Abstract Background The COVID-19 pandemic caused severe disruptions to healthcare in many areas of the world, but data remain scarce for sub-Saharan Africa. Methods We evaluated trends in hospital admissions and outpatient emergency department (ED) and general practitioner (GP) visits to South Africa’s largest private healthcare system during 2016 – 2021. We fit time series models to historical data and, from March 2020 to September 2021, quantified changes in encounters relative to baseline. Results The nationwide lockdown on 26 March 2020 led to sharp reductions in care-seeking behavior that persisted for 18 months after initial declines. For example, total admissions dropped 59.6% [95% confidence interval: 52.4, 66.8] during home confinement and were 33.2% [29, 37.4] below baseline in September 2021. We identified three waves of all-cause respiratory encounters consistent with COVID-19 activity. Intestinal infections and non-COVID-19 respiratory illnesses experienced the most pronounced declines, with some diagnoses reduced 80%, even as non-pharmaceutical interventions (NPIs) were relaxed. Non-respiratory hospitalizations, including injuries and acute illnesses (e.g., heart attack, stroke), were 20-60% below baseline throughout the pandemic and exhibited strong temporal associations with NPIs and mobility behavior. ED attendances exhibited similar trends to hospitalizations, while GP visits, particularly for chronic illnesses and HIV, were less impacted and have returned to pre-pandemic levels. Conclusions We find substantially reduced use of health services during the pandemic for a range of conditions unrelated to COVID-19. Persistent declines in hospitalizations and ED visits indicate that high-risk patients are still delaying seeking care, which could lead to morbidity or mortality increases in the future.
【저자키워드】 COVID-19, lockdown, social distancing, sub-Saharan Africa, healthcare,