Impact of the COVID-19 pandemic on gastrointestinal infection trends in England, February–July 2020

  1. Nicola K Love
  2. Alex J Elliot
  3. Rachel M Chalmers
  4. Amy Douglas
  5. Saheer Gharbia
  6. Jacquelyn McCormick
  7. Helen Hughes
  8. Roger Morbey
  9. Isabel Oliver
  10. Roberto Vivancos
  11. Gillian Smith

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Abstract

To establish the impact of the first 6 months of the COVID-19 outbreak response on gastrointestinal (GI) infection trends in England.

Design

Retrospective ecological study using routinely collected national and regional surveillance data from seven UK Health Security Agency coordinated laboratory, outbreak and syndromic surveillance systems using key dates of UK governmental policy change to assign phases for comparison between 2020 and historic data.

Results

Decreases in GI illness activity were observed across all surveillance indicators as COVID-19 cases began to peak. Compared with the 5-year average (2015–2019), during the first 6 months of the COVID-19 response, there was a 52% decrease in GI outbreaks reported (1544 vs 3208 (95% CI 2938 to 3478)) and a 34% decrease in laboratory confirmed cases (27 859 vs 42 495 (95% CI 40 068 to 44 922)). GI indicators began to rise during the first lockdown and lockdown easing, although all remained substantially lower than historic figures. Reductions in laboratory confirmed cases were observed across all age groups and both sexes, with geographical heterogeneity observed in diagnosis trends. Health seeking behaviour changed substantially, with attendances decreasing prior to lockdown across all indicators.

Conclusions

There has been a marked change in trends of GI infections in the context of the COVID-19 pandemic. The drivers of this change are likely to be multifactorial; while changes in health seeking behaviour, pressure on diagnostic services and surveillance system ascertainment have undoubtably played a role, there has likely been a true decrease in the incidence for some pathogens resulting from the control measures and restrictions implemented. This suggests that if some of these changes in behaviour such as improved hand hygiene were maintained, then we could potentially see sustained reductions in the burden of GI illness.

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  1. Version published to 10.1136/bmjopen-2021-050469
  2. ScreenIT

    SciScore for 10.1101/2021.04.06.21254174: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analyses were performed using Stata software version 14.2.
    Stata
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are further limitations to this work; it has not been possible to definitively differentiate the relative contributions of the reduced ascertainment of GI infections versus a true decrease in GI disease burden in this study, which an additional focussed analysis could address. An additional limitation of this study is that negative results are not captured by the SGSS laboratory surveillance system, therefore it was not possible to determine to what degree the changes were due to changes in testing. We were not able to calculate the positivity rate to assess whether only severe cases were being tested, although evidence from the North East suggested that symptomatology was comparable between 2020 cases and historic cases. Guidance was released in week 13 recommending the cessation of routine culture for non-bloody diarrhoea might be considered if laboratories were struggling to deliver the service [35]. However, by then laboratory confirmed cases were beginning to increase again, while other contemporaneous changes implemented to GI laboratory testing methods, such as the introduction of molecular methods could differentially affect ascertainment of GI pathogens. Furthermore, the smallest decreases in laboratory confirmed GI infections were observed in the North West and North East regions, which had the highest cumulative rates of COVID-19 over this time period [15], suggesting either increased laboratory capacity for both the identification of COVID-19 and GI infectio...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.04.06.21254174v2 on medRxiv
  4. Version published to 10.1101/2021.04.06.21254174v1 on medRxiv