Describing the indirect impact of COVID-19 on healthcare utilisation using syndromic surveillance systems

Claire F. Ferraro*, Lucy Findlater, Roger Morbey, Helen E. Hughes, Sally Harcourt, Thomas C. Hughes, Alex J. Elliot, Isabel Oliver, Gillian E. Smith

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Since the end of January 2020, the coronavirus (COVID-19) pandemic has been responsible for a global health crisis. In England a number of non-pharmaceutical interventions have been introduced throughout the pandemic, including guidelines on healthcare attendance (for example, promoting remote consultations), increased handwashing and social distancing. These interventions are likely to have impacted the incidence of non–COVID-19 conditions as well as healthcare seeking behaviour. Syndromic Surveillance Systems offer the ability to monitor trends in healthcare usage over time. 

Methods: This study describes the indirect impact of COVID-19 on healthcare utilisation using a range of syndromic indicators including eye conditions, mumps, fractures, herpes zoster and cardiac conditions. Data from the syndromic surveillance systems monitored by Public Health England were used to describe the number of contacts with NHS 111, general practitioner (GP) In Hours (GPIH) and Out-of-Hours (GPOOH), Ambulance and Emergency Department (ED) services over comparable periods before and during the pandemic. 

Results: The peak pandemic period in 2020 (weeks 13–20), compared to the same period in 2019, displayed on average a 12% increase in NHS 111 calls, an 11% decrease in GPOOH consultations, and a 49% decrease in ED attendances. In the GP In Hours system, conjunctivitis consultations decreased by 64% and mumps consultations by 31%. There was a 49% reduction in attendance at EDs for fractures, and there was no longer any weekend increase in ED fracture attendances, with similar attendance patterns observed across each day of the week. There was a decrease in the number of ED attendances with diagnoses of myocardial ischaemia. 

Conclusion: The COVID-19 pandemic drastically impacted healthcare utilisation for non-COVID-19 conditions, due to a combination of a probable decrease in incidence of certain conditions and changes in healthcare seeking behaviour. Syndromic surveillance has a valuable role in describing and understanding these trends.

Original languageEnglish
Article number2019
Number of pages11
JournalBMC Public Health
Issue number1
Publication statusPublished - 5 Nov 2021

Bibliographical note

Funding Information: CFF, LF and IO receive support from the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation. GES, RM and AJE receive support from the NIHR HPRU in Emergency Preparedness and Response. GES, HEH and AJE receive support from the NIHR HPRU in Gastrointestinal Infections.

The views expressed are those of the author(s) and not necessarily those of the NIHR, Public Health England or the Department of Health and Social Care.

Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Publisher Copyright: © 2021, The Author(s).

Citation: Ferraro, C.F., Findlater, L., Morbey, R. et al. Describing the indirect impact of COVID-19 on healthcare utilisation using syndromic surveillance systems. BMC Public Health 21, 2019 (2021).



  • Coronavirus
  • Epidemiology
  • Healthcare utilisation
  • Pandemic
  • Syndromic surveillance
  • Viral


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