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COVID-19 impact on other diseases

How COVID-19 has affected other diseases

The fast spreading COVID-19 infection has caused many countries to issue lockdowns and shelter in place orders. While these orders protect the overall public health of citizens, it also has its downsides. Many people are discouraged from leaving their house for checkups or diagnoses on non-COVID-19 related diseases. COVID-19 not only affects people infected with the virus, but also indirectly impacts patients living with other diseases.


Non communicable diseases (NCDs) are noninfectious health conditions that cannot be spread from one person to another. People living with NCDs are at higher risk for severe COVID-19 infection so many have refrained from attending checkups/treatments that need to be performed at a doctor's office. According to Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, "Many people who need treatment for diseases like cancer, cardiovascular disease and diabetes have not been receiving the health services and medicines they need since the COVID-19 pandemic began. It’s vital that countries find innovative ways to ensure that essential services for NCDs continue, even as they fight COVID-19".


COVID-19 and NCDs

In early June, the World Health Organization (WHO) released a survey completed by 155 countries during a 3 week period in May. The survey results confirmed that the impact of COVID-19 on NCDs is global, but low-income countries are most affected. Heath services have been disrupted in many countries. According to the survey, 53% of countries have partially or completely disrupted services for hypertension treatment. Similarly, 49% of countries have disrupted services for diabetes treatment, 42% of countries have disrupted services for cancer treatment, and 31% of countries have disrupted services for cardiovascular emergencies. Rehabilitation services in 63% of countries have been disturbed even though it plays a key role in COVID-19 recovery. There are many reasons for the discontinuation or disturbance of health services. 94% of countries had to partially or fully reassign staff working in NCDs to COVID-19. Public screening programs (used for many cancers) were postponed in over 50% of countries after recommendation to minimize non-urgent facility based care. In addition, 20% of countries experienced a shortage of medical supplies and technology. As the COVID-19 outbreak increases in severity, services for treating NCDs are also affected and disrupted.


COVID-19 Impact on Cancer and Related Research

Since the start of the COVID-19 pandemic, there's been a steep drop in cancer diagnoses in the United States. However, this isn't because there are less cancer cases in the U.S. but because many cancer diagnoses are being missed. Cancers that are being missed now will not only come to light eventually, but with more severity as the cancer continues to progress. Many hospitals have canceled or deprioritized 'elective' cancer treatment and surgeries to create more room for the increase of COVID-19 patients. This means that cancer patients are receiving less intense chemotherapy/radiation and operations to remove a patient's tumor are being postponed.   

    A study from Science Magazine modeled the effect of COVID-19 on screening and treatment for breast and colorectal cancer over the next decade. The results show that in the next decade, there will be an additional 10,000 deaths from breast and colorectal cancer due to COVID-19 impact.


    In addition to clinical care, COVID-19 has also caused a disruption in scientific research, shutting down labs and slowing clinical trial operations. Clinical trials are the only way to make progress in developing drugs/therapies for cancer so many researchers are hoping that this pause is only temporary. Many scientists are also changing the focus of their research from cancer to the impact of COVID-19 on cancer.

Consequences of Delayed Surgeries/Procedures

    Many elective surgeries, or surgeries that aren't urgently necessary, have been canceled as a result of the increase of COVID-19 patients. However, Brian Kolski, director of the structural heart disease program at St. Joseph Hospital, says, "A lot of the procedures deemed 'elective' are not necessarily elective". Two of his patients whose aortic valve replacements were postponed, died while waiting. Many patients don't have time to wait for their surgery and the consequences could result in death.
    Another of Kolski's patients, Mr. R, a 75 year old man with advanced heart failure, was greatly impacted by the rising COVID-19 cases. Mr. R was referred to a hospital for an LVAD placement in early March. However, when the hospital began admitting more COVID-19 patients, everyone else, including Mr. R, was kicked out. Mr. R's health deteriorated quickly to the point where his physician didn't even recognize him over a video call. Mr. R was quickly admitted to the hospital and an LVAD was placed. However, Mr. R and his wife still face many challenges including Mr. R's delirium as well as a visitor policy that requires Ms. R to stay at nearby lodging which is hard to afford.

Conclusion

    COVID-19 has not only affected patients with the virus, but also patients with other diseases. Many health services that aid those with NCDs have been discontinued or disturbed. Treatments/surgeries for patients with NCDs have been postponed and many of these patients can no longer receive the care they require. According to Dr. Bente Mikklesen, Director of the Department of NCDs at WHO, "It is very important not only that care for people living with NCDs is included in national response and preparedness plans for COVID-19 - but that innovative ways are found to implement those plans."

Sources

  1. Sharpless, Norman E. “COVID-19 and Cancer.” Science, American Association for the Advancement of Science, 19 June 2020, science.sciencemag.org/content/368/6497/1290.

  2. Rosenbaum, Lisa, et al. “The Untold Toll - The Pandemic's Effects on Patients without Covid-19: NEJM.” New England Journal of Medicine, 11 June 2020, www.nejm.org/doi/full/10.1056/NEJMms2009984.
  3. “COVID-19 Significantly Impacts Health Services for Noncommunicable Diseases.” World Health Organization, World Health Organization, www.who.int/news-room/detail/01-06-2020-covid-19-significantly-impacts-health-services-for-noncommunicable-diseases.

Comments

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