If you have diabetes, hypertension or are obese, you are more likely to be severely affected by COVID-19 or to die from it. These non-communicable diseases (NCDs) were the most common comorbidities identified in COVID-19 patients hospitalised in the New York City area, according to a study published in the April 2020 issue of the Journal of the American Medical Association. This relationship has also been observed globally. Some estimates, most notably in the Indian Journal of Medical Ethics, are that between 60% and 90% of people dying from COVID-19 also had an NCD.
As country after country imposed lockdowns to contain the virus spread, social distancing and quarantine restrictions affected the ability of people with NCDs to access care and regular medication. Interrupted NCD services were reported in 75 percent of countries, according to the World Health Organization (WHO). This has led to increased complications and more deaths. Further studies show that COVID-19 survivors with NCDs may see their pre-existing conditions worsen, and previously healthy COVID-19 patients may suffer cardiovascular damage leading to complex NCD cases in the future.
The interplay between COVID-19 and NCDs is deadly.
And yet, there is a great global opportunity here. The same tools we are using to fight the pandemic are those required to fight NCDs. While preventing COVID-19 is still an uncertain medical science and treatment is at an experimental stage, we know that a way to reduce COVID-19 deaths is to prevent, reduce and treat NCDs. These protocols are well established and result in less deaths. We know how to reduce the risks of NCDs.
In Asia, the COVID-19 case fatality rates of Singapore (0.2%) and South Korea (1.6%) stand out, being significantly less than the global average of 3% as these countries resorted to aggressive testing and screening. What is less known is that these countries have robust health care systems which have reduced NCD mortalities from a global median of 430 per 100,000 population (Vietnam) to a near global best of 266 (South Korea) or 247 (Singapore) per 100,000, according to WHO. So, an important lesson for the world grappling with the COVID-19 pandemic is that reducing NCDs by strengthening screening, testing and prevention can mitigate COVID-19-like pandemics.
Over 180 billion US dollars has been committed to tackling COVID-19 globally by development banks like The World Bank, Asian Development Bank and African Development Bank. And yet more by governments and philanthropic trust funds, such as the Bill and Melinda Gates Foundation, to address COVID-19. These funds are not currently being invested sufficiently to increase screening, testing or for strengthening health systems to care for NCDs in the long run.
It is not too late to turn this around. The huge investments channelled for the pandemic can be cross-purposed across COVID-19 and NCDs. Using funds to simply buy single-use personal protective equipment is not a sustainable outlay. Smarter stipulations on how the money is being spent need to be made.
Improving and increasing the capacity of medical laboratories to test and screen for COVID-19, should include the same for NCDs. The disease surveillance and health information systems being strengthened to track and report COVID-19, must also be used for NCDs. In Mumbai (India’s commercial hub and most populous city, with more than 18 million people), the monthly case mortality rate of COVID-19 was brought down from an initial level of above 4% to between 2.6% and 3%. This was done by surveying over 9 million people living in slums for diabetes and hypertension, alongside COVID-19 during the first two months of the pandemic. This also enabled better targeting of NCD-affected elderly people.
A global marketplace where affordable, quality medication and diagnostics are available to all would support in tackling NCDs, including during emergencies.
The Defeat-NCD Partnership was launched at the UN General Assembly on 24 September 2018, in response to Sustainable Development Goal 3.4, to reduce premature NCD mortalities by one third by 2030. The Defeat-NCD Partnership exists to ensure a multisectoral approach, bringing relevant private and public sector actors together with civil society organisations. Personnel from The Defeat-NCD Partnership sit within Myanmar and Rwanda’s Ministries of Health, supporting the development of national NCD strategies and costed action plans, to strengthen health systems and scale-up their response to addressing NCDs. With the onset of COVID-19, the Partnership is supporting the inclusion of NCDs in national COVID-19 plans and practical telemedicine innovations to support national effort.
For once, a lack of money is not the barrier to grasping this opportunity. The challenge instead is making the effort to reengineer the relationship between COVID-19 and NCDs for public benefit. We are at a critical juncture. A legacy of reducing premature deaths from NCDs, emerging from the COVID-19 pandemic, is what we must achieve.Praveen Pardeshi belongs to the Indian Administrative Service (IAS) and, since August 4, is on secondment as Global Programme Coordinator, The Defeat-NCD Partnership, United Nations Institute for Training and Research (UNITAR), in Geneva. Before this assignment, Pardeshi was Mumbai’s Municipal Commissioner and had initiated and led the city’s fight against Covid-19. Early in his civil service career, Pardeshi supervised relief and rehabilitation efforts during and after the devastating 1993 earthquake in Latur, Maharashtra, that killed some 10,000 people and injured another 30,000 people.