Abstract
ObjectivesThe growth of COVID-19 infections in England raises questions about system vulnerability. Several factors that vary across geographies, such as age, existing disease prevalence, medical resource availability and deprivation, can trigger adverse effects on the National Health System during a pandemic. In this paper, we present data on these factors and combine them to create an index to show which areas are more exposed. This technique can help policy makers to moderate the impact of similar pandemics.DesignWe combine several sources of data, which describe specific risk factors linked with the outbreak of a respiratory pathogen, that could leave local areas vulnerable to the harmful consequences of large-scale outbreaks of contagious diseases. We combine these measures to generate an index of community-level vulnerability.Setting91 Clinical Commissioning Groups (CCGs) in England.Main outcome measuresWe merge 15 measures spatially to generate an index of community-level vulnerability. These measures cover prevalence rates of high-risk diseases; proxies for the at-risk population density; availability of staff and quality of healthcare facilities.ResultsWe find that 80% of CCGs that score in the highest quartile of vulnerability are located in the North of England (24 out of 30). Here, vulnerability stems from a faster rate of population ageing and from the widespread presence of underlying at-risk diseases. These same areas, especially the North-East Coast areas of Lancashire, also appear vulnerable to adverse shocks to healthcare supply due to tighter labour markets for healthcare personnel. Importantly, our index correlates with a measure of social deprivation, indicating that these communities suffer from long-standing lack of economic opportunities and are characterised by low public and private resource endowments.ConclusionsEvidence-based policy is crucial to mitigate the health impact of pandemics such as COVID-19. While current attention focuses on curbing rates of contagion, we introduce a vulnerability index combining data that can help policy makers identify the most vulnerable communities. We find that this index is positively correlated with COVID-19 deaths and it can thus be used to guide targeted capacity building. These results suggest that a stronger focus on deprived and vulnerable communities is needed to tackle future threats from emerging and re-emerging infectious disease.
Highlights
The current COVID-19 outbreak is triggering a renewed understanding of health risks and underlying health vulnerabilities.[1]
Online supplemental figure S2 depicts the Clinical Commissioning Groups (CCGs)-level distribution of population prevalence for six diseases chosen with the aim of assessing the susceptibility of the system to healthcare demand shocks from the spread of COVID-19
In this article, we have presented an Index of Vulnerability to map the vulnerability of the English healthcare system to the unexpected and combined consequences of demand-related and supply-related pressures associated with infectious disease outbreaks such as the COVID-19 pandemic
Summary
The current COVID-19 outbreak is triggering a renewed understanding of health risks and underlying health vulnerabilities.[1]. Accumulated evidence from emerging and re-emerging infectious diseases, such as SARS, swine influenza, Middle East respiratory syndrome (MERS) and COVID-19, indicates that infections requiring critical care, and associated case fatalities, are usually, but not exclusively, concentrated in elderly patients, and in patients suffering from specific comorbidities, such as chronic obstructive pulmonary disease, cardiovascular diseases, diabetes, cancer, chronic kidney disease (CKD).[2,3,4,5]. Risk of transmission and may suffer from the physical and psychological impact of sudden surges in workloads that come with high case fatalities.[6 7] Lack of resources available to healthcare providers and suboptimal quality of health services in a community represent a further source of vulnerability, which hamper the supply of critical care, puts patients at higher risk of negative health outcomes, and endanger the safety of health workers.[8 9]
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