Moving towards universal health coverage, promoting health and well-being and protecting against health emergencies are WHO global priorities 1 shared by the proposed WHO European Work Program 2020-2025.
The coronavirus disease 2019 (COVID-19) pandemic has underscored the importance of interconnecting these strategic priorities. Of the six WHO regions, the European region is the most affected by morbidity and mortality related to non-communicable diseases (NCDs) 3 and the growth of NCDs is worrying.
Cardiovascular diseases, cancers, chronic respiratory diseases and diabetes are among the leading causes of death and disability in the region and an increasing proportion of children and adults live with overweight or obesity, 4 one of the main factors of risk of NCDs.
Prevention and control of NCDs are important during this pandemic because NCDs are the main risk factors for patients with COVID-19. 5 Furthermore, some of the restrictive measures such as lockdown, social distancing and travel restrictions to reduce the spread of infection in many countries have a specific impact on people living with NCDs by limiting their activity, ability to ensure healthy foods and access to preventive or health promotion services. 6
The COVID-19 pandemic has had a widespread impact on health, revealing the particular vulnerability of people with underlying conditions.
In Italy, a recent report revealed that the majority (96·2%) of patients who died in hospital from COVID-19 had comorbidities, mainly NCDs; lThe most prevalent NCDs among these patients were hypertension (69·2%), type 2 diabetes (31·8%), ischemic heart disease (28·2%), chronic obstructive pulmonary disease (16·9%), and cancer (16·9%). 3%) . 7
An association between COVID-19 severity and NCDs has also been reported in Spain, 8 China, 9 and the US. 10 However, many COVID-19 deaths also occur in older people who often have comorbidities. existing. eleven
Body mass index ( BMI) could also be associated with the severity of COVID-19; In China, severe COVID-19 patients and nonsurvivors generally had high BMI (>25 kg/m2) 12 .
The impact of COVID-19 response measures on NCDs is multifaceted. Physical distancing or quarantine can lead to poor management of behavioral risk factors for NCDs, including unhealthy diet, physical inactivity, tobacco use, and harmful use of alcohol. 13
Evidence from this and previous pandemics suggests that without proper management, chronic conditions can worsen due to stressful situations resulting from restrictions, insecure economic situations, and changes in normal health behaviors. As with other health services and preventive programs, postponement of routine medical appointments and tests can delay the management of NCDs, while physical distancing, restricted access to primary health care units, pharmacies and Community services, together with a reduction in transport links, disrupt the continuity of care for patients with NCDs. This disruption of routine health services and medical supplies risks increasing preventable morbidity, disability and mortality over time in patients with NCDs. Additionally, severely obese patients requiring intensive care have greater patient management needs. |
Prevention and control of NCDs have a crucial role in the COVID-19 response and an adaptive response is required to account for the needs of people with NCDs. Prevention of NCDs is important as the true scale of risk groups is probably underestimated as many cases of hypertension and diabetes go undiagnosed. 14.15
Communities and health systems must adapt to support and manage people’s greatest risks. with known NCDs and sensitivity to exercise on the vulnerability of the large population with undiagnosed NCDs and those at higher risk of NCDs.
The COVID-19 response and the continued and strengthened focus on the prevention and management of NCDs are key and interconnected aspects of public health today. If the COVID-19 response is not adapted to encompass the prevention and management of NCD risks, we will fail many people at a time when their vulnerability increases.
What steps should be taken to adapt the COVID-19 response?
The WHO Regional Office for Europe has begun to develop a list of actions that could be adapted by countries to address the needs of people at risk of NCDs or already living with NCDs, along with practical considerations for teams developing COVID-19 response plans at the local or national level.
| Specific answers for NCDs | Associated risks | |
| Extended time indoors | Use technology to provide knowledge and support for NCD management, online information on exercise and mental health self-management classes, healthy recipes for home preparation, and online delivery of healthy foods, among other responses | Reduced physical activity and increased strain on mental health could lead to increased consumption of unhealthy foods and harmful use of tobacco and alcohol |
| Family members at home | Provide special arrangements for families with NCD patients to self-isolate | Risk of increased contact with younger family members at home |
| Inadequate access to medications | Use telemedicine more, allow local or community doctors and pharmacists to renew or extend medication prescriptions, deliver essential NCD medications to your home. | Shortages of essential medicines such as insulin and other NCD-specific medicines. |
| Transportation and other restricted services | Prioritize and ensure continued services at the community level safely to address the needs of patients with NCDs. | Restricted transportation facilities and family support for continued NCD care. |
| Infection control | ||
| Early detection and laboratory tests | Prioritize NCD patients for COVID-19 testing; Triage should take into account whether patients have NCDs and are immunocompromised. | Those patients with NCDs for whom visits to health facilities are essential could be at higher risk of exposure to COVID-19. |
| Contact tracing | Focus especially on those with increased risk factors for NCDs and NCD patients (i.e. patients living with obesity) and alert and closely monitor any potential contacts for NCD patients. | Patients with NCDs may be unaware of the additional risks posed to them. |
| Extensive testing | Prioritize patients with NCDs for testing when possible. | Promote the need for testing to NCD patients who may be less motivated or able to actively seek testing (in a safe and physically distanced manner). |
| Healthcare settings (infection control) | Provide patients with NCDs and healthcare staff working in NCD services with special training and personal protective equipment, as well as healthcare professionals at increased risk of NCDs. | NCD patients with comorbidities are at increased risk of infection; Healthcare workers working in NCD clinics are also at increased risk of infection. |
Patients living with obesity and NCDs are at increased risk from the effects of health emergencies such as COVID-19. 16. NCD healthcare staff and associated workers and volunteers should be centrally involved in planning COVID-19 response strategies to ensure that the needs of patients and caregivers are addressed.
Specific advice should be provided at national and local level for patients living with NCDs, their families and carers. Prevention and control of obesity and NCDs are crucial in preparing for this and future public health threats. A streamlined response to COVID-19 in the context of NCDs is important to optimize public health outcomes and reduce the impacts of this pandemic on individuals, vulnerable groups, key workers and society.
About the authors: HHPK is Regional Director of the WHO Regional Office for Europe. JB is the Head of the WHO European Office for the Prevention and Control of Noncommunicable Diseases. KW is a technical officer and HLR and RM are consultants at the WHO European Office for the Prevention and Control of Noncommunicable Diseases. AK is the Deputy Director of the National Medical Research Center for Therapy and Preventive Medicine, Russia. We declare no other competing interests. The authors alone are responsible for the opinions expressed in this Commentary and do not necessarily represent the opinions, decisions or policies of the institutions with which they are affiliated.
