Make the most of Covid-19 crisis to fight other diseases

People queueing to take a Covid-19 swab test in Singapore last month. The writer says that the disease surveillance and health information systems being strengthened to track and report the coronavirus in various countries amid the pandemic must also
People queueing to take a Covid-19 swab test in Singapore last month. The writer says that the disease surveillance and health information systems being strengthened to track and report the coronavirus in various countries amid the pandemic must also be used for non-communicable diseases.ST PHOTO: KELVIN CHNG

If you have diabetes, hypertension or are obese, you are more likely to be severely affected by Covid-19 or to die from it.

These non-communicable diseases (NCDs) were the most common comorbidities identified in Covid-19 patients hospitalised in the New York City area, according to a study published in The Journal of the American Medical Association in April. This relationship has also been observed globally. Some estimates are that up to 90 per cent of people dying from Covid-19 also had an NCD.

As country after country imposed lockdowns to contain the virus spread, social distancing and quarantine restrictions affected the ability of people with NCDs to access care and regular medication.

Interrupted NCD services were reported in 75 per cent of countries, according to the World Health Organisation (WHO). This has led to increased complications and more deaths.

Further studies show that Covid-19 survivors with NCDs may see their pre-existing conditions worsen, and previously healthy Covid-19 patients may suffer cardiovascular damage, leading to complex NCD cases in the future.

The interplay between Covid-19 and NCDs is deadly.

And yet, there is a great global opportunity here. The same tools we are using to fight the pandemic are those required to fight NCDs.

While preventing Covid-19 is still an uncertain medical science and treatment is at an experimental stage, we know that a way to reduce Covid-19 deaths is to prevent, reduce and treat NCDs. These protocols are well established and result in fewer deaths.

We know how to reduce the risks of NCDs.

Singapore was able to mount a strong response to Covid-19, considering its careful investment in healthcare over many years. Comprehensive screening and testing is critical to reducing the risk of death from NCDs. WHO data shows Singapore is a world leader in achieving this, with just 247.8 deaths due to NCDs per 100,000 people in 2016, down from 408.5 per 100,000 in 2000. Deaths can be as high as 900 per 100,000 population elsewhere.

It is therefore no surprise that Singapore's current Covid-19 case fatality rate is less than 0.1 per cent, compared with the Asian average of 1.8 per cent or global average of 2.9 per cent.

Within Africa, Rwanda stands out, with Covid-19 deaths not rising in proportion to increased testing. The land-locked republic has a rare asset among low-and middle-income countries - universal health coverage. Delivered through a government-funded health insurance programme, there was already widespread screening for NCDs and prevention and treatment before Covid-19 struck.

Over US$180 billion (S$244.3 billion) has been committed to tackling Covid-19 by global development institutions such as the World Bank, Asian Development Bank and African Development Bank. The figure excludes yet more by governments and philanthropic trust funds, such as the Bill and Melinda Gates Foundation.

Currently these funds are not being invested in increasing NCD screening, testing and strengthening health systems to care for NCDs in the long run.

It is not too late to turn this around. The huge investments channelled towards the pandemic are fungible across Covid-19 and NCDs. Using funds to simply buy one-use personal protective equipment is not a sustainable outlay. Smarter stipulations on how the money is being spent need to be made. Improving and increasing the capacity of medical laboratories to test and screen for Covid-19 should include the same for NCDs.

The disease surveillance and health information systems being strengthened to track and report Covid-19 must also be used for NCDs. In Mumbai, India, the monthly case mortality of Covid-19 was brought down in the first two months of the pandemic by surveying slum populations for diabetes and hypertension alongside Covid-19 screening, enabling better targeting of NCD-affected elderly persons.

A global marketplace where affordable, quality medication and diagnostics are available to all would support both Covid-19 and NCD responses. To achieve these practical realities, a truly multi-sectoral approach is critical. The Defeat-NCD Partnership exists to bring relevant private and public sector actors together with civil society. For instance, its technical staff sit within Myanmar's Ministry of Health, supporting the inclusion of NCDs in national Covid-19 plans.

For once, a lack of money is not the barrier to grasping this opportunity. The challenge instead is making the effort to re-engineer the relationship between addressing the twin public health threats of Covid-19 and NCDs.

Next Monday, the World Health Summit in Berlin will bring together the health ministers of Myanmar, Rwanda, Gambia, Ecuador and Bhutan, international agencies such as the WHO and the Asian Development Bank, as well as private philanthropies Boehringer Ingelheim and the Helmsley Charitable Trust, to mobilise global action against NCDs and Covid-19.

We are at a critical juncture. A legacy of reducing premature deaths from NCDs, born out of the ashes of Covid-19, is what we must achieve.

Praveen Pardeshi is global programme coordinator, The Defeat-NCD Partnership, United Nations Institute for Training and Research.

A version of this article appeared in the print edition of The Straits Times on October 23, 2020, with the headline 'Make the most of Covid-19 crisis to fight other diseases'. Print Edition | Subscribe