Many – if not most – public health challenges have been sidelined in the global discourse by the COVID-19 pandemic. Noncommunicable diseases (NCDs), the World Health Organization (WHO) warns, are a case in point.
COVID-19 – the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), commonly referred to simply as the coronavirus – has resulted in hundreds of thousands of deaths and millions of cases. It has almost exclusively dominated the public health discourse and the news cycle as a whole. As a consequence, the plight of those affected by other health issues is often overlooked – and the WHO has warned that health services for those grappling with NCDs have been “significantly impacted.”
This comes as the WHO releases the findings of a survey covering 155 countries across a three-week period in May. The findings concluded that “prevention and treatment services for…NCDs have been severely disrupted since the COVID-19 pandemic began.”
WHO Director-General Dr Tedros Adhanom Ghebreyesus said “the results of this survey confirm what we have been hearing from countries for a number of weeks now. Many people who need treatment for diseases like cancer, cardiovascular disease and diabetes have not been receiving the health services and medicines they need since the COVID-19 pandemic began. It’s vital that countries find innovative ways to ensure that essential services for NCDs continue, even as they fight COVID-19.”
This is of concern on two fronts. One is that NCDs are already a sizeable public health challenge, to put it lightly. As the WHO release notes, 41 million people lost their lives to NCDs yearly – 71 percent of the global total mortality rate. Whilst NCDs were once considered an issue confined to wealthy nations, this is no longer the case. Low- and middle-income countries (LMICs) account for 85 percent of the fifteen million “premature” deaths due to NCDs, referring to NCD-related mortality in those between the ages of thirty and 69.
India is a prominent example of this epidemiological transition, as it has now grappled for a considerable amount of time with a so-called dual burden of disease. Whilst still battling a considerable burden of infectious, maternal and perinatal disease, India has witnessed NCDs emerge as its leading killer; the main driver of disability-adjusted life years; and a key driver of out-of-pocket expenditure on health, which can leave Indian families facing economic ruin.
As a 2018 comment published in The Lancet observed, “NCDs typically present in individuals aged 55 years or older in many developed countries, but their onset occurs in India a decade earlier (≥45 years of age)…Exacerbating this problem are the issues of multiple chronic conditions and the fact many remain undiagnosed due to lack of awareness and insufficient health-care access.” Such issues are likely to be exacerbated by COVID-19, given the pandemic’s enormous impact on India’s already overstretched and under resourced healthcare sector.
The second challenge is that those with pre-existing NCDs are more vulnerable to the effects of COVID-19. As noted by the WHO, “older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness.” In the example of diabetes, as previously noted by Health Issues India
“Prolonged viral infection in individuals with diabetes, resulting in symptoms such as a fever, can cause blood sugar levels to become erratic. This can add an additional layer of issues on top of the existing symptoms for diabetic patients, with the risk of a coma, and even death should blood sugar be improperly managed during the infection. For those in quarantine, there may also be issues with supplies of insulin. Should an individual run out of insulin during the course of the lockdown the results could indeed be lethal.”
These issues make the disruption to NCD prevention and treatment as a result of COVID-19 so worrisome. The WHO did note some “encouraging findings” of the survey, including that most “alternative strategies have been established in most countries to support the people at highest risk to continue receiving treatment for NCDs” and the more widespread adoption of telemedicine in 58 percent of countries (albeit 42 percent of low-income countries). Health Issues India previously interviewed Abhijeet Pandit – director and chief executive officer, SynPhNe India Pvt Ltd, VP Global Network Dev. and Marketing – on the importance of telehealth services during the pandemic to ensure access to therapy for patients with neuromuscular disorders.
”It will be some time before we know the full extent of the impact of disruptions to health care during COVID-19 on people with noncommunicable diseases,” commented Dr Bente Mikkelsen, Director of the Department of Noncommunicable Diseases at the WHO. “What we know now, however, is that not only are people with NCDs more vulnerable to becoming seriously ill with the virus, but many are unable to access the treatment they need to manage their illnesses.
“It is very important not only that care for people living with NCDs is included in national response and preparedness plans for COVID-19 – but that innovative ways are found to implement those plans . We must be ready to “build back better” strengthening health services so that they are better equipped to prevent, diagnose and provide care for NCDs in the future, in any circumstances.”
India must take note.