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The effects of COVID-19 related restrictions on health service use in NB

Category(s): Health
Status: Active
Principal: Ted McDonald
Project Number: P0087

Project Description 

Since 2020, public health efforts have prioritized limiting the spread of COVID-19 in the interest of keeping our communities safe from the risk of severe illness or death upon contracting the virus. While necessary, these efforts have resulted in a number of challenges to access other health care services when rising cases in regions throughout the province resulted in the delay of timely procedures or limited ability to acquire necessary medications throughout various stages of the pandemic. 

The Canadian Institute for Health Information (CIHI) reported that from March to June 2020, surgery numbers fell 47% compared with 2019, representing about 335,000 fewer surgeries.Cancellations of planned surgeries varied according to urgency, ranging from a 17% to 80% percentage change decline from 2019.1 The World Health Organization has warned against neglecting the provision of surgical treatment, as the burden of disease continues to accumulate while patients await surgery.2 Delays in treatment due to COVID-19-related restrictions have resulted in worse outcomes and higher mortality for patients across a broad spectrum of diseases.2 More advanced diseases at the time of surgery are also associated with higher costs.2 This is the case even for procedures typically considered low acuity, such as cataract surgery or joint replacements which have material implications via reduced activity, mobility and quality of life for patients. It is also assumed that delays in diagnostic evaluation during the pandemic may result in a decline in diagnoses of cancer and other diseases during this period, resulting in later stage of disease diagnoses which are more difficult and costly to manage.3 

Additionally, elective avoidance of contact with the health care system likely has contributed to an increased risk of morbidity and mortality associated with both chronic and acute conditions due to delayed medical care. Visits to emergency departments (ED) across Canada declined by almost 25,000 a day.1 By the end of June 2020, ED visits were 85% of 2019 volumes.1 While some of the reduced cases could be explained by fewer activities/events where injuries are likely to occur, a U.S. survey published by the CDC noted an estimated 41% of US adults had delayed or avoided medical care because of concerns about COVID-19 which suggests a similar phenomenon would have occurred in Canada.4 

What is less well known is the extent to which the impact of access barriers vary by personal characteristics such as region of residence, socioeconomic status and household composition or whether more vulnerable groups such as immigrant newcomers have been disproportionately affected. 

A better understanding of the consequences of delayed or avoided health service use will help guide planning for future demands for health services, including potential financial implications for the health system. It will also increase our understanding of chronic disease development more generally, leading to more efficient targeting of preventative health services. With a focus on areas and groups with particular vulnerability, opportunities to safely increase targeted access to healthcare will help to reduce non-COVID-19 mortality during the remainder of the pandemic and beyond. 

The project will compare health service use and health outcomes prior to and throughout the stages of the COVID-19 pandemic in New Brunswick by a range of personal demographic, socioeconomic and geographic characteristics to gain insight into potential future exacerbated negative health outcomes and healthcare costs among vulnerable groups.  


  1. Canadian Institute for Health Information. Impact of COVID-19 on Canada’s health care systems. 8 July 2021.
  2. Fu SJ, George EL, Maggio PM, Hawn M, Nazerali R. The consequences of delaying elective surgery: surgical perspective. 29 April 2020.
  3. Sharpless N. COVID-19 and cancer. 19 June 2020.
  4. Czeisler ME et al. Delay or Avoidance of Medical Care Because of COVID-19-Related Concerns – United States, June 2020. 11 September 2020.