Beyond the tip of the iceberg: direct and indirect effects of COVID-19.
Beyond the tip of the iceberg: direct and indirect effects of COVID-19.
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DOI：
10.1016/s2589-7500(21)00024-8
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发表时间：
2021-04
期刊：
影响因子：
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通讯作者：
Del Grande C
中科院分区：
文献类型：
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作者：
Kaczorowski J;Del Grande C
随着我们进入COVID-19大流行的第二个年头，全球确诊死亡人数超过200万，1越来越明显的是，尽管这一统计数字是悲惨和严峻的，但就对世界各地人民的社会、经济、心理和身体健康造成的附带损害而言，这可能只是冰山一角。此外，这些后果中的许多不仅会在未来数月或数年内产生影响，还会对不同社会和社会中的特定亚群体产生不平等和深远的影响。凯瑟琳曼斯菲尔德及其同事2在《柳叶刀数字健康》上发表的研究既及时又相关，因为全球许多司法管辖区已经实施或正在实施第二波和第三波封锁。作者使用了英国近1000万人的全国代表性样本的电子初级保健健康记录（占总人口的13%），以描述和量化截至7月COVID-19限制措施对精神健康、急性酒精相关事件、哮喘和慢性阻塞性肺疾病恶化以及心血管和糖尿病紧急情况的每周初级保健接触的间接影响，2020.结果显示，在2020年3月实施封锁后，这些身体和精神健康状况的每周初级保健接触显着下降，除不稳定型心绞痛和急性酒精相关接触外，仍低于封锁前的水平。作者得出结论，这些减少可能代表未满足需求的巨大负担（特别是精神健康状况），对随后的发病率和过早死亡率有潜在影响。关于精神健康接触的调查结果尤其令人不安。尽管根据封锁前水平计算的历史平均值对于分析中所包括的其他情况而言相当合适，但由于疫情及相关限制引发的压力，未得到解决的精神健康问题的可能负担可能比报告的更大。3，4封锁的其他附带损害已对一系列非急性
As we enter the second year of the COVID-19 pandemic, with more than 2 million confirmed deaths worldwide, 1 it is increasingly apparent that, as tragic and grim as this statistic is, it might be just the tip of the iceberg with respect to the collateral damage inflicted on the social, economic, psychological, and physical wellbeing of people around the world. Furthermore, many of these consequences will not only reverberate for months and years to come, but will also have unequal and profound effects on different societies and specific subgroups within societies.The study by Kathryn Mansfield and colleagues2 in The Lancet Digital Health is both timely and relevant as many jurisdictions around the world have implemented or are in the process of implementing second and third waves of lockdowns. The authors used electronic primary care health records of a nationally representative sample of nearly 10 million people in the UK (13% of the total population) to describe and quantify the indirect effects of COVID-19 restriction measures on weekly primary care contacts for mental health, acute alcohol-related events, asthma and chronic obstructive pulmonary disease exacerbations, and cardiovascular and diabetic emergencies up to July, 2020. The results showed that weekly primary care contacts for these physical and mental health conditions fell significantly after the introduction of lockdowns in March, 2020, and—with the exception of unstable angina and acute alcohol-related contacts—remained below pre-lockdown levels. The authors concluded that these reductions were likely to represent a substantial burden of unmet need (particularly for mental health conditions), with potential implications for subsequent morbidity and premature mortality. The findings around mental health contacts are particularly disturbing. Although the historical averages based on pre-lockdown levels are quite appropriate for other conditions included in the analysis, the possible burden of unmet mental health problems might have been even greater than reported as a result of the stressors induced by the pandemic and related restrictions. 3, 4 Other collateral damage of the lockdowns has been to patients with a range of non-acute