The direct consequences of the novel coronavirus are huge, in the Netherlands as well as elsewhere. Mortality from COVID-19 will probably be in the top 3 causes of death in 2020. The burden of disease is five times higher than with normal seasonal flu. Without the coronavirus measures that were implemented, the burden of disease from COVID-19 would have been even higher. It should be noted that the second wave of COVID-19 has not been incorporated into these figures yet. Moreover, the long-term effects for former COVID-19 patients are still unknown. The indirect effects of COVID-19 are also significant: access to regular health care has (temporarily) been limited, lifestyles have changed, and social life has been impoverished as a result of coronavirus measures.

RIVM announced these findings in a special edition of the Public Health Foresight Study, which describes how the coronavirus pandemic will eventually change public health in the Netherlands.

People are living unhealthier lives

The study shows that more people have started to live unhealthier lives during the COVID-19 crisis. Smokers are smoking more, and the number of overweight people is rising. RIVM has also observed an increase in the burden of disease due to delays in specialised care, for example interventions that could be planned. Mental health is also under pressure due to the COVID-19 crisis. One-third of the population feels more despondent, and one-third feels more stressed and anxious than before the crisis. 

Lower-educated people more severely affected

RIVM concludes that the COVID-19 crisis affects lower-educated individuals much more severely. They are more likely to have chronic illnesses, and are therefore at higher risk of a more serious course of disease. In addition, they have fewer opportunities to work from home, and their jobs are more often insecure. This also has a major impact on the mental health of this group. Mental health is also under pressure in other groups, including adolescents, young adults and the elderly. The pandemic also exacerbates the contrasting differences between generations. Young people feel that their freedom is being restricted by the coronavirus measures, which are primarily intended to protect older people.

Future public health challenges becoming even more urgent

Persistently high burden of disease due to cardiovascular disease and cancer; the steady growth in the group of older people still living on their own while suffering from dementia and from other complex issues; the increasing mental pressure on teenagers and young adults: before the start of the coronavirus pandemic, these were the major challenges in public health in the Netherlands. These tasks have now become even more urgent, according to RIVM, especially since the coronavirus SARS-CoV-2 or other viruses are expected to remain relevant health risks, even if there is a vaccine.

Need for broader consideration of measures

In the initial phase of the COVID-19 pandemic, there was understandably a strong focus on COVID-19 patients and the care that they needed. The economic consequences of the measures also received attention shortly after. However, in that initial phase, other important aspects received far less attention: perceived health, loneliness, self-management (control over one’s own life), quality of life, and a sense of significance. It is important to take these health perspectives into account in future measures.

Indirect positive effects of COVID-19

RIVM also outlines positive effects of the COVID-19 crisis. The application of digital technologies has increased enormously, for example. Remote care concepts are implemented much more widely, there has been a major surge in the digital emancipation of the elderly, and working from home also gives people more control of their own lives and more time with their families. In addition, there is a stronger sense of connection within the neighbourhood and more intensive cooperation between different parties in the healthcare system.

Better prepared for the future

The results of this foresight study paint a picture of a society that has been hit hard at all levels by the coronavirus pandemic. Being better prepared for the future calls for:

• Greater commitment to integrated prevention. The COVID-19 crisis has made this even more important. Integrated prevention focuses not only on (individual) lifestyle factors, but also on the physical living environment and social problems, such as debt and stress.
• Consideration of chronic illnesses as well as infectious diseases. A future in which infectious diseases can influence our health again requires new, integrated knowledge, new care concepts between formal and informal care, and more cooperation between different parties in healthcare and beyond.
• More insight into mental health. Better information and knowledge about mental health among different population groups affected by the COVID-19 crisis are needed to develop appropriate policies – and to offer future prospects to the people covered by those policies.
• More intensive cross-domain cooperation between ministries to improve health. Many of the aspects that could be leveraged for this purpose lie outside the field of health, such as work and labour, education, the physical living environment and social security.

Looking beyond COVID-19

The entire Public Health Foresight Study has been published online in Dutch.