Burden of Non-Communicable Diseases during COVID-19 Pandemic

Noncommunicable diseases (NCDs), notably cardiovascular diseases, cancers, diabetes and chronic respiratory diseases, are the leading causes of death and disability globally, affecting more people each year than all other causes combined. NCDs are responsible for over 70% of all deaths, with nearly 80% of these deaths occurring in low- and middle-income countries. Due to their chronic and sometimes life-long nature, NCDs often require repeated interactions with the health system over long periods of time which includes access to essential medicines and rehabilitation. 

Due to the rapid spread of covid-19 across the world, respond to NCDs has been impacted and people are more vulnerable, as it increases the risk of infection to severely ill patients and those who need regular care. For example, reduction in admission to hospitals with acute coronary disease and those facing long term complications of myocardial infarction or any other disease  due to non- availability of beds. hence, these outcomes increased the burden of care. 

This happens because of:

1. decrease in inpatient volume due to cancellation of elective care.
2. staffs are deployed to provide covid-19 relief.
3. closure of outpatient disease specific consultation clinics.
4. closure of screening.

Thus, the interaction between coronavirus disease 2019 (COVID-19) and non-communicable diseases may increase the global burden of disease. 

Due to their wide geographic spread, severity and lack of population immunity, Non-Communicable Diseases or NCDs constitute an ongoing pandemic. [1] Considering that more than 1.7 billion people or about 22% of the global population are currently living with at least one NCD, neglecting NCDs during emergencies may have fatal consequences for individuals affected by comorbidities.[3]

The addition of COVID-19 to pre-existing NCDs has resulted in increased morbidity and mortality [7]. Studies reported that a high percentage of hospitalized patients due to COVID-19 had underlying chronic conditions, hypertension being the most common.[2] The health condition has been more severe and mortality higher among older adults with NCDs [5] and people with bacterial infections caused by antibiotic resistant pathogens. [6] NCDs are known to exhibit several characteristics with infectious manifestations, including parameters like a proinflammatory state and compromised innate immune response [8], which can increase susceptibility to fall in radar of not just COVID-19 but possibly any disease.

To estimate how disruption in health system affected PLWNCDs, research showed that more than 53% of the surveyed countries reported partially or completely impaired services for NCDs and related complications, particularly after the COVID-19 trajectory changed from sporadic to community transmission.[9]  This problem got exacerbated because many have been deprived of treatment for their diseases since the onset of the pandemic with the reassignment of health staff from NCD facilities to COVID-19 in all surveyed countries [10] and the disruption of medical supplies and diagnostics as a result of nationwide lockdowns [11].

In the pandemic era and beyond, prevention and control of NCDs still need to be strengthened in national policies and governance. A sole focus on infectious diseases shall divert due attention from the larger picture of the global burden of diseases, which has been evident as vaccinations got ready to be administered around the world within months for COVID-19 but the healthcare system globally has not been able to manage prevention and treatment for NCDs even after all the years.[12] Broadening the public health emergency agenda would necessitate embedding NCDs into national public health emergency plans so that the public health systems can promptly respond when emergencies strike. [4]

Citations:

1. Morens, D.M., Fokers, G.K. and Fauci, A.S. (2009), “What is a pandemic?”, The Journal of Infectious Diseases, Vol. 200 No. 7, pp. 1018-21, doi: 10.1086/644537.
2. Suleyman, G., Fadel, R.A., Malette, K.M., Hammond, C., Abdulla, H., Entz, A., Demertzis, Z., Hanna, Z., Failla, A., Dagher, C., Chaudhry, Z., Vahia, A., Lanfranco, O.A., Ramesh, M., Zervos, M.J., Alangaden, G., Miller, J. and Brar, I. (2020), “Clinical characteristics and morbidity associated with coronavirus disease 2019 in a series of patients in Metropolitan Detroit”, JAMA Network Open, Vol. 3 No. 6, doi: 10.1001/jamanetworkopen.2020.10895.
3. Perone, S.A., Martinez, E., du Mortier, S., Rossi, R., Pahud, M., Urbaniak, V., Chappius, F., Hagon, O., Bausch, F.J. and Beran, D. (2017), “Non-communicable diseases in humanitarian settings: ten essential questions”, Conflict and Health, Vol. 11, p. 17, doi: 10.1186/s13031-017-0119-8.
4. Collins, T., Tello, J., Van Hilten, M., Mahy, L., Banatvala, N., Fones, G., Akselrod, S., Bull, F., Cieza, A., Farrington, J., Fisher, J., Gonzalez, C., Guerra, J., Hanna, F., Jakab, Z., Kulikov, A., Saeed, K., Abdel Latif, N., Mikkelsen, B., Pourghazian, N., Troisi, G. and Willumsen, J. (2021), "Addressing the double burden of the COVID-19 and noncommunicable disease pandemics: a new global governance challenge", International Journal of Health Governance, Vol. 26 No. 2, pp. 199-212. //doi.org/10.1108/IJHG-09-2020-0100
5. HHP K. Older People are at Highest Risk From COVID-19, but all Must act to Prevent Community Spread Copenhegan: World Health Organisation Reginal Office for Europe. (2020)..
6. Clancy CJ, Nguyen MH. Coronavirus disease 2019 superinfections, and antimicrobial development: what can we expect? Clin Infect Dis.(2020) ciaa524. doi: 10.1093/cid/ciaa524
7. World Heart Federeation. COVID 19 and CVD: World Heart Federation. (2020).
8. Chen L, Deng H, Cui H, Fang J, Zuo Z, Deng J, et al. Inflammatory responses and inflammation-associated diseases in organs. (2018) 9:7204–18. doi: 10.18632/oncotarget.23208
9. Yadav UN, Rayamajhee B, Mistry SK, Parsekar SS and Mishra SK (2020) A Syndemic Perspective on the Management of Non-communicable Diseases Amid the COVID-19 Pandemic in Low- and Middle-Income Countries. Front. Public Health 8:508. doi: 10.3389/fpubh.2020.00508
10. COVID-19 Significantly Impacts Health Services for Noncommunicable Diseases: World Health Organisation. (2020).
11. Basu S. Non-communicable disease management in vulnerable patients during Covid-19. Indian J Med Ethics. (2020) V:103–5. doi: 10.20529/IJME.2020.041
12. Pan XF, Yang J, Wen Y, Li N, Chen S, Pan A. Non-communicable diseases during the COVID-19 pandemic and beyond [published online ahead of print, 2021 Apr 20]. Engineering (Beijing). 2021;10.1016/j.eng.2021.02.013. doi:10.1016/j.eng.2021.02.013

With the rapid spread of COVID-19 across the world, the ability of countries to address and respond to NCDs has been impacted. The virus has caused broad disruptions to health services while at the same time drawing attention to countries’ NCD burden, as those living with NCDs are at increased risk of becoming severely ill with the virus. The disruption of health services is particularly problematic for those living with NCDs who need regular care. Several examples from countries show how the disruption of NCD services has directly affected people. For example, screening, case identification, and referral systems for cancer have all been affected by the COVID-19 pandemic which has resulted in a substantial decrease in cancer diagnoses. The reduction in admission to hospital of patients with acute coronary syndrome often results in increases in out-of-hospital deaths and long-term complications of myocardial infarction. Disruption in rehabilitation services for people with NCDs in various countries has potentially impacted their functional outcomes and consequently increased the burden of care.

1. Comorbidity:

The burden of Non-Communicable Diseases during COVID-19 pandemic

According to a survey conducted by WHO in 155 countries, the pandemic has curtailed the provision of healthcare services drastically. With the unprecedented blow to the healthcare system, 94% of the respondent countries have refurbished their infrastructure to work on NCDs during the pandemic. Among the NCDs, hypertension, diabetes, cancer treatments, and cardiovascular emergencies were partially or completely disrupted. ^[1]

Rehabilitation services and screening facilities have been stopped due to the pandemic leading to chaos across developing and the developed countries. A post-pandemic NCD health system will be required to achieve the tasks which have faced a setback due to the pandemic. ^[1] NCDs require iterative interactions with the patients due to their chronic nature – disease management and follow-ups. To manage these situations, some strategies had been developed, like triage and the use of telemedicine. Restrengthening and reallocation of resources were adopted to be the acceptable strategies to face the situation. ^[2]

In most cases, it has been seen that comorbid conditions have proven fatal for COVID-19. People Living with or Affected with NCDs (PLWANCDs) are more vulnerable to the infection, and thus, vaccination had also been prioritized for them. A resilient healthcare system will be required to achieve Universal Health Coverage (UHC) and SDG 3. Multisectoral collaboration is required to strike a balance and harmonize with the ongoing situation and for future preparedness. ^[3]

Reference –

1. Dyer O. Covid-19: Pandemic is having “severe” impact on non-communicable disease care, WHO survey finds.

//www.bmj.com/content/bmj/369/bmj.m2210.full.pdf

2. World Health Organization. The impact of the COVID-19 pandemic on non-communicable disease resources and services: results of a rapid assessment.

//apps.who.int/iris/bitstream/handle/10665/334136/9789240010291-eng.pdf

3. Takian A, Bakhtiari A, Ostovar A. Universal health coverage for strengthening prevention and control of noncommunicable diseases in COVID-19 era. Medical Journal of the Islamic Republic of Iran. 2020;34:153.

//www.ncbi.nlm.nih.gov/pmc/articles/PMC7787038/pdf/mjiri-34-153.pdf

Other interesting reads –

1. Yadav UN, Rayamajhee B, Mistry SK, Parsekar SS, Mishra SK. A syndemic perspective on the management of non-communicable diseases amid the COVID-19 pandemic in low-and middle-income countries. Frontiers in public health. 2020 Sep 25;8:508.

//www.frontiersin.org/articles/10.3389/fpubh.2020.00508/full?fbclid=IwAR3CnSTXa4COjit3YnoaMuolgHhbNPoRl0Sihy1Iomv1L3av8UWZVo3Oa94

2. Thornton J. Covid-19 pandemic has derailed progress on sustainable development goals, says WHO. BMJ: British Medical Journal (Online). 2020 May 14;369.

//www.proquest.com/openview/007ee9cbfdaa7e2cfb63699e2c48aaa1/1?pq-origsite=gscholar&cbl=2043523

3. Basu S. Non-communicable disease management in vulnerable patients during Covid-19. Indian J Med Ethics. 2020 Jun;2:103-5.

//www.researchgate.net/profile/Saurav-Basu-3/publication/340979621_Non-communicable_disease_management_in_vulnerable_patients_during_Covid-19/links/5ea85618a6fdcc705094ba50/Non-communicable-disease-management-in-vulnerable-patients-during-Covid-19.pdf

The early stages of the COVID-19 pandemic have focused on containing SARS-CoV-2 infection and identifying treatment strategies. While controlling this communicable disease is of utmost importance, the long-term effect on individuals with non-communicable diseases (NCD) is significant. Although certain NCDs appear to increase the severity of COVID-19 and mortality risk, SARS-CoV-2 infection in survivors with NCDs may also affect the progression of their pre-existing clinical conditions. 

Short and long term consequences :

1. Increasing social Distance.

2. Reduced Physical activity levels. And other life style changes.

3. Reduction in Vitamin - D

4. Effect on lonliness and mental health disorders.

5. Changes to routine management of NCD patients.

Many countries have made changes to routine management of NCD patients, e.g., cancelling non-urgent outpatient visits, which will have important implications for NCD management, diagnosis of new-onset NCDs, medication adherence, and NCD progression. We may have opportunities to learn from this unprecedented crisis on how to leverage healthcare technologies and improve procedures to optimize healthcare service provision. This article discusses how the COVID-19 outbreak and related infection control measures could hit the most frail individuals, worsening the condition of NCD patients, while further jeopardizing the sustainability of the healthcare systems. We suggest ways to define an integrated strategy that could involve both public institutional entities and the private sector to safeguard frail individuals and mitigate the impact of the outbreak.

INTERPRETATION:

Preventive measures against COVID-19 should protect the public from the dual burden of communicable and non-communicable diseases, particularly in the elderly. In addition to active COVID-19 surveillance, policymakers should utilize this evidence as a guide for prevention and coordination of health services. This model is timely, as many countries have begun to reduce social isolation.

COVID-19 and non-communicable diseases (NCDs) are closely interconnected. Although all populations are generally vulnerable to SARS-CoV-2 infection, individuals with preexisting chronic conditions such as cancer, CVD, diabetes, and chronic obstructive pulmonary disease are more likely to have severe symptoms and fatal outcomes from COVID-19.

• Cardiovascular diseases

Cardiovascular diseases, or CVDs, are the number one cause of death globally, taking an estimated 17.9 million lives each year. According to Global Heart, “Some small studies have shown that patients with cardiovascular disease are at a higher risk of complications.

• Cancer

Cancer is the second leading cause of death globally, being responsible for one in six deaths each year. People living with cancer who are in active chemotherapy or intensive radiotherapy, undergoing antibody treatments or who have undergone bone marrow or stem cell transplants in the last six months, may be particularly vulnerable to infection as these treatments weaken the immune system.

• Chronic respiratory diseases

Chronic respiratory diseases (CRDs), are diseases of the airways and other parts of the lung. People living with CRDs are more likely to have severe or even life-threatening symptoms of COVID-19, as the virus affects the lungs and breathing.

• Diabetes

About 463 million people are estimated to be living with diabetes.This chronic condition relates to insulin, the hormone that regulates blood glucose.

When people with diabetes develop a viral infection, it can be harder to treat due to fluctuations in blood glucose levels and the presence of diabetes complications.

• Obesity

Overweight and obesity are defined as excessive fat accumulation that may impair health.Managing weight can be difficult in the context of the COVID-19 pandemic, as many people around the world are living with severe restrictions on movement.

This pandemic had a great impact on the health care services.Since there is a need of lot of protection from Covid-19 , the services for NCD patient,sometimes it may not be on time.Even fatal consequences may occur, if acute services cannot be provided in a timely manner, such as dialysis for diabetic kidney disease, surgical procedures for coronary heart disease, and chemotherapy for acute myeloid leukemia.COVID-19 infections and major NCDs are linked by common risk factors such as advanced age, male sex, certain ethnicities or races,smoking, and poverty.The sedentary life style, diverted resources and staff,and importantly,the misinformation and fear about COVID increases the hesitancy of accessing health care services in the hospitals.

Finally, due to the stress of trying to avoid infection and respecting physical distancing recommendations may affect many people’s mental health.

CiTATION:

//www.ncbi.nlm.nih.gov/pmc/articles/PMC8056943/

//ncdalliance.org/sites/default/files/resource_files/COVID-19%20and%20NCDs-%20Frequently%20Asked%20Questions_June2020.pdf

Non-communicable diseases include heart diseases ,stroke ,cancer ,diabetes ,chronic lung diseases ,hypertension ,liver disorders etc.Covid-19 pandemic has shown severe impact on non communicable diseases in the sense that people who are suffering with any of the NCD's are unable to reach the hospitals for the regular check ups due to the lockdown restrictions which is implemented during the first and the second waves of pandemic. Due to the surge of covid-19 cases all the emergency ICU wards are allotted mainly to covid patients. Unless it is emergency chronic illness are not treated in most of the hospitals .Many minor/non emergency surgeries were also postponed during the pandemic. Even due to the fear of getting infected with covid-19 virus many people neglected the diseases and they only visited the hospitals unless their condition becomes very serious ,so due to this negligence many people loosed their lives as they didn't reach the hospital in correct time. Travel restrictions that were imposed during the lockdown also affected many people especially who are suffering from chronic illnesses i.e. they are unable to reach the hospital in time which led to the death of the person.

Even people are not visiting the hospitals for regular check ups/screening of the diseases which led to the severity of the conditions like for ex: cancer screening if not done in the correct time it may lead to final stages and after showing up of the severe/unbearable symptoms then only one reaches the hospital; at this final stage, treatment doesn't show any effect which automatically leads to the death of the person .People who are already suffering with co-morbidities like NCD'S are more prone to get infected with covid virus due to the low immunity. Mostly old age people are affected with covid because they already have a compromised/low immunity due to age related illnesses i.e. They may be suffering with chronic diseases like hypertension ,diabetes ,heart diseases etc. Due to the lockdown physical activity also got decreased and people tend to eat and sleep without any regular exercise/activity to the body which automatically increased their weight i.e. it lead to obesity which is again a major risk factor for many of the NCD'S.

Due to these pandemic restrictions all the health care schemes for chronic diseases which is providing support to the needy people(especially financially) in the time of illness got neglected and not implemented properly due to which many didn't attain those services and got severely sick without proper treatment and availability of healthcare services. Government health programs in schools like mid-day meals programs also got halted because of pandemic, due to which many school children suffered with hunger and malnutrition, thus pandemic indirectly increased the NCD i.e. malnutrition. Even many organ transplantations like liver, heart transplant etc. also have been stopped due to some of the reasons like the travel/mobility restrictions, emergency ICU ward unavailability, due to the fear of getting infected with the virus.

REFERENCES:

1. //english.onlinekhabar.com/covid-19-nepal-patients-with-chronic-non-communicable-diseases-left-in-the-lurch.html

2. //www.cnbctv18.com/views/managing-the-covid-19-syndemic-10097381.htm

3. //www.expresshealthcare.in/news/the-impact-of-covid-19-pandemic-on-cancer-care/430256/

4. //www.newindianexpress.com/magazine/2021/jul/25/other-side-of-midnight-covid-pandemic-caused-serious-health-conditions-to-take-a-backseat-2333948.html

Few studies had claimed that COVID-19 and NCDs have a reciprocal effect on each other where NCDs increases the vulnerability to SARS-CoV-2, and COVID-19 increases the NCD-related risk factors in the general population. There is a need to understand the health system that can address not just one or some medical problems but ensure delivering holistic care. Although all genders are generally vulnerable to SARS-CoV-2 infection, individuals with preexisting chronic conditions such as cancer, CVD, DM, and COPD are more likely to have severe symptoms and fatal outcomes. COVID-19 could provide new insights into interactions between the immune system and NCDs, and potentially change the way we understand and treat these diseases under various govt guidelines. In near future, can predict a new long-term disabilities that will add to the NCD burden.

Posted by: @ashishjoshi

Let's share your thoughts on impact of pandemic on Non Communicable diseases (NCDS).

Through the causative agent SARS-CoV-2, COVID-19 spreads quickly in a community and overwhelms the healthcare system if left uncontrolled. COVID-19 differs from major NCDs in that it has a clear cause, rapid transmission, and a lack of effective treatments. However, as the pandemic is prolonged, researchers are gaining a deepened understanding of the multifaceted link between COVID-19 and NCDs. First, pathophysiological pathways and mechanisms in disease development and progression are shared between COVID-19 and NCDs. Although all populations are generally vulnerable to SARS-CoV-2 infection, individuals with preexisting chronic conditions such as cancer, CVD, diabetes, and chronic obstructive pulmonary disease are more likely to have severe symptoms and fatal outcomes from COVID-19. . Preexisting conditions may contribute to adverse outcomes of COVID-19 through mechanisms such as chronic inflammation and elevated expression of SARS-CoV-2 receptor (i.e., angiotensin-converting enzyme-2) in certain organs. Furthermore, direct damage by SARS-CoV-2 to major organs (e.g., cardiac injury, arrhythmia, septic shock, acute kidney injury, and multi-organ failure) may worsen preexisting conditions. COVID-19 can also leave patients with sustained negative health effects even after recovery. Some of the acute damage from COVID-19 can progress into long-lasting chronic conditions, such as respiratory function decline and cardiomyopathy. Long-term follow-ups are thus essential in order to observe chronic conditions among COVID-19 survivors.

Containment and mitigation measures for COVID-19, including home containment, social distancing, and travel restrictions, can contribute to unhealthy lifestyles and risk behaviors such as a low-quality diet, smoking, excessive alcohol drinking, and physical inactivity , which predispose individuals to the risk and development of NCDs . Such impacts can be particularly relevant since COVID-19 is unlikely to disappear and strict preventive measures will not be lifted in the short run.

REFERENCE:

//www.ncbi.nlm.nih.gov/pmc/articles/PMC8056943/

The COVID-19 pandemic has affected the timely and appropriate treatment of patients with NCDs.

COVID-19 has amplified the risks of cancer patients who are undergoing:

• Chemotherapy
• Radiotherapy
• Antibody treatment
• Bone marrow or stem cell transplant

The reason for increased risks are :

• The procedures mentioned above affect the immune system and lead to decreased immunity.
• Healthcare staff diverted to COVID-19 duty.

History of stroke increases the risk of deaths due to COVID-19 by three times. Patients with diabetes mellitus already have underlying problems of immunodeficiency, making them more susceptible to COVID-19. Social distancing and lockdown interfered in their routine walks and gym visits. The fluctuations in blood glucose levels reduce their immunity and the virus thrives well in elevated blood glucose levels.

Patients with NCDs are affected during the pandemic by the following factors:

• Due to loss of jobs during the pandemic, they were not able to meet the expenses for their treatment.
• Restrictions of caretakers/attenders for elderly patients with NCDs.
• Access to pharmacies, hospitals and diagnostic laboratories restricted.
• Supplies disrupted.
• Routine medical appointments were delayed and cancelled.
• Reluctance to seek assistance from healthcare workers, fearing the transmission of coronavirus.

COVID-19 created challenges for patients with cardiovascular diseases as they were unable to undergo echocardiography during the critical period of transmission of COVID-19. Short-term and long-term follow ups were disrupted for patients. An alternative surgery for Structural Heart Disease is possible by transcatheter intervention. Since clean premises are not feasible, delay in the intervention has led to inevitable morbidity and mortality.

Steps taken to combat issues faced by patients with NCDs due to the pandemic are as follows:

• Teleconsultations and telemedicine.
• Doxy.me is an innovative outcome by which a virtual room is created for physicians to provide telemedical service.

Thus, there is a need to double our efforts to effectively address NCDs during the pandemic.

Citation -

1. Trejo-Gabriel-Galán JM. Stroke as a complication and prognostic factor of COVID-19. Neurologia (Engl Ed). 2020 Jun;35(5):318-322. English, Spanish. doi: 10.1016/j.nrl.2020.04.015. Epub 2020 May 6. PMID: 32493597; PMCID: PMC7200328.

2. Vogrig A, Gigli GL, Bnà C, Morassi M. Stroke in patients with COVID-19: Clinical and neuroimaging characteristics. Neurosci Lett. 2021 Jan 19;743:135564. doi: 10.1016/j.neulet.2020.135564. Epub 2020 Dec 19. PMID: 33352277; PMCID: PMC7749733.

3. Giordano A, Biondi-Zoccai G, Frati G, Bartorelli AL. Management of Structural Heart Disease and Acute Coronary Syndromes in the COVID-19 Pandemic. Curr Atheroscler Rep. 2020 Jun 10;22(7):29. doi: 10.1007/s11883-020-00849-5. PMID: 32524266; PMCID: PMC7283421.

4. Capotosto L, Nguyen BL, Ciardi MR, Mastroianni C, Vitarelli A. Heart, COVID-19, and echocardiography. Echocardiography. 2020 Sep;37(9):1454-1464. doi: 10.1111/echo.14834. Epub 2020 Sep 4. PMID: 32885490.

Due this pandemic no patients getting diseases rather than COVID-19 is getting proper treatment due to lack of bed.More vulnerable patients are coronary patients,cancer patients…And if they get a bed in hospital they fail in their financial field,because they lost their job in this pandemic.Ill people or the people having weak immune system or those who want regular treatment are getting more affected in this pandemic.

patients with non communicable diseases need life long medicines and follow-ups.

since, the pandemic has begun; healthcare sectors have shifted their attention to manage the burden of the COVID-19 disease.

in such scenario, the people with NCDs have been neglected; they are either tele-consulted or go to the hospitals in huge gaps which may hinder in proper maintenance  of the overall disease.

this has been a serious issue in remote areas as people need to travel for a long duration to reach hospitals; as now there are restrictions in travel; people have been using the same treatment regimen as mentioned before the pandemic.

On the other hand; it is not safe for people with NCDs to commute to hospitals especially where COVID-19 centers are available as  there are still huge number of patients affected from COVID-19.

people with NCDs belong to risk group of having covid-19 easily than other population as their immune system is already weakened or altered due a diseases.

therefore, until and unless it is a necessity; it is better to tele-consult the physician from home and only go for tests/investigations and examinations those that are  recommended by the physician and not due to fear or anxiety.

this phase is crucial for everyone and elective treatments or follow-ups have been pushed aside for indefinite period of time.

thus, people with NCDS should be in constant touch with their physicians; eat healthy; maintain the protocols guided to them by their doctors and seek help as and when necessary. 

NCDs, such as cardiovascular disease, cancer, diabetes, and chronic respiratory disease, are amplifying the impacts of COVID-19, and COVID-19 is exacerbating the burden of NCDs, particularly in already disadvantaged communities. Almost one-fourth (22%) of the global population is estimated to have an underlying condition that increases their vulnerability to COVID-19, and most of these conditions are NCDs. Urgent action across sectors is needed to address the root causes of NCDs and increase access to affordable and quality treatments and prevention.

Although the overall fatality rate of COVID-19 is relatively low, older adults and patients with comorbidities are more likely to have severe disease and subsequent mortality. The most commonly reported non-communicable diseases that have been shown to predict poor prognosis in patients with COVID-19 to include diabetes mellitus (DM), hypertension, cerebrovascular disease, coronary artery disease (CAD), and COPD. In India, 86% of COVID-19 patients had comorbid conditions such as diabetes, chronic kidney problems, hypertension, or heart ailments, revealing that an underlying illness makes a person more susceptible to infection by the coronavirus. The age distribution shows that 63% of the deaths were in the group of 60 years and above, 30% between 40 and 60 years, and 7% below 40 years. in the context of NCDs, already there is a high burden, which may increase the hospitalization and mortality across populations when co-occurring with COVID-19. From an economic perspective, such adverse health outcomes will affect the economic returns on existing and newly adopted strategies of health systems financing. In addition, many people with NCDs may experience restricted mobility due to lockdown or lack of transportation, which will affect their access to health services during COVID-19.

Prevention and control of NCDs are important during this pandemic because NCDs are major risk factors for patients with COVID-19. In addition, some of the restrictive measures such as lockdowns, social distancing, and travel restrictions to reduce the spread of infection in many countries impact specifically on people living with NCDs by limiting their activity, hampering their ability to secure healthy foods and access preventive or health promotion services. Evidence from this and previous pandemics suggests that without proper management, chronic conditions can worsen due to stressful situations resulting from restrictions, insecure economic situations, and changes in normal health behaviors. The disruption of routine health services and medical supplies can lead to an increase in morbidity, disability, and avoidable mortality among NCD patients.

REFERENCES

//www.ijncd.org/article.asp?issn=2468-8827;year=2020;volume=5;issue=2;spage=29;epage=35;aulast=Thakur

Non-communicable diseases (NCDs) and the pandemic

COVID 19 has left everyone wounded. But people suffering from underlying diseases and conditions are more severely impacted by the burden of this virus. Non-communicable diseases like cardiovascular and chronic respiratory diseases, diabetes, and cancers account for a staggering 71 % of global deaths annually; a majority of these premature deaths occur in low and middle-income countries due to poor health strategies.

Some of the risk factors for these diseases include:

• obesity
• smoking
• poor dietary habits and nutrition and 
• high levels of fat or glucose in the blood.

According to a study The Lancet Global Health, one in 5 people affected by COVID-19 are at risk of becoming severely infected if they have underlying chronic conditions like NCDs.

The pandemic has adversely affected those with NCDs by reducing the efforts of surveillance health programs and initiatives.

Different countries have tried to promote health programs but failed after initiating, like in the UK PM Boris Johnson initiated efforts against obesity after his suffering with coronavirus; but this seemed redundant by subsequent promotion to eat at restaurants to uplift local business practices.

The government must put a strong foot forward with a concrete plan to promote health especially among the vulnerable population(like those suffering from NCDs), in areas like tobacco cessation and nutrition programs in low and middle-income countries.

WHO has also recognized NCDs and their crucial impact on global health and aims to reduce one-third of the global deaths caused by NCDs through the 2030 Agenda for Sustainable Development, target 3.4. On an individual level adopting a healthy lifestyle with a balanced diet, advised medication, and adequate sleep along with avoiding unhealthy practices such as smoking will help to prevent and manage and prevailing conditions and promote overall health and well-being.

References:

//www.who.int/teams/noncommunicable-diseases/covid-19

//www.who.int/docs/default-source/inaugural-who-partners-forum/covid-19-and-ncds---final---corr7.pdf

//www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31856-0/fulltext

//www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases