COVID-19 escalated into 'syndemic' for chronic disease patients, says study

Scientists have assessed the synergistic impact of COVID-19 on people with non-communicable diseases (NCDs) like diabetes in low and middle-income countries such as India and found that there has never been a more dangerous time for them than the ongoing pandemic.

According to the study, published in the journal Frontiers in Public Health, people with NCDs 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, including Shradha S Parsekar from the Manipal Academy of Higher Education in Karnataka, also found that COVID-19 disrupted essential public health services which people with NCDs rely on to manage their conditions.

In the study, the scientists reviewed almost 50 studies 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.

According to the study lead author Uday Yadav from the University of New South Wales (UNSW) in Australia, the interaction between NCDs and COVID-19 was important to study because global data showed COVID-19-related deaths were disproportionately high among people with NCDs.

"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," Yadav said.

"People are familiar with COVID-19 as a pandemic, but we analysed it through a syndemic lens in order to determine the impact of both COVID-19 and future pandemics on people with NCDs," he added.

According to Yadav, 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 behavioural 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," Yadav added.

Based on the findings, the researchers recommended a series of strategies for healthcare stakeholders -- such as decision-makers, policymakers and frontline health workers -- to better manage people with NCDs amidst the syndemic.

They urged policymakers to 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.

The researchers said digital campaigns could be developed to disseminate information on how to make positive behaviour changes and better self-manage NCDs and COVID-19.

According to scientists, decentralising healthcare delivery for people with NCDs is critical to managing the syndemic.

In this approach, they said policymakers must involve local health districts and invest in community health worker programs to help mitigate future outbreaks.

The researchers said governments should ensure effective social and economic support for people with NCDs who are vulnerable to catching COVID-19, particularly indigenous, rural, and refugee communities, as well as people with severe mental illness.