Increasing NCDS Amid Covid – A Worry

Non-communicable diseases (NCDs) refer to a group of diseases that affect individuals over an extended period of time and are the result of a combination of genetic, physiological, environmental, and behavioral factors

Dr.  Ajay Aggarwal, Director, Internal Medicine, Fortis Hospital Noida

COVID-19 pandemic has a devastating effect on people and services across all age groups and borders. In resource-limited countries like India, COVID has overburdened our healthcare system. While battling with the pandemic, there’s another silent pandemic might emerge in the coming days because COVID has adversely impacted the non-COVID treatments ranging from cancer surgeries to teeth and eye issues, heart surgeries, kidney and liver issues, diabetes, hypertension and so on. Non-communicable diseases (NCDs) refer to a group of diseases that affect individuals over an extended period of time and are the result of a combination of genetic, physiological, environmental, and behavioral factors.

Some of the behavioral risk factors include an unhealthy diet, lack of physical activity, and use of tobacco and alcohol. Factors such as ageing, rapid unplanned urbanization, and globalization also are contributing to the rise of NCDs around the globe. As the COVID-19 pandemic has become a global threat, NCDs are also one of the major challenges for public health in the 21st century, not only in terms of human suffering, but they are also causing a socio-economic burden to the nation.

According to the report published by World Health Organization (WHO), in India, every year, nearly 300 million people are at risk of dying from NCDs (heart and lung diseases, stroke, cancer, and diabetes). A study by WHO has shown that more than 60% of the deaths in India are a result of cardiac diseases, respiratory disorders, and cancer, and 26% of this 60% is between the age group of 30-70 years. There is a higher incidence of gastroenterology, liver disease, uncontrolled hypertension, and diabetes among the Indian population. As COVID mainly affects immunity, the incidence of NCDs has increased significantly. All these co-morbidity issues either have been shown to be risk factors for severe COVID-19 and mortality or COVID itself can lead to serious systemic consequences affecting major organs including the kidney, heart, and even the digestive system. As per a NATHEALTH survey, 57% of patients had canceled or postponed their treatment plans during the period of March-December 2020 as they were anxious to access healthcare facilities amidst the pandemic. On the other hand, 100% of the elective surgery patients either canceled or postponed their surgeries and 34% of OPD patients canceled or rescheduled their OPD visits to the hospitals. Among the patients who canceled or postponed their treatment, 62% of patients have noticed a negative impact on their health condition.

During the second wave of the COVID 19 pandemic, with the hospitals fully occupied with COVID patients, struggling to supply oxygen, there are countless non-COVID patients who had suffered prolonged agony because of inadequate medical attention. As a result of lockdown, less supply of medicines, lack of testing capacity, and unavailability of doctors further added to the crisis. Chronic disease management which requires close monitoring and medical care had been affected the most. Patients with cardiovascular diseases, diabetes, and cancer require sustained care and can’t afford to delay their consultations and there should be no interruptions in their medications.

Patients with co-morbidity issues must be be monitored regularly and adhere to continuous treatment to stop further worsening of conditions. The current pandemic has adversely impacted cancer care as well. Statistics from the World Cancer Report 2020 indicate that the burden of cancer will be doubled in the next decade in low- and middle-income countries; nearly one in every 10 Indians is likely to develop cancer at some point in their lifetimes and one in 15 Indians will succumb to the disease.

Given that COVID-19 is here to stay for an extended period, India needs to have an equal focus on treating NCDs as COVID 19 becomes fatal in people living with pre-existing non-communicable diseases, and many people who have lost their lives due to COVID had some or the other pre-existing non-communicable diseases. Since the scale of risk for NCDs essentially depends on timing and outcomes, the necessity of the hour is robust preventive measures, screening, and timely diagnosis, particularly, the urgency lies in protecting the vulnerable groups. Digital interventions need to be developed and disseminated fully in remote parts of the country in order to enhance the accessibility of health services.

A better, resilient, and sustainable health system can be built with the successful implementation of AI and predictive models to predict stroke, cardiac arrests, etc. Indian populations need to shift the mindset from reactive to preventive because a large number of Indian populations miss out on regular health checkups as they don’t feel the urgency unless they suffer. A more conscious approach should be taken towards regular diagnostics checkups to reduce the NCD burden. People should be aware of the fact that the shutdown of routine clinical procedures will certainly lead to another catastrophe.

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