Researchers warn US health leaders and officials against national strategies for a "new normal" of life with COVID-19.
The warning, published in a Journal of General Internal Medicine viewpoint , argues that conversations about a new normal fail to incorporate important lessons from the first two years of the COVID-19 pandemic: the significant role of chronic non-communicable diseases in the exacerbation of COVID-19 and the disproportionate burden of COVID-19 on underserved populations and communities of color.
Chronic non-communicable diseases are those that are not transmitted from person to person and persist for at least a year, such as diabetes, heart disease and cancer. They are the leading cause of death worldwide and pose a threat to global health prior to the COVID-19 pandemic: according to the US Centers for Disease Control and Prevention, the non-communicable disease crisis it prematurely kills more than 15 million Americans each year.
Jun Ma of the University of Illinois Chicago is a co-author of the view. He said that together, the COVID-19 pandemic and the chronic disease crisis create what is called a synergistic endemic or syndemic : overlapping epidemics that interact, increasing the burden of disease and the likelihood of poor outcomes. Recent proposals for a new normal national strategy in the US focus too much on the SARS-CoV-2 virus and too little on the context in which the virus’s impact is most burdensome, he said.
"This is a huge missed opportunity to address the multifactorial, multilevel factors that contribute to severe mortality from COVID-19 and COVID-19, not to mention other health conditions," said Ma, Beth and George Vitoux Professor of Medicine and director of Vitoux. Aging and Prevention Program of the UIC Faculty of Medicine.
“What we really need is a comprehensive syndemic control strategy because, in reality, the pre-pandemic health status in the U.S. was not ideal in the first place,” said Ma, who is also associate chief research in the department of medicine.
In support of this argument, Ma and his co-author, James Sallis of the University of California, San Diego, cite data published in the medical literature showing how chronic non-communicable diseases have created a high susceptibility to severe and fatal COVID outcomes. -19 and have contributed to racial and ethnic inequalities. For example:
- Nearly 95% of U.S. adults hospitalized with COVID-19 between March 2020 and March 2021 had an underlying condition.
- Vaccinated people with breakthrough infections were 44% to 69% more likely to suffer severe outcomes if they had a chronic illness.
- Noncommunicable diseases and risk behaviors such as smoking, substance abuse, and physical inactivity confer an increased risk of severe COVID-19, according to the CDC based on conclusive evidence.
According to Ma and Sallis, “failing to address NCD control and prevention as a national priority is unacceptable because it contradicts compelling evidence and misses the opportunity to use a full set of effective intervention approaches that can save lives. The window of opportunity is fleeting, and the consequences of inaction could be devastating by allowing the continuation of high vulnerabilities to severe and inequitable outcomes from NCDs and future infectious disease pandemics.”
In their article, the authors also recommend "practical and immediately actionable steps" to incorporate chronic disease prevention and control into existing COVID-19 policies and infrastructure. For example:
- Health care systems could prioritize screening, including at COVID-19 vaccination and testing sites, for chronic medical and psychological conditions that are highly treatable but often go undiagnosed and poorly managed.
- The national infrastructure mobilized for vaccine promotion and distribution could be leveraged to also disseminate proven lifestyle and behavioral health programs.
- COVID-19 vaccination and masking campaigns could expand messaging to promote healthy lifestyles and mental well-being.
- Partnerships between medical systems and community organizations and public and private insurer efforts for COVID-19 emergency response could be expanded to include behavior change interventions in the delivery and coverage of routine health care.
Ma said agencies like the Centers for Medicare and Medicaid Services and state and local governments would need to prioritize supportive reimbursement and funding policies to make these steps happen, but that people and communities would feel the benefits through of greater awareness, information and opportunity to manage your health.
“We can help people feel a sense of control over their health,” Ma said.
“While we all hope the pandemic is subsiding, variants continue to emerge and vaccinations decline as well. Therefore, we must plan now for better responses to a possible next surge, as well as future pandemics,” said Sallis, a professor at the Herbert Wertheim School of Public Health and Human Longevity Sciences at UC San Diego.
