Experiences of some groups disproportionately affected by the pandemic  - PowerPoint Presentation

1. Experiences ofsome groups disproportionately affected by the pandemic Technical supplement 4 for theCOVID-19 impact inquiry reportJuly 2021

2. About this slide deckThis is the first in a series of four slide decks that accompany the COVID-19 impact inquiry report. These slide decks provide additional evidence and analysis to support arguments made within the main report for readers who are interested. Specifically, these slides contain: downloadable versions of the figures presented in the report. These can be copied and used as long as credit is given to the Health Foundation: Originally published by the Health Foundation as part of its COVID-19 impact inquiry [link].analysis referenced in the report where details are not published elsewhereadditional charts produced as part of the analysisselected evidence that was reviewed as part of the inquiry but not included in the report.This slide deck relates to section five of the report. The slides follow the sequence of the points made in the report. If you have any queries about the content of these decks, please contact COVID-19impactinquiry@health.org.uk.  July 2021Slide 2COVID-19 impact inquiry: technical supplement

3. Care home residentsDisabled peopleEthnic minority communitiesYoung peopleJuly 2021Slide 3COVID-19 impact inquiry: technical supplement

4. 1.Care home residents

5. COVID-19 mortality in care homes A study comparing deaths among care home residents across 22 countries – including the UK, Australia, Hong Kong, Brazil, Canada, Israel and other European countries (Comas-Herrera et al. 2020 - October 2020 and February 2021 ) – found that:On average, for the 22 countries in the report, 0.73% of their population lived in care homes. However, until January 2021, on average 41% of all COVID-19 deaths were among care home residents. In the UK, 0.75% of the population lived in care homes. During the first wave, 44% of COVID-19 deaths were care home residents. Counting deaths up to mid-January 2021, this figure fell to 34%.  By mid January 2021, 7.22% of care home residents in the UK had died due to COVID-19. The share of care home residents who died varied from 0.01% to over 9%. This variation was highly correlated to the mortality rate for those living outside of care homes. In other words, care home mortality tended to be higher where mortality in the community was higher. July 2021Slide 5COVID-19 impact inquiry: technical supplement

6. Excess mortality among care home residents in England and WalesReport figure 11Excess mortality in care homes, England and Wales,January 2020 to May 2021 Excess deaths in care homes at the start of 2020 were below the average of the last five years due to fewer flu deaths over winter 2020/21. At the peak of the first wave, there were over 200% excess deaths among care home residents.By June 2020 there had been over 25,000 excess deaths in care homes.  This level was not seen in the second wave – more action was taken to prevent outbreaks in these settings.July 2021Slide 6COVID-19 impact inquiry: technical supplement

7. Differences in mortality across care homes COVID-19 outbreaks in care homes did not vary by area deprivation. However, deaths related to COVID-19 were 16-23% more common in the most deprived areas compared with the least deprived areas (Bach-Mortensen and Esposti 2020). London and the North of England had the highest number of deaths per care home bed – almost twice that in other areas of England. (Health Foundation 2020). The Vivaldi study found that care homes with high infection rates among residents were associated with use of agency staff, lack of sick pay for staff and worse staff-to-bed ratios. (Shallcross et al. 2021)July 2021Slide 7COVID-19 impact inquiry: technical supplement

8. Access to health and social careHealth Foundation analysis found that:In September 2020, 12,150 fewer adults aged 65 or over were supported in care homes than in March 2020 – a reduction of 10.5%. Compared with 2019, 10% more requests for local authority-funded support resulted in signposting to other services for adults aged 65 or over. Care home residents had reduced access to health care between March and May 2020, compared with same period in 2019 (Grimm et al. 2021). Emergency admissions (excluding for COVID-19) fell by 36% for residential care and by 38% for nursing home residents. Elective hospital admissions fell by 64% for residential care and by 61% for nursing home residents. The largest drop was in admissions for eye conditions, with a 81% fall in admissions for cataract surgeries among residential care and nursing home residents alike. July 2021Slide 8COVID-19 impact inquiry: technical supplement

9. Mental health & wellbeingThere was limited evidence available detailing first hand accounts of the impact of the pandemic on care home residents. In a survey by Healthwatch Coventry, relatives of people in care homes reported seeing a decline in their family members' health and wellbeing. Healthwatch Leeds reported that 50% of relatives said their family members’ emotional wellbeing was worse than before lockdown. They reported that residents who were confined to rooms or isolating became increasingly immobile and their physical health worsened.July 2021Slide 9COVID-19 impact inquiry: technical supplement

10. 2.Disabled people

11. COVID-19 mortality rate by disability statusReport figure 12Age-standardised mortality rates for deaths related to COVID-19 among 30 to 100-year-olds by self-rated disability status, England, January 2020 to November 2020 Disabled people had higher rates of COVID-19 mortality. Women who were disabled had a mortality rate of more than four times that for non disabled women. For men, the rate was more than three times. July 2021Slide 11COVID-19 impact inquiry: technical supplement

12. Social impacts by disability statusReport figure 13Wellbeing and effect of social restrictions by disability status, Great Britain, February 2021In February 2021, disabled people had less access to health care, groceries, medication and essentials than non-disabled people. More disabled people reported that their relationships and wellbeing were being affected by the pandemic compared to non-disabled people.July 2021Slide 12COVID-19 impact inquiry: technical supplement

13. Disabled people reported impact on their mental wellbeing: ONS found that disabled people reported lower happiness and life satisfaction levels from April 2020 to February 2021 compared to 2019. A survey by Glasgow Disability Alliance found that 82% of respondents were concerned about social isolation. Almost half of respondents to a survey conducted by the Research Institute for Disabled Consumers reported feeling extremely concerned about not seeing family. ONS found that disabled people with mental health, social, behavioural, learning or memory impairments were more likely to report that their wellbeing and health was impacted: 65% of disabled people reported that their wellbeing was negatively impacted, compared with 50% of non-disabled people. For those with mental health, social or behavioural, learning and memory impairments, the figure was 85%, 81%, 79% and 76% respectively. 35% of disabled people reported that health was negatively impacted, compared with 12% of non-disabled people. This was higher among disabled people with impairments related to mental health (49%), memory (46%), learning (44%), stamina (43%) and dexterity (42%). WellbeingJuly 2021Slide 13COVID-19 impact inquiry: technical supplement

14. Access to supports and servicesIn September 2020, ONS reported that disabled people were more likely than non-disabled people to have their treatments cancelled or reduced. For 27%, treatment continued as normal compared with 44% of non-disabled people.  Mencap surveyed carers of people with a learning disability and found that 69% had their social care reduced during the first wave. A survey by Greater Manchester Disabled People’s Panel found that 80% of disabled people did not receive a letter from the government identifying them as being ‘high risk’. Within this group, 57% reported having support needs. Of these, only 19% reported getting all their needs met and 10% reported having none of their needs met. Inclusion London reported that disabled people had difficulty accessing supermarkets during the first wave, as reasonable adjustments were not made. Other issues included food boxes for the clinically extremely vulnerable not meeting dietary needs. The report found that 60% struggled to access food and medicine.The Glasgow Disability Alliance reported that a lack of adjustments to disabled people’s needs and negative attitudes faced by those with sensory and invisible impairments added to difficulties leaving the house and shopping.July 2021Slide 14COVID-19 impact inquiry: technical supplement

15. 3.Ethnic minoritycommunities

16. COVID-19 mortality by ethnicity - malesReport figure 14aRisk of COVID-19 mortality relative to those of white ethnicity in England (January 2020 to March 2021)Males from ethnic minority communities had an increased risk of COVID-19 mortality in wave one and two.The risk was higher in the second wave for those from Pakistani and Bangladeshi backgrounds but lower for other ethnic minority communities.  Rates are adjusted for demography, socio-economic factors and health conditions.     July 2021Slide 16COVID-19 impact inquiry: technical supplement

17. COVID-19 mortality by ethnicity - femalesReport figure 14bRisk of COVID-19 mortality relative to those of white ethnicity in  England (January 2020 to March 2021)Females from ethnic minority communities had an increased risk of COVID-19 mortality in the first two waves. The risk was higher in the second wave for those from Pakistani and Bangladeshi backgrounds but lower for other ethnic minority communities.Rates are adjusted for demography, socio-economic factors and health conditions.     July 2021Slide 17COVID-19 impact inquiry: technical supplement

18. MigrantsCompared with UK-born white British people, all migrants from ethnic minority communities were three times more likely to experience job loss.Migrants from ethnic minority communities were 1.2 times more likely to experience household income loss compared to UK-born white British people. However, probability of income loss was similar among white migrants as for UK born ethnic minority communities (Hu 2020).July 2021Slide 18COVID-19 impact inquiry: technical supplement

19. 4.Young people

20. Mental healthYoung people have suffered disproportionately worse mental health outcomes than adults (Daly et al. 2020). A survey of 16,338 people, where over 76% had personal experience of mental health problems, conducted during the first lockdown by MIND found that:1 in 4 young people were self-harming to cope1 in 3 were drinking alcohol or using illegal drugsmore than 1 in 2 were over or under eating to cope.Summarising a range of data, the Health Foundation showed that some groups such as care-experienced young people, those with pre-existing mental health conditions, young people not in education, employment or training and disabled young people were more severely affected. July 2021Slide 20COVID-19 impact inquiry: technical supplement

21. Mental health support and servicesThe Royal College of Psychiatrists reported that: 80,226 more children and young people were referred to Children and Young People’s mental health services between April and December 2020: an increase of 28% from the same period in 2019. the number of treatment sessions increase by one-fifth18% more children and young people needed urgent or emergency crisis care.NHS England reported that between March and July 2020:7.2% of young people received mental health services as normal and the same proportion had their sessions remotely. 3.5% had their sessions cancelled and 7.4% tried to seek support but did not receive it. the remainder did not need any support. YoungMinds found, in a survey of 2,438 young people aged 13-25 who have looked for mental health support previously in their lives, that in January 2021:24% of young people who needed mental health support reported having looked for it but not received it. 54% had accessed some supportthe remaining 22% had not looked. July 2021Slide 21COVID-19 impact inquiry: technical supplement

22. Learning The IFS 'making utilising time-use' surveys found that:primary and secondary school pupils spent 4.5 hours a day on school learning in the first lockdown, compared to 6 hours and 6.6 hours in school, respectively before the pandemic. the least deprived third of pupils spent more time (5.3 hours) learning than the most deprived third (4.2 hours). During the January lockdown, the Sutton Trust reported that:the proportion of pupils spending 5 or more hours a day on learning increased significantly from 19% in the first lockdown to 45%. the gap between private and state schools was substantial - more than double the share of pupils at private schools were studying more than 5 hours a day, compared with pupils at state schools. secondary school teachers reported that the biggest differences between private and state schools were parental support for learning online (65% versus 25%) and access to suitable technology (44% versus 14%). July 2021Slide 22COVID-19 impact inquiry: technical supplement

23. Food security The Food Foundation reported that:throughout the pandemic (March 2020 to January 2021), a higher percentage of households with children experienced food insecurity compared with households without children. the proportion of people experiencing food insecurity decreased between March 2020 and January 2021. In March 2020, 20.8% households with children and 13.7% households without children had experienced food insecurity in the past month, compared with 9.6% and 6.6% respectively in January 2021. in January 2021, 12% of households with children had experienced food insecurity in the past six months, equalling 2.3 million children and 1.3 adults living with them.41% of children receiving Free School Meals had experienced food insecurity. households with a lone parent or more than 3 children were more likely to experience food insecurity. In May 2020, 31% households with a lone parent, compared with 15% households with couple parents, experienced food insecurity. July 2021Slide 23COVID-19 impact inquiry: technical supplement

24. Comas-Herrera A, Zalakaín J, Lemmon E, Henderson D, Litwin C, Hsu AT, Schmidt AE, et al. Mortality associated with COVID-19 in care homes: international evidence. LTCcovid.org, International Long-Term Care Policy Network. 2021 (https://ltccovid.org/2020/04/12/mortality-associated-with-covid-19-outbreaks-in-care-homes-early-international-evidence/)Bach-Mortensen, A. M., & Degli Esposti, M. (2021). Is area deprivation associated with greater impacts of COVID-19 in care homes across England? A preliminary analysis of COVID-19 outbreaks and deaths. J Epidemiol Community Health, 75(7), 624-627 (https://jech.bmj.com/content/75/7/624)Care homes in London and the North worse hit by COVID-19 than other areas of England [Webpage]. Health Foundation. 2020. (https://health.org.uk/news-and-comment/news/care-homes-in-london-and-the-north-worse-hit-by-covid-19)Shallcross L, Burke D, Abbott O, Donaldson A, Hallat G, Hayward A et al. Factors associated with SARS-CoV-2 infection and outbreaks in long-term care facilities in England: a national cross-sectional survey. Lancet Health Longevity. 2021; 2 (3). (https://www.sciencedirect.com/science/article/pii/S2666756820300659?via%3Dihub#tbl3fn4)Dunn P, Allen L, Alarilla A, Grimm F, Humphries R, Alderwick H. Adult social care and COVID-19 after the first wave: assessing the policy response in England. Health Foundation. 2021 May. (www.health.org.uk/publications/reports/adult-social-care-and-covid-19-after-the-first-wave)Grimm F, Hodgson K, Brine R, Deeny SR. Hospital admissions from care homes in England during the COVID-19 pandemic: a retrospective, cross-sectional analysis using linked administrative data. Preprints. 2021. (www.preprints.org/manuscript/202102.0593/v1)COVID-19 experiences and learning in Coventry care homes. Healthwatch Coventry. 2020. (https://www.healthwatch.co.uk/reports-library/covid-19-experiences-and-learning-coventry-care-homes)Covid might not kill them … but loneliness possibly will. Healthwatch Leeds. 2020. (https://healthwatchleeds.co.uk/wp-content/uploads/2020/07/Care-Home-Report.pdf)Office for National Statistics. Coronavirus and the social impacts on disabled people in Great Britain [Webpage]. Office for National Statistics. 2021. (https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/disability/articles/coronavirusandthesocialimpactsondisabledpeopleingreatbritain/february2021)Glasgow Disability Alliance. Supercharged: A Human Catastrophe Inequalities, Participation and Human Rights before, during and beyond COVID19. Glasgow Disability Alliance; 2020. (https://gda.scot/resources/supercharged-a-human-catastrophe)Research Institute for Disabled Consumers. Covid-19: the impact on disabled and older people in the UK. ResearchInstitute for Disabled Consumers. 2020. (www.ridc.org.uk/researchconsultancy/our-insights/covid-19-studies/covid-19-impact-disabled-and-older-people-uk)Office for National Statistics. Coronavirus and the social impacts on disabled people in Great Britain [Webpage]. Office for National Statistics. 2020. (https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/disability/articles/coronavirusandthesocialimpactsondisabledpeopleingreatbritain/september2020#disabled-peoples-access-to-healthcare-during-the-coronavirus-pandemic)ReferencesJuly 2021Slide 24COVID-19 impact inquiry: technical supplement

25. Mencap. I don't know what day it is or what the weather is like outside”: Social care cuts for people with a learning disability leaves families stuck in lockdown [Webpage]. Mencap. 2020. (https://www.mencap.org.uk/press-release/i-dont-know-what-day-it-or-what-weather-outside-social-care-cuts-people-learning)Greater Manchester Disabled People’s Panel. GM Big Disability Survey- Covid19. GM Disabled People’s Panel. 2020. (https://gmdisabledpeoplespanel.com/2020/07/09/gm-big-disability-survey-covid19)Inclusion London. Abandoned, forgotten and ignored: The impact of the coronavirus pandemic on Disabled people. Inclusion London; 2020. (www.inclusionlondon.org.uk/wp-content/uploads/2020/06/Abandoned-Forgotten-and-Ignored-Final-1.pdf)Hu Y. Intersecting ethnic and native–migrant inequalities in the economic impact of the COVID-19 pandemic in the UK. Res in Soc Stratification and Mobility. 2020; 68 (https://doi.org/10.1016/j.rssm.2020.100528)Daly M, Sutin A, Robinson E. Longitudinal changes in mental health and the COVID-19 pandemic: evidence from the UK Household Longitudinal Study. Psychol Med. 2020. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737138/)Mind. The mental health emergency: How has the coronavirus pandemic impacted our mental health? Mind. 2020. (www.mind.org.uk/media-a/5929/the-mental-health-emergency_a4_final.pdf)Fairer foundations: How has the pandemic affected young people’s mental health? [Webpage]. Health Foundation. 2021. (https://www.health.org.uk/news-and-comment/charts-and-infographics/fairer-foundations)Country in the grip of a mental health crisis with children worst affected, new analysis finds [Webpage] Royal College of Psychiatrists. 2021. (https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2021/04/08/country-in-the-grip-of-a-mental-health-crisis-with-children-worst-affected-new-analysis-finds)NHS Digital. Mental Health of Children and Young People in England, 2020. NHS Digital. 2020. (https://files.digital.nhs.uk/AF/AECD6B/mhcyp_2020_rep_v2.pdf)YoungMinds. Coronavirus: Impact on young people with mental health needs: Survey 4: February 2021. YoungMinds. 2021 (https://youngminds.org.uk/media/4350/coronavirus-report-winter.pdf)Andrew A, Cattan S, Dias MC, Farquharson C, Kraftman L, Krutikova S, et al. Family time use and home learning during the COVID-19 lockdown. Institute for Fiscal Studies. 2020. (https://ifs.org.uk/publications/15038) Montacute R, Cullinance C. Learning in lockdown. Sutton Trust. 2021 Jan. (www.suttontrust.com/wp-content/uploads/2021/01/Learning-in-Lockdown.pdf)Food Foundation. The impact of covid-19 on Household food insecurity. Food Foundation. 2021.(https://foodfoundation.org.uk/wp-content/uploads/2021/03/FF_Impact-of-Covid_FINAL.pdf)July 2021Slide 25COVID-19 impact inquiry: technical supplement

26. Learn more:Read the COVID-19 impact inquiry report: Unequal pandemic, fairer recoverySee all content from the COVID-19 impact inquiryDiscover all of the inquiry's technical supplements:Supplement 1: COVID-19 health outcomesSupplement 2: The pandemic’s implications for wider health and wellbeingSupplement 3: Changes in the wider determinants of health.Sign up for ongoing updates about this work.