Scoping the Indirect Health Effects of COVID-19: An Open Call for Resources

April 23, 2020

Although there have been attempts to quantify the number of deaths directly due to COVID-19, the number of deaths indirectly related to the novel coronavirus remains unknown. How many people have died because they cannot get to a doctor owing to transportation shutdowns? How many patients will be left without care as entire facilities are repurposed for COVID-19? With new information emerging daily, we would like your help in identifying which health services are being affected by COVID-19 with a focus low- and middle-income countries (LMICs). Our aim is to build an online open access inventory of accounts of indirect health effects of COVID-19, and to support researchers across the world, including at CGD, in their attempts to quantify these indirect health effects of COVID-19 and pragmatic approaches to minimize these effects. We aim to do this in a timely manner and to provide information for policymakers live—and we need your help!

“Crowding out” occurs when finite health care resources are reallocated to focus on an emerging disease or threat. This includes human capital, medicines, transportation, and supply chains being repurposed. Already, during the coronavirus pandemic we have seen health services suspended, displaced, or becoming inaccessible. In Wuhan, patients with severe and chronic diseases found themselves cut off from vital supplies of medicine because of the lockdown. Restrictions on travel due to lockdown policies can have disastrous consequences; for example, when governments have banned travel in private vehicles, women in labour have been forced to walk to hospitals and have consequently died. Those are few examples, but we believe to be many more out there. This invariably leads to more deaths, indirectly linked to the coronavirus pandemic.

History shows indirect effects on mortality during pandemic responses, such as the 2013-2016 Ebola virus pandemic, and the 2009-2010 H1N1 pandemic. The lessons we have learned from past outbreaks exemplify the harmful impacts that can result from an epidemic in the absence of focused responses to protect essential services. However, recommendations for pandemic responses often come years after the pandemic has been contained, and they are not always the same. The reasons for “crowding out” of health services and other indirect health effects can be complex and tied tightly to the health service context, and in the context of COVID-19, we have a lot to learn.

We would like to ask for your help by contributing to our tracker of stories of indirect health effects of COVID-19 in LMICs. We are crowdsourcing any information that you might have on this, in order to have a wider reach and to cover more countries. The more information we have, the more we can work to make practical and up to date recommendations to minimise lives lost during this pandemic around the world.

If you have any information on health services that are currently being affected around the world due to coronavirus, including journal and newspaper articles, blogs, or anecdotal information, please forward all to [email protected].


CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.

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