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 Table of Contents  
EDITORIAL
Year : 2020  |  Volume : 5  |  Issue : 2  |  Page : 25-28

COVID-19 and chronic noncommunicable diseases: Profiling a deadly relationship


Senior Visiting Fellow, School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia; Former Director, Communicable and Noncommunicable Diseases, WHO Regional office for South-East Asia, New Delhi, India

Date of Submission05-Jun-2020
Date of Acceptance06-Jun-2020
Date of Web Publication29-Jun-2020

Correspondence Address:
Dr. Jai Prakash Narain
F-20a, Hauz Khas Enclave, New Delhi - 110 016

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jncd.jncd_36_20

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How to cite this article:
Narain JP. COVID-19 and chronic noncommunicable diseases: Profiling a deadly relationship. Int J Non-Commun Dis 2020;5:25-8

How to cite this URL:
Narain JP. COVID-19 and chronic noncommunicable diseases: Profiling a deadly relationship. Int J Non-Commun Dis [serial online] 2020 [cited 2020 Oct 26];5:25-8. Available from: https://www.ijncd.org/text.asp?2020/5/2/25/288256



We are presently in the midst of an unprecedented public health challenge never before experienced in our life time. The story of COVID-19 pandemic began on December 31, 2019, on the New Year eve, when the Chinese authorities notified the World Health Organization (WHO) an event involving pneumonia-like illnesses reported from Wuhan city of Hubei province in China.[1],[2] Caused by a novel coronavirus, the rapidly escalating situation rapidly compelled the authorities to lockdown the whole city.

Soon after, the disease began to spread from China to other countries causing outbreaks in Italy, Iran, and other European countries and beyond. The WHO declared the novel coronavirus a public health emergency of international concern or PHEIC on January 30, 2020,[3] and then a pandemic on March 10, 2020.[4] By that time, more than 118,000 cases had been reported in 114 countries, and 4291 deaths had been recorded. At present, COVID-19 is now being reported nearly by 210 countries around the globe.[5]

Early research has shown that the new coronavirus (COVID-19) affects people of all ages. However, the risk of becoming severely ill with the virus appears to increase disproportionately for people in the age group of 60 plus and those with preexisting conditions or chronic noncommunicable diseases (NCDs) such as cardiovascular disease, hypertension, diabetes, cancer, and other respiratory conditions, in addition to obesity. Such a deadly relationship between a communicable disease and NCDs has never been seen before!

It must be recognized that the NCDs already are, in fact, the leading cause of mortality in all regions of the world, except Africa. Of the 57 million global deaths, 36 million, or 63%, were due to NCDs. The four main NCDs are cardiovascular diseases, cancers, diabetes, and chronic lung diseases. The burden of these diseases is rising rapidly among lower-income countries.[6] Moreover, many deaths occur prematurely that is below 60 years of age. Globally, nearly two-thirds of people over 60 have high blood pressure, and across six WHO regions, the prevalence was highest in Africa, where it was 46% for both sexes combined.[7] In addition, the global prevalence of diabetes in 2019 was estimated at 9.3% or 463 million people, rising to 578 and 700 million by 2030 and 2045, respectively.[8] Cardiovascular diseases are the number 1 cause of death worldwide, taking an estimated 18 million lives, great majority, or three-fourth of them in low- and middle-income countries, followed by cancer taking 9.6 million lives and chronic pulmonary diseases taking more than 3 million lives.[9] In fact, three of the four leading causes of deaths globally are NCDs.

COVID-19 outbreak data from China and Italy – countries hit early by the virus – show higher risk of COVID-19 infections and complications in people with NCDs. In China, one study showed that the most prevalent comorbidities were hypertension (21.1%) and diabetes (9.7%), followed by cardiovascular disease (8.4%) and respiratory system disease (1.5%). When compared between severe and nonsevere patients, the pooled odds ratio of hypertension, respiratory system disease, and cardiovascular disease was 2.36, 2.46, and 3.42, respectively.[10] According to another study, nearly 50% of the hospitalized patients have comorbidities, highest being hypertension followed by diabetes and cardiovascular disease, and the odds of dying is higher in patients with diabetes or cardiovascular disease.[11]

In Italy, a recent report revealed that 96.2% of patients who have died in-hospital from COVID-19 had comorbidities, the most prevalent being hypertension (69·2%), type 2 diabetes (31·8%), ischemic heart disease (28·2%), chronic obstructive pulmonary disease (16·9%), and cancer (16·3%).[12] In the European region of the WHO as a whole, 94% of all deaths were in persons aged ≥60 years and 59% of all deaths were in men. Moreover, 95% of all deaths on whom the information was available had at least one underlying condition, with cardiovascular disease being the leading comorbidity (65%).[13] In the USA, approximately one-third of COVID-19 patients (37.6%) had at least one underlying comorbidity condition. Diabetes mellitus (10.9%), chronic lung disease (9.2%), and cardiovascular disease (9.0%) were the most commonly reported comorbidities.[14]

Smoking which each year kills 8 million people globally, is a known risk factor for many respiratory infections and/or increases the severity of respiratory diseases. According to the WHO, smokers are more likely to develop severe disease with COVID-19, compared to nonsmokers.[15]

In addition, these days are quite stressful indeed for adults and children as well as healthcare providers. The pandemic can result in fear and anxiety about one's own health and that of the loved ones. The isolation and stigma can adversely impact the mental health status during these stressful times.[16]

There is some evidence to explain the link between COVID-19 and comorbidities, most of which are NCDs and the associated mortality. Much of it has to do with weaker immune system, caused either by old age or to the chronic diseases themselves or to drugs used to treat COVID-19 such as renin–angiotensin system blockers.[17] The long-term health conditions and aging often weaken the immune system, so it is less able to fight off the virus.

Moreover, the COVID-19 crisis has also disrupted healthcare services including for NCDs as health workers responsible for NCD care are now diverted for responding to COVID-19 pandemic. Availability of services such as dialysis or cancer care is also disrupted as are the supplies of life-saving medicines and diagnostics.

The relationship between COVID-19 and NCDs therefore has an impact both at individual level and program level. COVID-19 not only enhances the individual vulnerability, especially of the elderly population with chronic health conditions, but by virtue of it also enhances the burden of NCDs. Therefore, the action too is needed at two levels—individual and the policy level.

At individual level, the most important priority for those with NCDs is to:

  • Prevent COVID-19 and stay safe through social distancing or maintaining a distance of at least 1 m from people with a cough, cold, or flu; washing your hands often with soap and water; cough etiquette; wearing a mask whenever going out
  • Continue taking your medications and follow medical advice; ensure you have adequate supply of your medications during lockdown period and other supplies. Make sure to keep your comorbidities such as diabetes or high blood pressure under control
  • Practice a healthy lifestyle which will make all bodily functions work better, including immunity. Eating healthy and balanced diets, with a plenty of fruit and vegetables, keeping physically active through regular exercise or yoga, or taking time to go for a long walk, etc., which can help reduce mental stress also, quitting smoking, limiting or avoiding alcohol intake, and getting enough sleep are the key components of a healthy lifestyle.


At policy level, we need to:

First, address data/evidence gap. We urgently need to enhance access to real-time surveillance and epidemiological data on COVID-19 and comorbidities. While data are available from other countries, own country-specific data are needed for policy making, establishing COVID-19 dashboard and database can help make analyzed data accessible for public use. We also need research on the long-term follow-up for clinical outcome among COVID patients comparing those with or without NCDs.

Second, make NCDs an investment case. It is surprising that in spite of increased vulnerability to severe disease, NCDs as an issue are presently not being given the priority it deserves. Even during the H1N1 pandemic of 2009, underlying chronic diseases were the most important risk factor for mortality. Clearly, the priorities for low- and middle-class–income countries are not only to prevent transmission but also to protect or shield the vulnerable populations (elderly and those with underlying conditions), by ensuring that health services remain available to them. This pandemic is therefore not only a challenge but also an opportunity to highlight the burden of NCDs and ensure that budget allocation for NCD programs is enhanced, not curtailed as is happening with tuberculosis and other programs in many countries.

Third, Recognise that skilled public health workforce, ably supported by digital technology, is a clear prerequisite for an effective public health response to COVID-19 and NCDs. Methods should be found to enable health personnel deliver during the pandemic the essential clinical care to people with NCDs. Given the travel restrictions and lockdown, telemedicine has emerged as an effective mechanism for teleconsulation, without having to resort to one-on-one meeting with the physician. Many apps provide information on COVID-19 and advice on what precautions people can take, and sending text messages on mobile is helping to ensure intake of medicine and treatment adherence.

Fourth, ramp up communication campaign with credible messages. COVID-19 and NCDs present a unique communication challenge of not only imparting information (risk communication) but also ensuring we can counter the misinformation campaign, often fueled by social media. For the latter, we not only need to provide credible and factual information on daily basis but also try to engage community and community-based organizations which have the trust of the community.

Fifth, to focus on primary care and ensure equitable access to care and support by all those who need it. COVID-19 has placed another challenge in the spotlight: health inequities. People with comorbidities, especially those with lower socioeconomic status, are more likely to suffer serious complications or die from COVID-19. For them, the psychosocial and economic impacts of this pandemic are likely to be felt for months and years. Therefore, it is critical to bring synergy between COVID-19 prevention and the care of the vulnerable populations whereever they are and whatever their social or economic status. Equitable access to quality services is critical for those who need it the most, irrespective of their geographic location or their ability to pay. This will be possible only through strengthening primary health care in all countries.

Finally, to conclude on a personal note. I should like to take this opportunity as the Guest Editor of the International Journal of NCDs (IJNCD), to thank profusely Dr. J. S. Thakur, Editor, Dr. Arun Chockalingam, Chief Editor, and the Editorial Board of the IJNCD for the opportunity given to me to put together the special issue with focus on the link between COVID-19 and NCDs and its various dimensions. This is both honor and privilege, as the subject is critical as well as of topical importance! The special issue attempts to cover a fairly wide range of topics, contributed by the most prominent national and international experts.

I do hope that the readers will benefit immensely from these insightful reviews and papers. Looking forward to your feedback.



 
  References Top

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Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-33.  Back to cited text no. 1
    
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Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020;579:270-3.  Back to cited text no. 2
    
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World Health Organization. Statement on the Second Meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). 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 2020 Mar 20].  Back to cited text no. 4
    
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WHO. Coronavirus Disease (COVID-19) Situation Report 119. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200518-covid-19-sitrep-119.pdf?sfvrsn=4bd9de25_4. [Last accessed on 2020 May 25].  Back to cited text no. 5
    
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Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Diabetes Res Clin Pract 2019;157:107843. [doi: 10.1016/j.diabres.2019.107843].  Back to cited text no. 8
    
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Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020;395:1054-62.  Back to cited text no. 11
    
12.
Istituto Superiore di Sanità. Characteristics of SARS-CoV-2 Patients Dying in Italy. Report Based on Available Data; on 29 April, 2020. Available from: https://www.epicentro.iss.it/en/coronavirus/bollettino/Report-COVID-2019_29_april_2020.pdf.[Last accessed on 2020 May 25].  Back to cited text no. 12
    
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Chow N, Fleming-Dutra K, Gierke R, Hall A, Hughes M, Pilishvili T, et al. Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019 United States, February 12–March 28, 2020. MMWR Morb Mortal Wkly Rep 2020;69:382-6. Available from: http://www.cdc.gov/mmwr/volumes/69/wr/mm6913e2.htm?s_cid=mm6913e2_w). [Last accessed on 2020 Apr 15].  Back to cited text no. 14
    
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WHO Statement: Tobacco use and COVID-19; 11 May, 2020. Available from: https://www.who.int/news-room/detail/11-05-2020-who-statement-tobacco-use-and-covid-19. [Last accessed on 2020 Mar 20].  Back to cited text no. 15
    
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CDC. Coronavirus Disease 2019 (COVID-19): Coping with Stress. Available from: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html. [Last accessed on 2020 May 25].  Back to cited text no. 16
    
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Kreutz R, Algharably EA, Azizi M, Dobrowolski P, Guzik T, Januszewicz A, et al. Hypertension, the renin-angiotensin system, and the risk of lower respiratory tract infections and lung injury: Implications for COVID-19. Cardiovasc Res 2020. doi: 10.1093/cvr/cvaa097. Avaialble from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184480/. [Last accessed on 2020 Jun 22].  Back to cited text no. 17
    




 

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