This study used PHE syndromic surveillance data from Wednesday 1st January 2020 to Sunday 24th May 2020, and Tuesday 1st January 2019 to Friday 24th May 2019 (one day fewer due to 2020 being a leap year). These figures represent the data routinely available through the syndromic surveillance systems, but for some systems this is not necessarily representative of the whole of England (Table 1). The total number of NHS 111 calls was 5,630,117 for this time period in 2019, and 6,175,249 in 2020, an increase of 9.68%. The total number of GP Out-of-Hours contacts was 3,803,553 in 2019, and 3,665,455 in 2020, a decrease of 3.63%. The number of GP Out-of-Hours contacts assigned a Read code was 1,634,938 in 2019 (43% of contacts), and 1,331,478 in 2020 (36% of contacts). The daily mean GPIH registered practice population was 23,998,209 in 2019, and 39,455,662 in 2020, an increase of 64.41%. The number of ambulance calls was 2,100,527 in 2019, and 2,105,082 in 2020, a slight increase of 0.22%. The total number of attendances at the 100 emergency departments included in the study was 3,909,796 in 2019, and 2,997,082 in 2020, a decrease of 23.34%. The number of ED attendances with a diagnosis was 3,138,470 in 2019 (80%), and 2,491,255 in 2020 (83%).
Daily trends in total activity across all five syndromic surveillance systems showed significant variation during the COVID-19 pandemic in England compared to equivalent months in 2019 (Fig. 2). The daily mean percentage changes in activity during the peak pandemic period in 2020 (Weeks 13 to 22) compared to the same period in 2019 are shown in Table 1. These showed the least difference for NHS 111 calls (12% increase; 95%CI: 9 to 15%) and GPOOH consultations (11% decrease; 95%CI: − 8 to − 14%). The total number of ambulance calls varied markedly throughout the pandemic period, increasing during the introduction of social distancing, before reducing during lockdown, such that the mean daily number during the peak pandemic period hides the marked variation seen in Fig. 2. The total number of attendances at ED nearly halved during the peak pandemic (daily mean percentage change: -49% (95%CI: − 45% to − 52%). (Trends in healthcare usage during the peak pandemic period in 2020 compared to 2019, stratified by weekdays, and weekend and bank holidays, for each syndromic surveillance system and indicators are available in Additional Table 1.)
Eye conditions, monitored through GPIH, GPOOH, and NHS 111, showed a sharp decline in mid-February (earlier than other syndromic indicators). GPIH conjunctivitis remained low throughout the 2020 peak pandemic period (64% reduction; 95%CI: − 63% to − 65%, compared to 2019 during peak pandemic period) as did GPOOH eye irritation (71% reduction; 95%CI: − 68% to − 74%). In contrast, though the number of calls to NHS 111 for eye problems initially reduced during March, call numbers returned to baseline (2019) by May, resulting in a smaller (25%; 95%CI: − 20% to − 31%) reduction across the entire peak pandemic period (Fig. 3).
GP In Hours mumps consultations showed a dramatic decline after the introduction of NPIs, following high activity early in 2020. During the peak pandemic period, the number of GP In Hours consultations for mumps showed a 31% (95%CI: − 11% to − 54%) reduction compared to 2019 (Fig. 4).
Fractures presenting to EDs showed a sharp decline from the 12th March 2020 when COVID-19 restrictions were introduced, before starting to increase during May (Fig. 5a). During the peak pandemic period, there was a 49% (95%CI: − 46% to − 52%) reduction in attendance at ED for fractures compared to the same period in 2019. In 2019, weeks 13 to 22, the mean number of females attending ED with a fracture was highest on Monday mornings and for males there were peaks on both Sunday late morning and Monday morning. The trends of ED attendances by hour of day and day of week for the peak pandemic period in 2020 demonstrated that there was no longer any weekend effect, resulting in similar patterns of attendance across each day of the week for both males and females (Fig. 5b, c).
GP In Hours consultations for herpes zoster showed a decline following the interventions in March and an overall 27% reduction (95%CI: − 23% to − 31%) in consultations during the peak pandemic period compared to 2019 (Fig. 4).
ED attendances for myocardial ischaemia also showed a marked decline following the interventions in March, with a 35% reduction (95%CI: − 31% to − 39%) in attendance for the peak pandemic period in 2020 compared to 2019 (Fig. 6). Opposing trends were observed for chest pain in ambulance calls and chest pain/myocardial infarction in GPOOH.