Strategies ignore COVID pandemic’s early lessons around chronic diseases.
By UNIVERSITY OF ILLINOIS CHICAGO
The warning, published
in a Journal of General Internal Medicine viewpoint,
contends that discussions of a new normal fail to incorporate key lessons from
the first two years of the COVID-19 pandemic, including the significant role of
noncommunicable chronic diseases in exacerbating COVID-19 and the
disproportionate burden of COVID-19 on underserved populations and communities
of color.
Noncommunicable chronic diseases are those that are not spread from person to person and persist for at least one year, such as heart disease, diabetes, and cancer. They are the leading cause of death worldwide and represent a global health threat that predates the COVID-19 pandemic — the noncommunicable disease crisis kills more than 15 million Americans prematurely each year, according to the Centers for Disease Control and Prevention (CDC).
Jun Ma, of the University of Illinois Chicago, is a co-author of the viewpoint. She 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 U.S. focus too much on the SARS-CoV-2 virus and too little on the context in which the virus’ impact is most burdensome, she said.
“This is a major missed
opportunity to address the multilevel and multifactorial factors that
contribute to severe COVID-19 and COVID-19 mortality, not to mention other
health conditions,” said Ma, the Beth and George Vitoux Professor of Medicine
and director of Vitoux Program on Aging and Prevention at the UIC College of
Medicine.
“What we really need is
a comprehensive syndemic control strategy because, in truth, the pre-pandemic
state of health in the U.S. was not ideal in the first place,” said Ma, who is
also associate head of research in the department of medicine.
In support of this
argument, Ma and her co-author, James Sallis, of the University of California
San Diego, cite data published in medical literature showing how
noncommunicable chronic diseases have created high susceptibility to severe and
fatal COVID-19 outcomes and contributed to racial and ethnic inequities. 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 disease.
Noncommunicable diseases
and risk behaviors such as smoking, substance abuse and physical inactivity
conferred a higher risk for severe COVID-19, according to the CDC based on
conclusive evidence.
According to Ma and
Sallis, “failure to address NCD control and prevention as a national priority
is unacceptable because it contradicts compelling evidence and misses the
opportunity to use a whole 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 continuation of high vulnerabilities
for severe and inequitable outcomes of NCDs and future infectious disease pandemics.”
In their article, the
authors also recommend “practical, immediately actionable steps” for
incorporating the prevention and control of chronic diseases into existing
COVID-19 policies and infrastructure. For example:
Health care systems
could prioritize screening, including at COVID-19 vaccination and testing
locations, for medical and psychological chronic conditions that are highly
treatable but often 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.
Campaigns for COVID-19
vaccination and masking could expand messaging to also promote healthy
lifestyles and mental well-being.
Partnerships between
medical systems and community-based organizations and efforts by public and
private insurers for the COVID-19 emergency response could be expanded to
include behavior change interventions in routine health care delivery and
coverage.
Ma said agencies like
the Centers for Medicare & Medicaid Services and state and local
governments would need to prioritize supportive reimbursement and funding
policies for these steps to be realized, but that the benefits would be felt by
individuals and communities through more awareness, information and opportunity
for managing their health.
“We can help people gain
a sense of control of their health,” Ma said.
“Though we all hope the
pandemic is waning, variants keep appearing and vaccinations wane as well.
Thus, we need to plan now for better responses to a possible next surge as well
as future pandemics,” said Sallis, professor at UCSD’s Herbert Wertheim School
of Public Health and Longevity Science.
Ma and Sallis’ Journal
of General Internal Medicine article is titled “A National Strategy for COVID
Response and Pandemic Preparedness Must Address Noncommunicable Chronic
Diseases.”
Reference: “A National
Strategy for COVID Response and Pandemic Preparedness Must Address
Noncommunicable Chronic Diseases” by Jun Ma MD, PhD and James F. Sallis PhD, 9
May 2022, Journal of General Internal Medicine.
DOI: 10.1007/s11606-022-07552-y
