Focusing on diseases sidelined by COVID-19

Strengthening the primary healthcare system will help tackle the burden of non-communicable diseases

Nearly (NCDs) such as hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, and cancer. Cardiovascular diseases such as stroke, heart attacks and coronary artery disease are the top cause of global deaths. One out of every four deaths occurs due to cardiovascular diseases, especially among younger patients. In the Indian subcontinent, there is early onset and rapid progression of such diseases, and a high mortality rate. Premature loss of life due to NCDs in the age group of 30-69 years is also very high among Indians. Half the deaths due to cardiovascular diseases occur in the age group of 40-69 years. To address this growing burden of NCDs, the National Health Mission launched the , in 2010, focusing on strengthening infrastructure, promoting good health, human resource development, early diagnosis, management and referral. The rapid spread of COVID-19 has severely tested primary healthcare systems, which perform myriad functions, across the world. Maternal healthcare services, immunisation, health surveillance, and the screening and management of NCDs have all been severely disrupted. A World Health Organization (WHO) survey conducted in May 2020 among 155 countries found that low-income countries were the most affected by this disruption. More than half (53%) of the countries surveyed had partially or completely disrupted services for hypertension treatment, 49% for treatment for diabetes and diabetes-related complications, 42% for cancer treatment and 31% for cardiovascular emergencies. The outcomes in COVID-19 patients with pre-existing cardiovascular disease risk factors or with established cardiovascular disease can be worse than others, perhaps due to low cardiorespiratory reserve, worsening of the underlying cardiovascular disease due to systemic effects of the illness, or precipitating novel cardiac complications. Data from the National Health Mission’s Health Management Information System in India show that emergency services for cerebrovascular diseases dropped by about 14%. Among NCDs, persons with diabetes are at an exceptionally higher risk of severe clinical outcomes of COVID-19. A recent study reported that nearly one in every two Indians living with diabetes is unaware of their condition. They are at higher risk of dying if they contract COVID-19 because of uncontrolled glucose levels in their blood. Findings from an observational study in Delhi show that 47.1% of hospitalised COVID-19 patients had diabetes.