More than three years into the Covid pandemic, both the virus and the measures taken to control its spread have affected people’s lives around the world. But how can we fully quantify these effects?

Given the number of people who have died from Covid worldwide (which is currently just under 7 million), it has wide-ranging effects – such as the deterioration of mental health, for example, the anxiety of being infected or the isolation of lockdowns. has received less research attention.

In a new study we tried to measure how the Covid pandemic has affected global health using an international survey of the general population.

Health economists often quantify health using a metric known as quality-adjusted life years (QALY). The idea is to assign a value to each year of a person’s life based on their overall health. A perfectly healthy person gets a score and those who are very sick get close to zero.

A common way to measure QALYs is through a short survey called the EQ-5D, which consists of five questions covering key dimensions of health. A person determines their level of mobility, self-care, normal activities, pain and discomfort, and levels of anxiety and depression.

The responses provide a profile of the individual’s health-related quality of life, summarized by what is known as the EQ-5D index. When measured at different points in time this can be used to estimate QALYs, which adjust life expectancy to account for overall health.

For example, a person in relatively poor health might have an EQ-5D index of 0.5 and therefore gain one QALY for every two years they live. This technique has been widely used to assess the effects of various diseases and treatments on health.

We measured overall health-related quality of life by including the EQ-5D in a global survey of the public in late 2020, the end of the first year of the pandemic, just before the start of vaccine distribution for COVID. The survey was conducted online on just over 15,000 people from 13 different countries.

To gauge how the pandemic has affected people, we asked them to rate their current health compared to a year ago.

A limitation of our study is that we had to rely on being able to recall what their health was like before the epidemic. Although it is unlikely that a person will be able to remember exactly how they responded to a survey a year in the past, there is evidence that overestimation and underestimation errors cancel each other out.

What we found

The epidemic was associated with significantly worse health-related quality of life for more than one-third of respondents. Anxiety and depression were the health aspects that worsened the most, especially for younger people (under 35) and women.

Translating the decline in health into a QALY measure indicates that perceived health was on average about 8% lower during the pandemic.

Looking at the results by country, those worst affected were middle-income countries including India (which had lockdowns for more than 40 weeks) and Chile (which had high rates of Covid infections).

In contrast, participants in China reported no significant deterioration in their health status. Although there were lockdowns in China following the emergence of the virus in early 2020, the low level of infection meant these were lifted within weeks.

Average difference in overall health pre-COVID and December 2020:

Average difference in overall health pre-COVID and December 2020

To put the findings into context, previous studies have shown that each COVID death causes an average loss of three to six QALYs. We combined these estimates with the number of deaths reported in each country to measure the impact of deaths from COVID on each country’s overall QALY.

Based on the changes in health reported in our study, the loss in QALYs due to the COVID pandemic and lockdowns is five to 11 times greater than that of COVID-related deaths. It highlights that focusing only on Covid cases and deaths ignores the burden of the epidemic and the implications of policies designed to control it.

For example, most countries used some form of lockdown as a way to contain the spread of the virus, but the subsequent social isolation can have a negative impact on the mental health and well-being of the population. Similarly, some countries have offered economic assistance to those in financial trouble, which can have a positive impact on their emotional well-being. QALYs provide a way to quantify the trade-offs that exist between the positive and negative effects of different strategies.

Lessons for future pandemics

While individual countries have attempted to measure the impact of the epidemic on overall well-being, the limited number of international studies looking at specific aspects of health, such as mental health, have tended to focus on high-income countries. Most global analyzes of the pandemic’s impact rely on reported COVID cases and related deaths.

Regular measurement of various aspects of health in a standardized survey enables researchers to begin to disentangle the effects of lockdowns and other policies from the effects of COVID.

Measuring multiple aspects of health through QALYs would be a useful supplement to existing measures focusing on cases and mortality. This will enable us to see some of the effects of the COVID pandemic as they are distributed across the population. For example, while mortality was highest among older people, mental health effects were more prominent among those under 35.

Moving beyond death counts to understanding the overall health of global populations can help us better prepare for potential future health shocks.the conversation

the writer

Philip Clarke, Professor of Health Economics University of Oxford

Jack Pollard, health economics researcher, University of Oxford

Mara Violato, Associate Professor, Health Economics, University of Oxford

the conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Disclosure statement

Philip Clarke receives funding from the NIHR Oxford Biomedical Research Centre, the NIHR Oxford Health Biomedical Research Centre, the Health Foundation and the EuroCOOL Research Foundation. The views expressed are those of the authors and not necessarily those of the NIHR, or other funding bodies.

Jack Pollard receives funding from the Eurocool Research Foundation. The views expressed are those of the author and not necessarily those of the EuroCol Research Foundation.

Mara Violato receives funding from the National Institute for Health and Care Research (NIHR) Oxford Health Biomedical Research Centre; NIHR Applied Research Collaboration Oxford and Thames Valley; Eurocool Research Foundation. The views expressed are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health and Social Care or the Eurocule Research Foundation.


The University of Oxford provides funding as a member of The Conversation UK.

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