Introduction and Headlines

Internationally, the COVID-19 pandemic of 2020, 2021, 2022 and 2023 has had a devastating impact on morbidity and mortality, and with no current indication of it abating it is likely it will continue to be a worldwide concern throughout subsequent years. The poor and declining state of health of the UK population, as the virus arrive result in greater levels of death in the UK compared with equally rich countries.

The impact of COVID-19 has hit our poorest hardest in two major ways across the East Riding, directly from the disease and indirectly via disruption to the conditions of living. Many of the occupations that our poorest are employed in, where those most exposed to the virus such as care workers. Sadly this translated in the early waves too many of those essential workers falling ill and in the worst cases dying from coronavirus.

The pandemic disrupted much of the usual health care activity, delays in diagnosis and subsequent treatment due to the NHS having to respond, has created a growing burden of ill health and poorer wellbeing for our population. Disease burden is causing physical and mental wellbeing to deteriorate across groups of people often who are most vulnerable in society. The distribution of where this growing burden is felt is not equal across the East Riding, those in our poorest communities are experiencing greater levels of ill health, poorer mental health and deteriorating social connectedness.

As the pandemic progress the economic impacts of distribution to supply chains began driving the cost of goods and services upward. Economic hardship faced by many in our county because of the pandemic is having lasting effects on communities. As this grows the poorest in society are finding it harder to access services, who are often the most in need of these, further compounding the late presentation/need for more acute support

• Over 1400 people have died from coronavirus in the East Riding, 477 of these occurred since changing to the living with COVID stance on the 19th July 2021 nationally.
• Premature death (those <75 years old) in the last 3 years has increased 
• Premature death has occurred more in our poorest communities. 
• Cardiovascular diseases in the last 3 years has killed more people than COVID for those under 75. 

The Need

Premature Mortality defined as those dying before their 75th birthday, through the pandemic and in to present time this has been unfairly experienced by those poorest in the East Riding. COVID-19 related deaths were felt unequally with our poorest being most likely to have died from COVID-19, but pattern is worst in terms of all causes as per below. the ongoing burden of ill health is continuing, with excess deaths in the East Riding continuing to be high.

Visual

Source; NHS Primary Care Mortality Database

Service Usage

Source: Fingertips National Practice Profiles

Source: Fingertips National Practice Profiles

Source: Fingertips National Practice Profiles

Insight

Loneliness and anxiety

The impact of loneliness was referred to on several occasions for children, adults and the elderly. The requirement of some residents having to isolate alone due to the lockdowns or due to having an infection meant there was an absence of contact with friends, family and colleagues.  Once lockdowns were lifted there were high levels of anxiety reported where people had to get out to access services.  This was particularly noticeable with learning disability services, as people returned to day services but didn’t want to exposure to the wider community, instead preferring to remain in small bubbles. Many adults suffering from low confidence, a lack of motivation and not re-engaging with society.  Large numbers of social places such as pubs and gyms had closed for part of the pandemic.  For some there was the stress of having to go to work either with Covid or the fear of catching Covid as the nature of their jobs did not allow them to work from home.  To compound this issue, the full impact may never be fully appreciated as people are not readily willing to communicate it.

Deconditioning and increased frailty in older people

The threat of deconditioning and increased frailty in the East Ridings older population was mentioned in numerous responses by partners.  The requirement to isolate had had a negative effect on both mental and physical health, reducing independence and an increase in the risk of falls. Residents with dementia were highlighted as having a more rapid increase in cognitive decline due to reduced social activity and a loss of routine in their daily lives.  Falls were reported to be an issue due lack of podiatry and some people living in residential care still making up ground in terms of foot care.

Low level mental health issues in adults increasing in severity

There were reports of issues relating to low level mental health (depression and anxiety) increasing due to financial hardships brought on by pandemic (including unemployment) and bereavement.  Some mental health services reported that whilst they hadn’t seen an increase in mental health referrals, the severity of issues was worse. 

Education interrupted

Tyler D & Lawer D (2021) stated that having to conduct schooling at home and join lessons online was often demotivating for many children and sometimes difficult to participate in as not all children are fully competent in using computers nor have the equipment needed to participate (such as a reasonably fast broadband connection) or simply may not have the space to set it all up within the home environment.  Whilst many young people who responded to surveys that supported the research said they were happy not having to go into school or college during the pandemic, this was not the case for all young people.  The research found that young people felt de-motivated and worried about their futures with regard to their education

Unemployment                                                              

The disruption caused by the pandemic over the past 2 years has been extremely have been very challenging for businesses in the UK. Many were put into an impossible situation of employees not being able to attend work nor could customers buy their products. Many employees were put onto the furlough via the governments Coronavirus Job Retention Scheme, losing at least part of their income, whilst others lost their jobs completely.  Those companies hit hardest included restaurants, theatres and construction companies.  Even as lockdown measures ease and consumer demand recovers, surging inflation, labour shortages and uncertainty about future sales present several obstacles ahead

Assets

Below are local voluntary sector organisations and assets across the East Riding

Resources

Full needs assessment document Health Impact Assessment of COVID-19 in ERY (PHI 2023) v3