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 Table of Contents  
EDITORIAL
Year : 2020  |  Volume : 5  |  Issue : 1  |  Page : 1-3

Novel Coronavirus Pandemic may worsen existing Global Noncommunicable disease crisis


Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission24-Mar-2020
Date of Acceptance24-Mar-2020
Date of Web Publication31-Mar-2020

Correspondence Address:
Prof. J S Thakur
Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jncd.jncd_2_20

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How to cite this article:
Thakur J S. Novel Coronavirus Pandemic may worsen existing Global Noncommunicable disease crisis. Int J Non-Commun Dis 2020;5:1-3

How to cite this URL:
Thakur J S. Novel Coronavirus Pandemic may worsen existing Global Noncommunicable disease crisis. Int J Non-Commun Dis [serial online] 2020 [cited 2020 Jun 5];5:1-3. Available from: http://www.ijncd.org/text.asp?2020/5/1/1/281671



In the month of December 2019, a large number of cases of “pneumonia of unknown origin” in the people of Wuhan, China, were reported.[1] Within few days, the Chinese health authorities confirmed that this was associated with a Novel Coronavirus 1 and was named coronavirus disease 2019 (COVID-19) by the World Health Organization. Recently, COVID-19, a declared pandemic,[2] is characterized by the symptoms of viral pneumonia such as fever, fatigue, dry cough, and lymphopenia. Specifically, many of the older patients who become severely ill have evidence of underlying illness such as cardiovascular disease, liver disease, kidney disease, or malignant tumors.[3],[4] The existing epidemic of noncommunicable diseases (NCDs) which is responsible for 72% of the deaths globally has been an aggravating factor for the adverse outcomes of the COVID-19. It has been seen that these patients often die of their original comorbidities; therefore, there is a need to accurately evaluate all original comorbidities of individuals with COVID-19.[3],[4],[5]

The most prevalent comorbidity associated with Corona virus infection are hypertension and diabetes, followed by cardiovascular diseases and respiratory diseases.[4] These comorbid conditions are the risk factors for the adverse outcome of the infection. According to the data from the World Population Prospects,[6] one in 11 people in the world is over the age of 65 years in 2019 which accounts for a total of 9% of the population. Out of total deaths due to NCDs, 71.5% of deaths are in the age group of 70 years and above. This old-age population and associated chronic NCDs are leading to the adverse impacts and susceptibility in this age group. The global statistics on COVID-19 shows that the death rate is 21.9% in the age group of above 80 years followed by 8% in the age group between 70 and 79 years and further 3.6% in the age group of 60–69 years of age.[7] The percentage of deaths in the COVID-19 patients with pre-existing conditions such as cardiovascular disease, diabetes, chronic respiratory disease, hypertension, and cancer contributes to 13.2%, 9.2%, 8%,8.4%, and 7.6%, respectively, at the global level.[7] This is low in comparison to the deaths due to COVID-19 patients with no pre-existing condition contributing to only 0.9%. Another study in China on 1590 patients with COVID-19 reported that out of all patients, 25.1% had at least one comorbidity, whereas 16.9% were hypertensive and 8.2% were diabetics.[8]

These associated pre-existing conditions which are mainly NCDs and their susceptibility condition, i.e., old age, may be associated with the pathogenesis of COVID-19. Chronic diseases such as hypertension, cardiovascular diseases, diabetes, and respiratory system diseases share various features similar to infectious diseases such as attenuation of innate immunity and pro-inflammatory response.[9] As a case, diabetes occurs due to the accumulation of activated innate immune cells in the metabolic tissues which leads to the release of inflammatory mediators which promotes systemic insulin resistance and beta-cell damage, so these metabolic damages may lead to low immune function by the impairment of macrophagic and lymphocytic functions.[9] All of this will ultimately lead to the individual's increased susceptibility to disease complications. It has been recently reported that in the death group of COVID-19, patients who died had comparatively lower absolute count of CD3+ T-cell, CD3+ CD8+ T-cell, and CD3+ CD4+ T-cell.[10] Hence, the identified associated pre-exiting conditions, i.e., chronic NCDs, are important risk factors and should be considered while developing any health education and vaccination recommendations.

The current projections of the COVID-19 by a mathematical modeling study in the Wuhan on the dynamics of transmission of infection showed that the overall median daily reproduction number declined after the travel restrictions were implemented. The number was 2·35 1 week before the travel restrictions were introduced and the number reduced to 1·05 after 1 week of travel restrictions.[11] Furthermore, a study revealed that when the transmission period decreases from 4 days to 2 days, the outbreak finished early without the change in the total number of patients. Whereas if the transmission rate decreases about 90% or 99%, the outbreak finished early, and the size of the peak and the total number of patients also decreased.[12] All of this presently focuses on the importance of social distancing with the participation of the public, along with the policy of isolating patients as early as possible through. COVID19 is also leading to a lot of stress, anxiety, and obsessive-compulsive disorders, thereby adversely affecting mental health which is also with other NCDs.

Combining all the evidence published and reported so far and keeping in view of the current scenario due to COVID-19, it is clear that COVID-19 pandemic will further aggravate the global NCD crisis.[13] However, with the COVID-19 pandemic, in which the population with any of the chronic NCD are at highly susceptible and vulnerable, comorbidity is one of the major threats which is exiting and will worsen the existing and ongoing epidemic of both chronic NCDs and COVID-19. At present, there are no such dedicated guidelines available at the global level to combat the comorbid condition of COVID-19 and NCDs. Some of the risk factors for the NCDs which include unhealthy diet, stress, alcohol, and tobacco use are linked to COVID-19. With lock out in many countries including India, physical activity has been adversely affected which will further contribute to more NCDs, the action needed in the current scenario is to assess the existing risk factors which are common in both chronic NCDs and the COVID-19 and address them in changed scenario. Household leisure time physical activity needs to be promoted. National Governments are being forced to divert health budgets to deal with COVID-19 pandemic, thereby leading to further poor availability to under-resourced National NCD programs, especially in low- and middle-income countries (LMICs). There are many who are becoming jobless due to serious global economic recession due to COVID-19 pandemic. The high burdens due to NCDs are already pushing many in the LMICs below the poverty line.[13] There is an urgent need for ensuring adequate resourcing of NCD programs and strengthening disease surveillance to ensure that relevant policies, best tools, and programs can be implemented for mitigating the problems caused by COVID-19 along with comorbid conditions.

Prevention is the only options for COVID-19 at present for the general public and health-care workers without any effective treatment. A study on 41 health-care workers, regarding the transmission of COVID-19 infection in health-care providers and in regard to judicious use of masks, suggests that surgical masks, hand hygiene, and standard operating procedures protected from being infected.[14] However, focus and funding for prevention for the general public is poor or missing many countries including India.[15],[16] The need for an hour is to prevent and reduce the community transmission of the COVID-19 by social distancing, hand hygiene, quarantine and good nutritious diet rich in Vitamin C to boost immunity and access to testing, isolation, and treatment facilities in the population with underlying diseases conditions so as to reduce the overall morbidity and mortality globally.

Acknowledgment

The author is thankful to Dr. Ronika Paika, Research Scholar, Department of Community Medicine and School of Public health, PGIMER, Chandigarh, for her help in preparing this article.



 
  References Top

1.
Hui DS, I Azhar E, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health - The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis 2020;91:264-6.  Back to cited text no. 1
    
2.
WHO. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Geneva: World Health Organization; 2020. Available from: https://www.who.int/news-room/detail/30–01–2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov). [Last accessed on 2019 Mar 20].  Back to cited text no. 2
    
3.
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020. [Epub ahead of print].  Back to cited text no. 3
    
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Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  Back to cited text no. 4
    
5.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13.  Back to cited text no. 5
    
6.
United Nations Ageing. Available from: https://www.un.org/en/sections/issues-depth/ageing. [Last accessed on 2020 Mar 19].  Back to cited text no. 6
    
7.
Leung C. Clinical features of deaths in the novel coronavirus epidemic in China. Rev Med Virol 2020;e2103.  Back to cited text no. 7
    
8.
China Medical Treatment Expert Group for COVID-19. Comorbidity and its impact on 1,590 patients with COVID-19 in China: A Nationwide Analysis; 2020.  Back to cited text no. 8
    
9.
Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: Convergence of two epidemics. Lancet Infect Dis 2009;9:737-46.  Back to cited text no. 9
    
10.
Guo L, Wei D, Zhang X, Wu Y, Li Q, Zhou M, et al. Clinical features predicting mortality risk in patients with viral pneumonia: The MuLBSTA score. Front Microbiol 2019;10:2752.  Back to cited text no. 10
    
11.
Kucharski AJ, Russell TW, Diamond C, Liu Y, Edmunds J, Funk S, et al. Early dynamics of transmission and control of COVID-19: A mathematical modelling study. Lancet Infect Dis 2020. [Epub ahead of print].  Back to cited text no. 11
    
12.
Choi SC, Ki M. Estimating the reproductive number and the outbreak size of Novel Coronavirus disease (COVID-19) using mathematical model in Republic of Korea. Epidemiol Health 2020; e2020011.  Back to cited text no. 12
    
13.
Thakur J, Prinja S, Garg CC, Mendis S, Menabde N. Social and economic implications of noncommunicable diseases in India. Indian J Community Med 2011;36:S13-22.  Back to cited text no. 13
    
14.
Ng K, Poon BH, Kiat Puar TH, Shan Quah JL, Loh WJ, Wong YJ, et al. COVID-19 and the risk to health care workers: A case report. Ann Intern Med 2020. [Epub ahead of print].  Back to cited text no. 14
    
15.
Thakur JS, Jaswal N, Grover A, Kaur R, Jeet G, Bharti B, et al. Effectiveness of district health promotion model (Hoshiarpur Ambala model): An implementation experience from two districts from Northern part of India. Int J Non-Commun Dis 2016;1:122-30  Back to cited text no. 15
    
16.
Thakur JS, Jaswal N, Grover A. Is Focus on Prevention Missing in National Health Programs? A Situation Analysis of IEC/BCC/Health Promotion Activities in a District Setting of Punjab and Haryana. Indian J Community Med 2017;42:30-6.  Back to cited text no. 16
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