THERE are many moving parts in the response to a highly infectious disease such as COVID-19. In the acute phase, the focus is rightly on public health strategies to contain the pandemic or prevent new outbreaks.
Over the longer term, it’s critically important for policymakers and health services to understand what impact the COVID-19 pandemic – and the measures to control it – is having on the health and wellbeing of the population. Whatever the phase of the response, evidence to guide decision making is paramount. We need to know how the population is responding to public health orders, to changes in health services and to the rollout of vaccination programs so that the challenge of COVID-19 can be met with the best possible response.
Cohort studies are an important tool to gather evidence in a timely manner, particularly in response to unpredictable events. The Sax Institute’s 45 and Up Study has been tracking the health of over 260 000 NSW people over the age of 45 years for the past 14 years through regular follow-up surveys on health and well-being along with linkages to administrative data.
Early in the pandemic, a broad team of both policy and research collaborators came together to develop an approach to gathering evidence from 45 and Up participants about the impact of COVID-19 to inform the health sector response. As a result, the 2020 45 and Up follow-up survey included COVID-19 questions to shed light on the impact of the pandemic.
Since that time, thanks to a COVID-19 research grant from the NSW Government, a new rapid survey methodology has been implemented within the study called COVID Insights. This approach as seen over 60 000 participants in the 45 and Up study complete short COVID-focused surveys on a range of topics, including the pandemic’s impact on health, loneliness, lifestyle, physical activity, diet, sleep, alcohol use, access to health services, experiences with telehealth and more, providing data and insights that will help guide policy and health services in the coming months and years.
There are three more 45 and Up Study COVID Insights surveys to be conducted throughout 2021 and new evidence continues to emerge from them. To date, they have yielded some fascinating insights into the concerns and behaviour of people during the COVID-19 pandemic.
A key public health concern is how the COVID-19 pandemic and associated measures have affected people’s mental health. Surprisingly, we found that in 2020, a higher proportion of people in the study rated their quality of life as excellent or very good, compared with surveys from the previous two years. However, one in four still said their psychological health was worse and the same proportion reported some degree of psychological distress, demonstrating that the pandemic is having very different effects in different parts of the population. Men were less likely to suffer from high distress levels, while people aged between 56 and 65 years were more likely to experience high or very high levels of distress (8%) compared with older groups.
Loneliness due to lockdowns and restrictions, particularly among older people, has been another important issue. In our surveys, almost one in 10 people were intensely lonely in 2020, with 56% missing having other people around. Loneliness is associated with a number of poor health outcomes, including higher mortality and hospitalisation rates. Of respondents, 92% reported reduced personal contact outside their own household in 2020.
The pandemic has had an impact on health care provision well beyond the care of people infected with COVID-19. Forty per cent of people in the 45 and Up Study surveys reported missed or delayed access to health care services, including missed appointments with a dentist (25%), GP (16%) and medical specialist (12%). On the flip side, respondents were largely positive about telehealth, which expanded substantially in 2020. Nearly half of participants said they had received telehealth services, mostly by telephone. The experience was mostly good, with 56% of people of the opinion that it was just as good or better than a face-to-face visit, compared with only 28% who said it was worse.
We also found a changing pattern of exercise during the lockdown, with over a quarter of participants reporting spending less time on all forms of physical activity compared with the same time in the previous year, while 24% reported spending more time watching television.
Among the challenges faced by governments during the pandemic is the need for effective communication strategies to inform the public and provide advice on prevention. Three in five respondents reported being confused about the COVID-19 information they read or heard, with people from more disadvantaged areas more likely to feel this confusion. The most frequently accessed sources of information about COVID-19 prevention among participants was public service television and radio (72%), followed by commercial television and radio (45%) and newspapers (34%). Health care providers were the most trusted source of information – and yet the least accessed – closely followed by government information sources as the second most trusted. Social media was least used as an information source and by far the least trusted.
As Australia continues its rollout of COVID-19 vaccines, the latest survey in this 45 and Up Study series is providing vital information on attitudes to immunisation. Early insights have already shown strong public opinion on national vaccination, with 88% of respondents reporting they’ve had a vaccination to protect against illness in the past five years, an important indicator of likelihood to vaccinate in the future. When it comes to getting the COVID-19 vaccine, 86% said they think it will be important for their own health, while 84% agree getting the vaccine will protect others. Seven in ten would prefer to get their vaccination from a GP.
More detailed results from the surveys are still being processed, and there are more surveys planned in 2021 to gather further evidence on changes in mental health and attitudes towards vaccination. Importantly, the evidence generated through the 45 and Up study will continue to support an effective response to the pandemic and its impact on the population. The data will also be made available to approved researchers to help with future health research.
Dr Martin McNamara is Deputy CEO of the Sax Institute.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.