Chandigarh, August 27, 2020: The COVID-19 outbreak data shows higher risk of COVID-19 infections and complications in people with NCDs.
The four main NCDs are cardiovascular dis-eases, cancers, diabetes and chronic lung dis-eases.The burden of these diseases is rising rapid-ly among lower-income countries.
There is an evidence to explain the link between COVID-19 and comorbidities, most of which are NCDs and the associated mortality. Much of it has to do with weaker immune system, caused either by old age or chronic diseases themselves or to drugs used to treat COVID-19 such as reninangiotensin system blockers.
The long-term health conditions and aging often weaken the immune system, so it is less able to fight off the virus.
In India, out of total deaths, 70-80% occurred in patients above 60 years and suffering from any chronic noncommunicable diseases.
With this background, World NCD Federation came up with the special issue of IJNCD, its official publication on ‘COVID-19 and NCDs’. It includes 1 editorial, 8 review articles and 3 perspectives. The special issue attempts to cover a wide range of topics, contributed by prominent national and international experts.
The key articles include ‘COVID-19 and non-communicable diseases: Impact and the strategic approaches’ by Prof JS Thakur, Department of Community Medicine and School of Public Health, PGI, Chandigarh which highlights that the strategies are required to address this comorbidity of COVID-19 and NCDs which may include integration and convergence of the existing communicable and NCD programs, strengthening primary health care for universal health coverage, updating guidelines, enhancing surge capacity and multisectoral participation.
* Combating coronavirus disease 2019 and comorbidities: The Kerala experience for the first 100 days by Prof. KR Thankappan, Department of Public Health and Community Medicine, Central University of Kerala, Kerala which depicts that Kerala followed an aggressive strategy of quarantining people arriving from hotspots, after obtaining information from the immigration department.
Those who arrived from hotspots were quarantined for 28 days and those who developed symptoms among them were tested.
Those tested positives were shifted to hospitals and isolated. All primary contacts (those who come in contact with a laboratory-confirmed case of COVID-19) were quarantined.
Secondary contacts (any person who has come in contact with a primary contact) were given strict instructions to follow social distancing, wearing masks and handwashing and to report to the health system in case they develop any symptoms.
* Is the COVID-19 pandemic an opportunity to advance the global noncommunicable disease agenda? by Dr. Jacob Kumaresan, Former WHO Executive Director, New York, USA quoted that data indicates that persons with NCDs are extremely susceptible to COVID-19 and its complications including death.
Focus on controlling the pandemic has led to delays in the diagnosis, treatment, and management of NCDs. This pandemic has exposed the weaknesses of the health-care systems, exacerbated the inequalities within societies, and disproportionately affected the vulnerable groups.
In the process of recovery and in future planning, governments and leaders need to take proactive actions toward the prevention and con-trol of all avoidable deaths from NCDs if the SDG target 3.4 is to be achieved by 2030.
* Cardiovascular disease in the context of the COVID-19 pandemic by Dr. Shanthi Mendis from Geneva Learning Foundation, Geneva, described that cardiovascular manifestations of COVID-19 are complex with patients presenting with one or more of the following: myocarditis, acute myocardial infarction, stroke, cardiomyopathy, heart failure, arrhythmias, acute pericarditis and venous thromboembolism.
Pre-existing CVDs make people more vulnerable to SARS-CoV-2 infection and adversely impact clinical outcomes.
Clinicians caring for COVID-19 patients need to be aware of the potential cardiovascular side effects of various therapies used for treating SARS-CoV-2 infection, including chloroquine/ hydroxychloroquine and azithromycin.
* Managing diabetes and COVID-19: A nation-al strategic framework by Dr. V Mohan, Dr. Mohan’s Diabetes Specialities Centre, Chennai concluded that coronavirus infection across the world and it being designated as a global pandemic by WHO, has severely affected people in general and even more so, those who have con-firmed COVID-19. In people with both diabetes and COVID-19, the morbidity is greater and those older in age or with comorbidities have significantly increased risk of mortality.
* Problems of management of non-corona respiratory diseases in the era of COVID-19 by Prof. SK Jindal, Head, Jindal Clinics, Chandigarh concluded that the management of respiratory dis-eases has suffered the most because of the clinical similarities between COVID-19 and non-COVID flu, respiratory allergies, pneumonias and respiratory failure.
Because of these similarities, some of the patients tend to avoid seeking treatment lest they be diagnosed as COVID-19 infection.
Diagnostic tests such as spirometry and invasive investigations (bronchoscopies and thoracostomies) are avoided by physicians for the fear of spread of the infection. Patients with acute worsening of asthma and chronic obstructive pulmonary disease requiring nebulization therapy are thus not even entertained by medical facilities.
Many patients themselves are often afraid of inhalation therapy. *Role of tobacco in SARS-CoV-2 infection and COVID-19: A scoping review by Brarti Banerjee, Professor, Department of Community Medicine, Maulana Azad Medical College, New Delhi in the systematic review based on the existing evidence, concluded that tobacco smoking evokes adverse pathophysiological changes in the smokers and is associated with worse progression of COVID-19 to its severe form, with the patients requiring admission in intensive care unit and placed on ventilator support or may even succumb to the disease
* COVID-19 and noncommunicable diseases: Identifying research priorities to strengthen public health response by Dr. Prashant Mathur, Director, National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, Karnataka, India concluded that key research domains are burden and epidemiology, health-care delivery, use of technology, sectoral approach, surveillance-monitoring-evaluation, behavioural and communication research, and governance and policy. Within each domain, key research priorities are identified which would be cross-cutting across more domains.
* Psychological dimensions of COVID-19: Perspectives for the practicing clinician by Prof Arun Ravindran from Centre for Addiction and Mental Health; Department of Psychiatry, University of Toronto, Toronto, Canada Provided a framework that integrates the mental, physical, and social domains of the COVID-19 pandemic and their interrelationships.
It recommended that management includes a psychological component, and evidence supports the use of psychoeducation and social support groups to mitigate the adverse psychological effects of the pandemic.
* Hypertension and COVID-19: A public health perspective by Dr. Alka Aggarwal Singh, Independent Public Health Consultant, Gurugram concluded that in hypertension there should be increased advocacy for HT as a serious condition and for its control and for continuity of services for HT and other NCDs, regular screening and care for HT and CVDs among the healthcare workers, adaptation of treatment protocols, data sharing, and reserve funds and human resources for surge capacity.
* Noncommunicable diseases and maternal health in face of the coronavirus disease 2019 response by Dr Jennifer Prince Kingsley from University of Alabama USA reviewed that measures such as lockdowns, social distancing and transportation restrictions impact maternal health-care by disrupting access and continuity of care for NCDs and to preventive and health promotion services.
In parallel, it negatively impacts the global progress made in decreasing the maternal and neonatal mortality rates (MMR and NMR) in the lower and middle-income countries. There is an urgent need to incorporate maternal health with a focus on high-risk pregnancies into the response measures for COVID-19 and in the planning of preparedness of future pandemics if the Sustain-able Development Goals targets for MMR and NMR are to be achieved by 2030.
The editorial on COVID-19 and chronic non-communicable diseases: Profiling a deadly relationship by Dr. Jai Prakash Narain, School of Public Health and Community Medicine, Aus-tralia, the Guest Editor for this special issue.
The special issue is first of its kind focusing on NCDs and COVID-19 at global level.