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Are Long-COVID and NCDs another Pandora’s box?

Noncommunicable diseases (NCDs) have been increasing at an alarming rate in India in the last few decades, overtaking infectious diseases as India’s most common causes of death. Now, some speculate that NCDs coupled with long-COVID could open up a Pandora’s box in the country.

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Government data shows that the proportion of deaths due to NCDs has increased from 37.9 percent in 1990 to 61.8 percent in 2016. Heart disease has emerged as the frontrunner as the causative factor in these NCD deaths, taking up a startling proportion of India’s overall deaths.

As previously reported by Health Issues India “there has been a startling rise in heart disease cases over the last few decades. Over the last 25 years, India has seen a fifty percent rise in heart disease cases according to doctors at the Meenakshi Mission Hospital and Research Centre. In 2016, heart disease accounted for 28.1 percent of all deaths in the country. It is India’s most common cause of death by a significant margin, yet, despite this grim reality, it is still viewed by many as a disease that is only common among the elderly. This is a misconception, and one that may be placing countless lives at risk.”

While many NCDs, including heart disease, cancer, and diabetes were formerly viewed as being afflictions of the elderly, it is becoming increasingly more apparent that even young people are at risk. According to IndiaToday, “the leading reasons for heart disease among young people in India are stress, smoking, a family history of cholesterol imbalances, undetected diabetes and obesity. There’s a shift in the profile of Indian cardiac patients; compared to twenty years ago, younger people are now developing heart disease.”

Shifts in lifestyle habits have played a major role in increasing the prevalence of NCDs. Many factors such as a lack of physical exercise and poor diets are major risks to developing NCDs. Many individuals shifting from a mostly vegetarian diet traditional to Indian cuisine, to a more Western-style diet with large amounts of processed foods high in saturated fat and sugar content may be a major contributing factor to the rise in NCDs.

Just a few short decades ago most individuals worked manual jobs that led to a high degree of physical activity. This has rapidly changed with the industrialisation of the country, with many now shifting to office based working that has created a situation where many lead sedentary lifestyles. Following the onset of the COVID-19 pandemic the rise in individuals working from home has allowed the potential for some to go days without ever leaving their house.

Another aspect of the COVID-19 pandemic – that of long-COVID – has some worried of a further exacerbation of the NCD crisis due to comorbidity. As reported last year by The Economic Times, “doctors are dealing with [a] rising number of long-COVID patients with symptoms like persistent body ache, low grade fever, lung fibrosis, pulmonary embolism and brain fogging in the outpatient departments (OPD) of hospitals. Many have mental health issues including anxiety, depression, confusion and loss of memory, new onset of diabetes and hypertension.”

Many of the symptoms, such as body ache and chronic lung issues overlap with that of many NCDs. More worrying still is the issue that long-COVID has reportedly caused issues such as diabetes and hypertension. It is speculated that lasting damage relating to scarring of the lungs during the initial COVID-19 infection could result in a chronic decrease in lung capacity. This is of particular concern as it may elevate the risks of lung conditions such as emphysema, lung cancer, or asthma.

Long-COVID has been reported across a wide range of individuals ranging from those with pre-existing NCDs and comorbidities, to young, healthy individuals whose lives are transformed as a result of the issue. 

The issue serves to underline India’s current dual burden of both infectious disease and NCDs. While many infectious diseases have decreased in prevalence in recent years, they are by no means gone. With the rise of NCDs in the country, along with India’s ageing population – another prominent risk factor for NCDs – the situation is unlikely to be easily resolved. There is an ever-present risk that long-COVID severely inflates this figure, and, in turn, the health system will be overwhelmed. Preparations must be made to ensure hospital capacity accounts for such an event. 


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