Focusing On Diseases Sidelined By COVID-19

Context: Strengthening the primary healthcare system will help tackle the burden of non-communicable diseases (NCDs).

Need for focusing on NCDs

• Global prevalence: 71% of all deaths worldwide occur due to NCDs such as hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, and cancer.
• One out of every four deaths occurs due to cardiovascular diseases, especially among younger patients.
• India’s vulnerability: In the Indian subcontinent, there is early onset and rapid progression of such diseases and a high mortality rate.
• Premature loss of life due to NCDs in the age group of 30-69 years is also very high among Indians. 
• Half the deaths due to cardiovascular diseases occur in the age group of 40-69 years.

Impact of the pandemic impact on NCD patients and services

• Widespread disruption of NCD services:  A World Health Organization (WHO) survey conducted in May 2020 among 155 countries found that low-income countries were the most affected by this disruption. 
  • 53% of countries surveyed had partially or completely disrupted services for hypertension treatment.
  • 49% for treatment for diabetes and diabetes-related complications, 42% for cancer treatment and 31% for cardiovascular emergencies.
• NCD patients are at higher risk of COVID-19 complications: Findings from an observational study in Delhi show that 47.1% of hospitalised COVID-19 patients had diabetes.
• Resource re-allocation and shift in policy priority: 
  • In most countries, staff working in the area of NCDs were reassigned to support patients with COVID-19, and public screening programmes were postponed.
  • Shortage of medicines and diagnostics, cancellations of planned treatments, decreased availability of public transport, and lack of staff were the most common reasons for the disruption.
• Rise in stresses due to pandemic lifestyle disruptions: 
  • Lockdowns and reduced physical interactions led to loneliness, especially in the geriatric population. This resulted in mental health disorders such as anxiety and depression.
  • Lockdowns increase exposure to NCD risk factors as people became more likely to increase their consumption of alcohol and tobacco and adopt an unhealthy diet.

Way forward: Effective and participatory leadership with strong vision and communication is the need of the hour to tackle the silent epidemic transition to NCDs.

• Include NCD services in COVID-19 preparedness and response plans: Although most countries reported that they had included these, only 42% of low-income countries did so.
• Strengthening the primary health system to prevent, diagnose and provide care for NCDs
  • Incentivising already overburdened ASHA workers for health promotion and primordial prevention of NCDs.
  • Access to essential NCD medicines and basic health technologies in all primary healthcare facilities is essential to ensure that those in need receive treatment and counselling. 
• An ‘all of society multidisciplinary approach’: 
  • Strategies must include mitigation efforts to address administration challenges, a strong health workforce, infrastructure, supplies, maintaining the standard of care, and continued access and care for the vulnerable populations. 
  • Importance of physical activity and mental health due to restrictions on movement should be brought to the forefront.
  • Utilising the existing network of NGOs while respecting local factors will go a long way in tackling the growing burden of NCDs. 
• Tech adoption: Use of alternative modalities such as online platforms for disseminating information on exercise and mental health management must be made available to the marginalised. 
  • Telemedicine can reduce travel expenses, thus lowering patients’ expenditure burden.