COVID-19 and preexisting conditions: Is a holistic approach needed?

A recent reflection on the literature has found that people with noncommunicable diseases (NCDs), such as hypertension, diabetes, and chronic heart and lung conditions, are doubly worse off during the ongoing pandemic.

Researchers from Australia, Nepal, Bangladesh, and India have collaborated on a consideration of the literature relating to COVID-19 and NCDs. They identified some important general trends and made recommendations for a holistic approach to helping people with preexisting conditions.

The researchers have found that NCDs and the COVID-19 pandemic affect each other adversely.

People with NCDs have a higher risk of severe COVID-19. At the same time, various aspects of the pandemic increase the risk of developing these diseases.

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On the one hand, people with NCDs are more likely to have serious consequences if they develop COVID-19. On the other, their socioeconomic circumstances and access to healthcare can be adversely affected by public health responses.

The authors of the survey advocate a “syndemic perspective” when managing the treatment of people with NCDs during the ongoing pandemic.

What is a syndemic?

The term “syndemic” — short for “synergistic epidemic” — was coined in the 1990s. It refers to the interaction of socioecological and biological factors leading to adverse outcomes.

During syndemics, people with NCDs are more exposed to risk factors such as mental health issues, lack of access to health services, and poverty.

According to the present research, published in Frontiers in Public Health, the COVID-19 pandemic has developed into a syndemic by mid-June 2020. This is due to factors including loneliness, financial insecurity, and restricted access to healthcare.

For example, due to a loss of income, people are more likely to cut food expenses and may have poorer diets as a result. Or, people with mental health issues may experience exacerbated symptoms because of isolation.

For people living with NCDs, factors like these can increase the risk of severe COVID-19 and worsen their preexisting conditions.

How COVID-19 and NCDs interact

The aim of lead author Uday Narayan Yadav — a Ph.D. student at the University of New South Wales, in Sydney, Australia — and the team was to focus on low- and middle-income countries, though they also included supporting references from other countries.

They highlight some evidence to support the idea of a higher proportion of malnutrition and psychological problems among people with NCDs.

The researchers then hypothesize that people with preexisting conditions who live with more social and economic deprivation are less likely to access health services during the pandemic.

Some measures that aim to reduce the spread of the virus responsible for COVID-19, such as lockdowns, quarantines, and physical distancing, have made it more difficult for people to access health services for other conditions.

A World Health Organization (WHO) survey of data from 155 countries found that 53% of these countries had partially or completely impaired services for people with NCDs.

Studies have also found that negative coping mechanisms, such as the use of tobacco and consumption of unhealthy processed foods, have increased during the pandemic, leading to further risks.

These and similar issues could lead to the worsening of preexisting conditions, which could lead to increased hospitalization and high societal costs.

To tackle the problem, the authors recommend that public health responses to the pandemic take into account not only individual health issues but a combination of preexisting conditions and socioeconomic status. This is what they mean by a syndemic perspective.

Specific recommendations

The authors of the article highlight four areas in which a syndemic approach may bring about positive change:

  • Essential supplies and information dissemination: They call for a supply of basic needs, such as groceries and sanitary items, as well as for the timely dissemination of information and combatting of fake news.
  • Self-management support at the community level: They call for health authorities to educate and support people with NCDs as they monitor their symptoms, adhere to treatment plans, and seek care. The authors note that traditional and social media, as well as community healthcare workers, also have a crucial role to play.
  • Revitalizing healthcare delivery: They call for the further use of digital healthcare platforms to increase access to services and information necessary for people with NCDs. This also relies on the increased mobilization of community healthcare workers.
  • Policy, advocacy, and research: They call for governments, civil society organizations, researchers, and the private sector to pool expertise and resources. Also, they say, international organizations, philanthropists, and industrialists should come forward to help countries facing financial crises.
  • Increased taxes on unhealthful items: These, they argue, should be used to subsidize the cost of nutritious foods.

The authors emphasize that while their work focused on low- and middle-income countries, several of its recommendations are relevant for places with more developed economies.

They also believe that the syndemic approach will help when fighting future pandemics.

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