BACKGROUND: The COVID-19 pandemic has had an unprecedented impact on Europe, in terms of morbidity and mortality, as well as in social and economic terms. Health systems came under strain, with non-urgent treatments postponed and resources reserved for treatment of COVID-19 patients. Delayed care-seeking has been reported, for fear of infection with SARS-CoV2. This study investigates and compares indirect effects of the pandemic in 10 European countries, while highlighting the potential of Population Health Information Research Infrastructures as part of the EU project (www.phiri.eu). *** METHODS: Focusing on (i) major vascular events (MVE) and (ii) elective surgery for joint replacements (ESJR) this study analyses individual level hospital data with a standardised harmonised data model. We compared incidence rates in the year 2019 with rates for 2020. Analyses are systematically contrasted with SARS CoV2 incidence rates, and policy measures taken based on the OxCGRT index. *** RESULTS: In all countries, a drop in hospital discharge rates is observed during the pandemic but differing by condition and month, e.g. 7% drop in MVE in Wales, and 25% drop in inpatient stays with MVE in Austria vs. 78.6% in ESJR and reduction of 80% in Austria in April 2020 in endoprosthetic surgeries. First evidence suggests that countries with more severe policy measures also saw more dramatic drops in regular hospital activities.
Conclusions: Our findings provide novel insights on the dramatic level of de-prioritisation of essential services faced by non-COVID-19 patients in Europe. From a public health perspective, hospital escalation plans should be developed early on so as to avoid negative mid and long term health and financial consequences of indirect effects. The study demonstrates large potential in exploiting health information systems in a systematic way across countries. Further research should investigate policy trade-offs involved in severe lockdown measures during a pandemic.