COVID-19: Management Of Non Communicable Diseases During A Pandemic

Non communicable diseases are not caused by infectious agents but due to a combination of genetic, physiological, environmental, and behavioural factors. The top four health conditions that form the largest chunk of NCD's in India are cardiovascular diseases, chronic respiratory disease, cancer, and diabetes, and they are responsible for nearly 63% deaths in India annually. While COVID-19 being a highly infectious disease has a mortality of only 3% (observed globally). Though the burden of NCD's has always been prevalent in the country but it took a pandemic like COVID-19 for authorities to actually highlight the fact that people who are living with such diseases are extremely vulnerable to infectious diseases.

Management of Non Communicable Diseases during a pandemic

These were otherwise always considered as underlying or pre-existing medical conditions when, in fact, they should be in the foreground. The NCD's as an epidemic pose life threatening consequence for individuals, families and communities and consequently create a lingering burden on the healthcare framework. Health conditions like diabetes and hypertension are major consequences of rapid unplanned urbanisation, globalisation of unhealthy lifestyles and population ageing.

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For the past eight months the world has been battling COVID-19, and we have evidence that people living with NCDs (PLWNCDs) are at a greater risk of COVID-19 and its complications. Many countries including India, have seen a high fatality rate from COVID-19 in the elderly with one or more co-morbidities like diabetes, hypertension or heart related problems. The increased spread of COVID-19 puts lives of these people under constant threat and more so now when several nations are ending lockdown the situation for PLWNCDs (people living with NCDs) may not improve unless conscious efforts are not made by the government and healthcare intuitions jointly to identify such people and protect them from the possible severity of COVDI 19.

More and more people are developing NCDs. With months of lockdown, social distancing and self-isolation, there is an increased incidence of people resorting to indulging in junk food, alcohol and tobacco consumption as coping mechanism and in turn limiting any kind of physical activities. An unhealth lifestyle currently poses a new threat to the now healthy population developing NCDs in the near future. While the focus majorly lies on COVID-19 related issues, it is important to emphasise on:

• Developing healthy eating and living habits, more so in a situation where people don't have access to gyms or public parks/playgrounds
• Helping people develop hobbies as coping mechanisms to reduce their reliance on unhealthy eating and living habits

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All these are small efforts that will in turn help the country curb the lingering burden of NCDs and help individuals keep their immunity strong against any infectious viruses.

Additionally, For ensuring health security, there is a need to identify PLWNCDs, and then provide them with a health system support through telemedicine, digital interventions to manage their NCDs, and helping them prevent risk factors by quitting tobacco and alcohol are some immediate steps to protect them from the current crisis. The need of the hour is to develop strong health care systems, a resilient, qualified, well-resourced health workforce, and healthy populations.

Challenges due to disrupted health services

During the lockdown, PLWNCDs around the world have faced innumerable challenges in managing their conditions. Overburdened health systems were reorganized and PLWNCDs were not a priority. There have been reported disruptions in chronic care, blockages in supplies of essential medicines and technologies, screenings, and diagnoses, as well as limited access to health workers and support services critical to the management of NCDs.

The only way to reduce the impact of viruses like novel coronavirus is investment in better management of NCD's. The main objective should be to control and monitor such health conditions through a public health approach which stresses on prevention, early detection and timely local treatment at the primary health care level. Access to palliative care at home for those with more advanced conditions should be an integral part of this strategy. Our best defence against any such virus is a robust public healthcare system.

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(Dr Karan Thakur, Vice President - Operations And Communications at Indraprastha Apollo Hospitals, New Delhi)

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