Dynamic zero-COVID policy and healthcare utilization patterns in China during the Shanghai COVID-19 Omicron outbreak

BackgroundIn April 2022, an outbreak of the SARS-CoV-2 virus Omicron variant in Shanghai precipitated an extensive lockdown. We assessed changes in healthcare utilization during this outbreak and investigated the relationship between the stringency of mitigation strategies and disruptions in healthcare utilization.MethodsUsing provincial-level data from routine health information systems covering all hospitals across Mainland China, we conducted an interrupted time series analysis to examine changes in healthcare utilization during the Shanghai outbreak. Linear regression was used to evaluate the direction and magnitude of the association between the relative changes in the move-out movement index, a proxy for the stringency in population-level mitigation strategies, and the estimated relative changes in healthcare utilization.ResultsOverall, there were 22.9 billion outpatient visits and 1.2 billion discharged inpatients during the study period from January 2016 to May 2022, including 9.1 billion (39.7%) and 0.46 billion (38.2%) in the post-COVID-19 period (January 2020-May 2022), respectively. From March through May 2022, the outbreak resulted in an accumulative loss of 23.5 million (47%) outpatient visits and 0.6 million (55%) discharged inpatients in Shanghai, and a loss of 150.3 million (14%) outpatient visits and 3.6 million (7%) discharged inpatients in other regions. We find that for every 10-percentage point reduction in the relative change of move-out index, a 2.7 (95% CI: 2.0-3.4) percentage point decline in the relative change of outpatient visits, and a 4.3 (95% CI: 3.5-5.2) percentage points decline in the relative change of inpatient discharges.ConclusionsThe Shanghai COVID-19 Omicron outbreak associates with a substantial reduction in outpatient visits and inpatient discharges within Shanghai and other regions in China. The stringency of the COVID-19 lockdown policies associates with more profound reductions in healthcare utilization. In April 2022, outbreaks in Shanghai owing to the SARS-CoV-2 virus Omicron variant prompted China's most extensive lockdown since the 2020 Wuhan shutdown. We use mathematical models to study the impact of stringent lockdown measures on the nation's use of healthcare services. We estimate that Omicron outbreak have reduced the number of outpatient visits and inpatients discharged from hospitals by 47% and 55%, respectively, in Shanghai alone, and 14% and 7% at the nationwide level. We show there is a direct correlation between increased level of strictness of lockdown strategies and reduction in healthcare usage. Our findings highlight the importance of investing in preparations of future pandemics, so that access to essential healthcare facilities is unaffected Xiao et al. evaluate the impact of China's Dynamic zero-COVID policy during the Omicron outbreak on the nation's healthcare utilization. Aside from regional COVID-19 severity and health system performance, the stringent lockdown policy drastically reduces access to inpatient and outpatient services.

Automated summary

The outbreak of the SARS-CoV-2 virus Omicron variant in Shanghai in April 2022 resulted in a significant decrease in healthcare utilization, both in Shanghai and other regions. The stringency of mitigation strategies is directly associated with a further reduction in healthcare utilization.