The impact of COVID-19 on health systems
By Louis Torronde , November 8 2020
Covid-19 has caused more than 1,200,000 deaths since the onset of the pandemic in December 2019. This figure will evolve steadily before vaccines or treatments are found and produce their effects. This uninterrupted evolution of positive cases and deaths linked to Covid-19 has led the WHO to consider the pandemic as the 3rd most deadly disease in the world after tuberculosis and liver diseases. This classification is a response to the different readings and interpretations of health data that relativize the dangerousness of the pandemic and its comparison with other diseases.
This observation is shared throughout the United States, for example, where Covid-19 is the leading cause of death from heart disease and cancer.
Moreover, a European study on the evolution of mortality in 2020 clearly demonstrates the impact of Covid-19 on deaths by age group and in the countries most affected by the pandemic, such as France, Italy, the Netherlands, Belgium, Spain or England for example.https://euromomo.eu/graphs-and-maps/
In France, in particular, the number of deaths in hospitals is expected to increase by more than 16% in March/April 2020 and by more than 50% in retirement homes. Similarly, the number of deaths of people over 75 years old in France is expected to increase by approximately 30% between 2019 and 2020
The situation is identical in the United States, where the average number of deaths generally observed has been greatly exceeded since April 2020.
On an American scale, the evolution of the pandemic clearly shows the different waves and the way they have affected the American states: from March to June in the Northeastern states, since July in Florida and Texas, or over the entire period starting in March for California in particular.
Most countries decide on health measures to protect populations but also to avoid overloading their health systems because these systems are not calibrated to cope with severe epidemic episodes over a relatively long period of time, even if the issues differ from one country to another.
In the case of France, for example, the country has had to take measures to compensate for the successive budget cuts that have led to a reduction in the number of available beds by giving priority to just-in-time operation with a minimum of spare beds.
In the case of Germany, the government took into account a higher saturation threshold than in France because of a much higher number of available beds, which raises questions about its cost and overcapacity in normal times.
England faces another problem since a study conducted by the National Health Service highlights a significant number of deaths due to waiting times in normal times, hence the choice to set up military hospitals in the event of saturation of the system.
However, these measures have not prevented a certain saturation of the health systems of many countries with the appearance of a large influx of patients. It was then necessary to organize and plan a hierarchy in the care of patients in hospitals, as in France, for example.
Responses to the epidemic closely link the number of available beds to the number of deaths in the population. This correlation is clear for some countries, such as Germany, Japan and South Korea, which are the countries with the most hospital beds per capita and one of the lowest numbers of deaths.
For Iran, India, Mexico, Brazil and Peru the situation is reversed, as these are the countries with more than 100 hospital beds and one of the highest numbers of deaths.
Other variables should be taken into account for countries in the middle of the ranking such as the United States, European countries, New Zealand or Canada: if New Zealand ranks 81st and Canada 89th for hospital beds but they are among the countries with the fewest Covid-related deaths, rapid containment measures should be linked to this ranking. For the United States and Great Britain the low number of available beds and the late implementation of containment measures is accompanied by a high number of deaths.
The number of hospital beds or restrictive measures are not the only variables involved, as countries also find themselves in difficulty because of the way their health systems are financed. In the case of the United States, for example, the financing of the system and personnel is mainly done through revenues from interventions offered to patients. With the influx of patients linked to Covid-19 that do not require specific technical interventions, the sources of financing are drying up, making it impossible to finance part of the dedicated personnel and reducing the capacity to take care of a growing number of patients.
In addition, in countries with a low level of public social protection, such as the United States, a number of patients are denied access to healthcare because the cost to the patient remains too high.
In the United States in particular, this system is running up deficits: the American Hospital Association estimates the loss due to Covid-19 for the American healthcare system at 323 million dollars.
The adaptation of emergency services and the hospital system varies from one country to another. In particular, some countries have developed decentralized care centers for hospital emergencies, as Martin Hirsch, head of public assistance – Paris hospitals, reminds us, whereas the French-style centralized system puts pressure on French hospitals and saturates their reception capacity.
The adaptations implemented all tend towards the same common goal, that of focusing efforts on those patients who have a chance of recovering. Some countries have chosen to prioritize the reception of patients in healthcare institutions, to favor the transfer of patients between regions of the same country, or by calling on international solidarity to welcome patients, as was the case in France.
Others choose to welcome foreign health care personnel to complement the national staff, as was the case in Italy. Still others favour the installation of field and military hospitals, as in Great Britain and New York in the spring of 2020.
However, if the impact of Covid-19 on the saturation of certain health establishments is real, the mortality statistics remain delicate to evaluate in particular at the beginning of the pandemic and in the retirement homes in particular in the absence of test and precise counting as of March 2020. In many countries, the lack of rapid social distancing measures in retirement homes has been the trigger for the high mortality rate in these institutions, as was the case in Canada, for example.
It will be several months or years before a definitive assessment of the impact of Covid-19 on the mortality of the world population can be made, because the waves of contaminations are far from over and will continue until a virus has been discovered and cross-checks on the different causes of mortality during the period when the coronavirus is present have not been established. As a reminder, we had to wait 4 years in France to have a definitive assessment of the mortality linked to the 2003 heat wave.