Pandemic trends in health care use: From the hospital bed to self-care with COVID-19

  1. Fredrik Methi
  2. Kjersti Helene Hernæs
  3. Katrine Damgaard Skyrud
  4. Karin Magnusson

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Abstract

To explore whether the acute 30-day burden of COVID-19 on health care use has changed from February 2020 to February 2022.

Methods

In all Norwegians (N = 493 520) who tested positive for SARS-CoV-2 in four pandemic waves (February 26 th , 2020 –February 16 th , 2021 (1 st wave dominated by the Wuhan strain), February 17 th –July 10 th , 2021 (2 nd wave dominated by the Alpha variant), July 11 th –December 27 th , 2021 (3 rd wave dominated by the Delta variant), and December 28 th , 2021 –January 14 th , 2022 (4 th wave dominated by the Omicron variant)), we studied the age- and sex-specific share of patients (by age groups 1–19, 20–67, and 68 or more) who had: 1) Relied on self-care, 2) used outpatient care (visiting general practitioners or emergency ward for COVID-19), and 3) used inpatient care (hospitalized ≥24 hours with COVID-19).

Results

We find a remarkable decline in the use of health care services among COVID-19 patients for all age/sex groups throughout the pandemic. From 83% [95%CI = 83%-84%] visiting outpatient care in the first wave, to 80% [81%-81%], 69% [69%-69%], and 59% [59%-59%] in the second, third, and fourth wave. Similarly, from 4.9% [95%CI = 4.7%-5.0%] visiting inpatient care in the first wave, to 3.6% [3.4%-3.7%], 1.4% [1.3%-1.4%], and 0.5% [0.4%-0.5%]. Of persons testing positive for SARS-CoV-2, 41% [41%-41%] relied on self-care in the 30 days after testing positive in the fourth wave, compared to 16% [15%-16%] in the first wave.

Conclusion

From 2020 to 2022, the use of COVID-19 related outpatient care services decreased with 29%, whereas the use of COVID-19 related inpatient care services decreased with 80%.

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  1. Version published to 10.1371/journal.pone.0265812
  2. ScreenIT

    SciScore for 10.1101/2021.07.09.21260249: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: The Ethics Committee of South-East Norway confirmed (June 4th 2020, #153204) that external ethical board review was not required.
    Sex as a biological variableWe divided our population into mutually exclusive age and sex groups, i.e. girls and boys, men and women by the following age categories: 1-19 (children and adolescents), 20-67 (working age population) and 68 years or older (elderly).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    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:
    Several limitations should be mentioned. First, we do not know the causes or severity of complaints behind the care use following a positive test for SARS-CoV-2. Although we only included care visits with diagnostic codes of COVID-19, we could not separate the complaints affecting e.g. the respiratory or digestive system. Also, we had no comparison group, simply because we did not aim for any causal inference and because comparable data are not available for a similar epidemic or pandemic setting with other infectious diseases. However, in recent studies of post-acute COVID-19, we demonstrate a likely causal effect of being infected with SARS-CoV-2 on the post-acute health care use [14]. Here, we also exclusively included visits that were specific to COVID-19, i.e. we did not study all-cause visits. Second, our study was of an explorative and descriptive character. Thus, we looked for patterns and trends in a large amount of data using mainly graphs in a self-developed structure, such as the division of age into children and adolescents, adults in working age population and the elderly, and by sex. We did not apply any data-driven analyses in our exploration of pandemic trends in health care use, thus we might have missed important details. To combat some of these issues, we chose to present a large amount of raw data visualized as alluvial diagrams in the supplementary files (S-Figure 1). Third, we may have underestimated the care use among persons aged 68 years or more. Ver...

    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.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.07.09.21260249v1 on medRxiv