COVID-19 pandemic has escalated into a ‘syndemic’ for chronic disease patients

University of New South WalesOct 23 2020

The COVID-19 pandemic has escalated into a ‘syndemic’ for people with chronic illnesses, a new UNSW study analysing data from low and middle-income countries shows.

The COVID-19 pandemic is a double blow for people with non-communicable diseases, a new UNSW study has found. Photo: Shutterstock

There has never been a more dangerous time than the COVID-19 pandemic for people with non-communicable diseases (NCDs) such as diabetes, cancer, respiratory problems or cardiovascular conditions, new UNSW Sydney research has found.

Among the adverse impacts of the pandemic for people with NCDs, the study found they are more vulnerable to catching and dying from COVID-19, while their exposure to NCD risk factors - such as substance abuse, social isolation and unhealthy diets - has increased during the pandemic.

The researchers also found COVID-19 disrupted essential public health services which people with NCDs rely on to manage their conditions.

The study, published in Frontiers in Public Health recently, reviewed the literature on the synergistic impact of COVID-19 on people with NCDs in low and middle-income countries such as Brazil, India, Bangladesh, Nepal, Pakistan and Nigeria.

The paper, which analyzed almost 50 studies, was a collaboration between UNSW and public health researchers in Nepal, Bangladesh and India.

Lead author Uday Yadav, PhD candidate under Scientia Professor Mark Harris of UNSW Medicine, said the interaction between NCDs and COVID-19 was important to study because global data showed COVID-19-related deaths were disproportionally high among people with NCDs - as the UNSW researchers confirmed.

This illustrates the negative effect of the COVID-19 'syndemic' - also known as a 'synergistic epidemic' - a term coined by medical anthropologist Merrill Singer in the 1990s to describe the relationship between HIV/AIDS, substance abuse and violence. We applied this term to describe the interrelationship between COVID-19 and the various biological and socio-ecological factors behind NCDs. So, people are familiar with COVID-19 as a pandemic, but we analyzed it through a syndemic lens in order to determine the impact of both COVID-19 and future pandemics on people with NCDs."

Uday Yadav, Lead Author

Mr Yadav said the COVID-19 syndemic would persist, just as NCDs affected people in the long-term.

"NCDs are the result of a combination of genetic, physiological, environmental and behavioral factors and there is no quick fix, such as a vaccine or cure," he said.

"So, it's no surprise we found that NCD patients' exposure to NCD risk factors has increased amid the pandemic, and they are more vulnerable to catching COVID-19 because of the syndemic interaction between biological and socio-ecological factors.

"The evidence we analyzed also showed there was poor self-management of NCDs at a community level and COVID-19 has disrupted essential public health services which people with NCDs rely on."

Tackling NCDs in the COVID-19 era

Mr Yadav said the researchers' findings led them to recommend a series of strategies for healthcare stakeholders - such as decision-makers, policymakers and frontline health workers - to better manage people with NCDs in light of the COVID-19 syndemic.

"Healthcare systems - such as Australia's - do have some of these strategies in place, but they need improvement," he said.

Highlights from the recommended strategies include:

• Develop plans for how to best provide health services to people with NCDs, from the moment they are assessed through to their treatment and palliation.
• Develop digital campaigns to disseminate information on how to make positive behavior changes and better self-manage NCDs and COVID-19.
• Decentralize healthcare delivery for people with NCDs: involving local health districts and investing in community health worker programs could help to mitigate future outbreaks. In addition, tailor self-management interventions for people with NCDs.
• Ensure effective social and economic support for people with NCDs who are vulnerable to catching COVID-19, particularly Indigenous, rural, Culturally and Linguistically Diverse (CALD) and refugee communities, as well as people with severe mental illness.
• Evaluate technology-assisted medical interventions to improve healthcare services, because complex case management, assessment and support is increasingly being done via telehealth appointments or other technology.

Why healthcare must focus on prevention

Mr Yadav said high-income countries could also learn from the researchers' findings.

"COVID-19 has been a major threat to people with NCDs in developed countries - for example, new statistics from Britain show that in 2020, high numbers of people in England and Wales died from NCDs at home after shunning the healthcare system because of the pandemic," he said.

"In Australia, COVID-19 will increase inequality and poses a risk to some high and middle-income earners, but it's a double threat to others such as Indigenous, rural, CALD and refugee communities, as well as people with severe mental illness - as reflected in our paper."

Mr Yadav said in Australia in 2018, the most recent data available, 89 per cent of deaths were associated with 10 chronic diseases.

The Australian healthcare system needs a bigger focus on preventive healthcare, to improve outcomes for patients with NCDs and prevent more people from developing these diseases amid the COVID-19 pandemic.

Uday Yadav

Mr Yadav said putting serious preventive healthcare investment on the backburner could lead to individual, societal and economic upheaval in the long-term.

"If this trend continues, Australia will struggle to achieve Sustainable Development Goal (SDG) target 3.4, which is to reduce premature mortality from NCDs by a third by 2030 - relative to 2015 levels and to promote mental health and wellbeing," he said.

"Investment in prevention today will help save healthcare costs in the long-term, help reduce the incidence of NCDs and enhance our resilience against future pandemics."