a quarter of enterprises across all industries had experienced a decrease in turnover of more than 50%. Data for the period ending 1 November shows that the proportion of the UK workforce on furlough leave across all industries has decreased to under a tenth, as the initial lockdown restrictions were gradually relaxed and more businesses were able to reopen.

At the end of February 2021, the take up rate of eligible employees that made a claim to HMRC under the furlough scheme was highest in those aged under 18 (34.1%) and those aged 18 to 24 (20.4%). Take up was lowest in those aged 45 to 64 at 13.4%.

The Self-Employment Income Support Scheme (SEISS) was announced on 26 March 2020 as part of the UK government’s support package for businesses and self-employed people during the coronavirus outbreak in early 2020. At the end of January 2021, the SEISS take-up rate was 65%.

Access to care and hospital admissions

During the pandemic, there has been concern that people are not accessing healthcare for non-Covid related health issues. Survey data collected during the period 6 July 2020 to 26 January 2021 show that of those people reporting that they had a worsening health condition in the preceding 7 days, around half reported that they had not sought advice for their condition. The most common reason for not doing so was to avoid putting pressure on the NHS.

There was a reduction in monthly elective and emergency hospital admissions in the period April to December 2020 in England compared with the monthly average for the equivalent months in 2018 and 2019 combined. This pattern was observed in men and women, and across all age groups, ethnic groups and deprivation deciles.

In children and young people, rates of hospital admissions from April to December 2020 for dental caries, asthma, diabetes, epilepsy, gastroenteritis, lower respiratory tract infections and following accidents were generally below the average rates in 2018 and 2019 for equivalent months.

Rates of admission following self-harm and assault for children and young people were generally below the average for 2018 and 2019 equivalent months for April to June 2020, rose in the second quarter to similar or slightly above this baseline level, and decreased to below the baseline level in the third quarter. This decrease was driven by a reduction in admissions for males, as admissions for females was above baseline in this quarter.

In older adults aged 65 and over, rates of hospital admissions for hip fractures from April to September 2020 were similar to in the average rates for 2018 and 2019 for equivalent months. Rates from October to December 2020 were below the 2018 and 2019 baseline level. These patterns were broadly consistent across age groups, sex, deprivation, ethnic groups and regions. Rates of hospital admissions due to injuries caused by falls from April to June 2020 were below the 2018 and 2019 baseline level, rose to similar levels from July to September 2020, and decreased back to below baseline from October to December 2020.

Cardiovascular disease

During the pandemic, there has been a reduction in the number of emergency admissions to hospital with cardiovascular related conditions. Weekly admissions for acute coronary syndromes (including heart attacks) and stroke were lower during the first national lockdown compared with the 2018 to 2019 average. From mid-June until 27 October, rates of admissions were similar to that of the 2018 to 2019 average and then admissions from acute coronary syndromes decreased below baseline to the end of December. The pattern was seen in both men and women. Reduced admissions during this period may result in increased out-of-hospital deaths, long-term complications and missed opportunities to provide secondary prevention treatment to patients.

Safeguarding

The rate of safeguarding referrals for those aged under 19 received by community health care services decreased in the period April to June 2020, the start of the pandemic, by 12.3% compared with the equivalent months in 2019. The referrals have significantly increased between July and September 2020 by 23.8% compared with the equivalent months in 2019.

Community delivered healthcare

Community delivered healthcare includes all health care related activities that are carried out in community settings such as health centres or in a patient’s own home. Rates of community delivered healthcare activity for the period April to November 2020 are lower compared with the same month in 2019. This trend is seen across all age groups but are most marked in the groups that would usually have the most contact with community delivered healthcare, such as children and some older adults.

Pregnancy and birth

There was a decrease in the percentage of premature birth deliveries in England during April and May 2020 compared with a monthly average baseline of combined data from April 2016 to March 2019. The rate was similar to baseline from June 2020 through to January 2021. The rate of low birthweight babies was significantly lower in October 2020 compared with the baseline. There were no statistically significant differences in other outcomes compared with baseline, such as the percentage of deliveries with very low birthweight in England or the percentage of deliveries which included one or more stillbirths.

The rate of maternity bookings appointments was significantly higher in April, September and December 2020 compared with the 2019 baseline. The rate was significantly lower than the baseline in May and August 2020 and about the same in June, July and November 2020.

Reproductive health

The rate of GP prescribed long acting reversible contraception (LARC) was significantly lower at the beginning of the first national lockdown than the monthly average from 2017/18 to 2019/20. Rates gradually increased from May to September and from October to December were closer to baseline nationally and in most regions. In January and February 2021 rates of prescription decreased compared to baseline levels.

Life expectancy

Life expectancy at birth is a key summary measure of mortality in the population. The England estimates for 2020 represent the average number of years a new-born baby would live if he or she experienced the national age-specific mortality rates for 2020 throughout his or her life. The figures reflect current mortality rates and are not the number of years a baby born in 2020 could actually expect to live, because mortality rates will change in the future. The life expectancy estimates are therefore an alternative way of presenting mortality rates, in order to show the impact of COVID-19 on levels of mortality in 2020.

The provisional estimates show that in 2020, life expectancy for both sexes in England was lower than in each of the previous 5 years. All English regions had falls in life expectancy between 2019 and 2020, with the biggest fall in London, for both sexes.

Data also show inequalities in life expectancy in England, and the English regions, for 2020, and each of the previous five years. These provisional data show falls in life expectancy across all deprivation deciles in England in 2020, compared with the same period in 2019. Inequality in life expectancy for England increased for both males and females. At regional level, there was variation in the trend in inequality over this time period.

Mortality rates

These data show the impact on inequalities for causes of death in 2020 where COVID-19 was not mentioned on the death certificate. Provisional mortality rates for cancer, stroke, circulatory disease, heart disease and respiratory disease were lower in 2020 compared to the baseline period (2015 to 2019) across all deprivation deciles. For dementia and Alzheimer’s disease, and digestive diseases, mortality rates in 2020 were similar to that of the baseline period.

How to use this Tool

Use the tabs at the top of the screen to move between the different metric groups.

Each tab provides a visualisation of the selected metric by different breakdowns and the trends over time for the metrics available.

1. Select the metric to display in the ‘Indicator’ drop down. The dashboard will populate with the selected data.
2. Select the breakdown you would like to display from the ‘Breakdown’ drop down.
3. Navigate between viewing charts, data tables and metadata using the tabs in each theme.
4. To see a single variable on a chart click on the variable name in the legend.
5. View data from previous releases using the 'Release Date' drop down.

Grocery purchasing and food usage

Social determinants of health

Mental health and wellbeing

Behavioural risk factors

Access to care

Air quality

Pregnancy and birth

Life expectancy

Mortality

COVID-19 Health Inequalities Monitoring for England (CHIME)

The COVID-19 Health Inequalities Monitoring for England (CHIME) tool brings together data relating to the direct impacts of COVID-19, such as on mortality rates and hospital admissions.

By presenting inequality breakdowns, including by age, sex, ethnic group, level of deprivation and region, the tool provides a single point of access to:

• show how inequalities have changed during the course of the pandemic and what the current cumulative picture is
• bring together data in one tool to enable users to access and utilise the intelligence more easily
• provide indicators with a consistent methodology across different datasets to facilitate understanding
• support users to identify and address inequalities within their areas and identify priority areas for recovery