Selecting indicators for signalling and monitoring the wider effects of the COVID-19 pandemic

Background The COVID-19 pandemic and the actions taken to control the spread of the coronavirus have a substantial impact on population health beyond the morbidity and mortality caused by the virus directly. To provide a comprehensive picture of the pandemic's impact, suitable indicators for signalling and tracking these wider effects should be incorporated into monitoring activities. Therefore, WHO/Euro developed a tool to select indicators for this purpose. Methods Based on desk research and extensive expert consultation, a framework was developed for the main pathways through which the COVID-19 pandemic influences population health. For each pathway in the framework, underlying mechanisms and related indicator areas were defined. In addition, groups that are particularly vulnerable to the wider effects of the pandemic were identified, as these require specific attention in monitoring exercises. Results The main pathways through which the pandemic impacts general population health as used in the tool are: Fear of getting infected or spreading infection Impaired healthcare for non-COVID-19 conditions Direct effects of containment measures Indirect effects of containment measures through risk factors Indirect effects of containment measures through wider determinants of health A total of 27 underlying mechanisms and related indicator areas were defined. E.g., one underlying mechanism under the first pathway involves stockpiling disinfectants and cleaners. This results in people being more exposed to dangerous substances and applying disinfectants improperly, which leads to an increase in poisonings. Identified vulnerabilities relate to people's age, gender, socioeconomic status, place of residence/living situation, morbidity/disability status, and refugee or migrant status. Conclusions Developing a conceptual framework provides a useful approach for structuring widespread and complex developments such as the wider health impacts of the COVID-19 pandemic.