COVID-19 and NCDs: A Deadly Combination
How NCDs have exacerbated the pandemic and how we can respond
The COVID-19 pandemic has brought the global burden of noncommunicable diseases (NCDs) into sharp focus, as those living with NCDs are far more likely to die from this novel coronavirus. It is also disrupting care for numerous chronic conditions, which could lead to countless additional fatalities. Accordingly, plans for pandemic recovery must place a clear emphasis on addressing and reducing the existing burden of NCDs. Fortunately, blended finance mechanisms offer a promising path forward to deliver these results, particularly in developing regions where traditional private investments are less feasible.
Impact of NCDs on COVID-19 clinical and financial costs
In less than a year, the COVID-19 pandemic has led to devastating health and economic costs globally, the loss of human life, increased healthcare spending, and the cessation of economic activity through government lockdown measures. As evidence emerges from the pandemic, it’s become clear that this impact has been further compounded by underlying chronic conditions including non-communicable diseases (NCDs) such as diabetes, cardiovascular disease, chronic respiratory disease, and cancer.
As the pandemic has developed, clinical observations and research reports have revealed COVID-19 patients with underlying chronic conditions experience more severe infection and worse outcomes as compared to COVID-19 patients without underlying chronic conditions. Various studies have reported a significant link between COVID-19 hospitalizations and ICU admissions with NCDs. For example, a CDC report analyzing over 7,100 patients greater than 19 years old in the United States reported that 74% of COVID-19 patients hospitalized in standard care and 82% of patients admitted to intensive care units (ICU) had at least one NCD documented. This reflects the high burden of NCDs in the U.S. generally; it’s estimated that well over 80% of Americans suffer from one or more NCDs. Another recent CDC report analyzing over 1.3 million laboratory-confirmed COVID-19 cases reported during January 22–May 30, 2020 showed that hospitalizations were six times higher and deaths 12 times higher among those with reported underlying chronic conditions compared with those with none reported. The most commonly reported underlying chronic conditions were cardiovascular disease, diabetes, and chronic lung disease.
Figure 1: A recent CDC report analyzing over 1.3 million laboratory-confirmed COVID-19 cases reported during January 22–May 30, 2020 showed that hospitalizations were six times higher and deaths 12 times higher among those with reported underlying conditions compared with those with none reported.
Figure 2: NCD comorbidities in COVID-19 patients. In nearly all groups of COVID-19 patients with co-morbidities, those with the underlying condition were more likely to be hospitalized than those without.
Impact of COVID-19 on NCD Treatment and Access to Care
Though COVID-19 is a serious disease, particularly for those of older age and with underlying chronic conditions, the most significant and long-term health impacts of the COVID-19 pandemic on a population level will likely be secondary disruptions of essential healthcare services. A recent WHO survey reports that approximately 60% of responding member state countries have experienced a decrease in outpatient volumes due to patients canceling appointments. More than half of these countries have partially or completely disrupted services for hypertension treatment; 49% for diabetes treatment; 42% for cancer treatment, and 31% for cardiovascular emergencies. Additionally, to preserve healthcare system capacity for COVID-19, more than 50% of countries have suspended population screening programs.
The extension of lockdown measures and delay of NCD care could have a large impact on the burden of NCDs in the future — both increasing their prevalence and mortality rates. As seen in similar epidemics such as the SARS outbreak in 2002, hospitalizations for nearly all comorbidities increased after the SARS period, and some, such as diabetes, increased to levels above even the pre-SARS period. Additionally, lockdown measures during the pandemic have already significantly affected mental health and increased the number of suspected substance overdoses in the United States.
Figure 3: Hospital admission rate in Taiwan of chronic diseases before, during, and after SARS outbreak.
Plans for COVID-19 recovery
While a majority of WHO Member States have included continuity of NCD services within their COVID-19 response plans, many have also reported a significant financing gap implementing measures such as digital technologies and novel supply chains for NCD treatment and care.
The prevention and management of NCDs could lead to both a reduction in NCD-related morbidity and mortality as well as a reduction in risk for possible future pandemics similar to COVID-19. Interventions aimed at the prevention and control of NCDs have been shown to be widely cost-effective and the WHO “Best Buys” are estimated to lead to returns on investment (ROI) of more than seven times.
The cost-effectiveness of the WHO “Best Buys” in the prevention and control of NCDs could likely be extended in times of a global pandemic such as COVID-19. For example, based on comparable hospitalizations, an average COVID-19 hospitalization in America costs approximately $42,486 and $74,310 for COVID-19 patients admitted to the ICU. Given these high costs of COVID-19 care and increased risk in the need of care with underlying NCDs, it is likely that the prevention and control of NCDs could have a more significant impact on saving lives and healthcare spending during this pandemic and in the future.
The following graph shows the financial impact, both direct savings to COVID19 treatment as well as direct and indirect economic impacts, of the WHO “Best Buy” interventions.
Figure 4: Annual USA savings in COVID19 and NCD costs. The figure above shows the financial impact, both direct savings to COVID19 treatment and general economic impact of investment in NCD intervention, for various scenarios of reduced hospitalizations. Cumulative direct savings refer to the savings resulting from reduced hospitalization and ICU costs for various hospitalization reduction scenarios. Best Buys Savings less costs represent the savings resulting from population level investments in the Best Buy interventions in the United States. See appendix for detailed explanation of calculations.
How blended finance can deliver
There are several ways blended finance can support the COVID-19 response in developing countries and close the financing gap mentioned above.
In the short-run, blended finance frameworks could leverage existing overseas development assistance and donations to attract additional private investment for the immediate response for COVID-19. These can include scaling-up affordable diagnosis and treatment, accelerating R&D of vaccines through advanced market commitments (AMCs), providing personal protective equipment for preventing spread, and expediting the restoration of the disrupted NCD medicine supply chain.
In the medium- to long-term, blended finance can create potential investment opportunities and raise additional capital investment to lower the financial and technical risk and make the primary healthcare system more robust, resilient, and sustainable in the future. Further, blended finance can mitigate the risks of investing in developing countries and strengthen borrowing ability, thereby providing liquidity and stimulus to local SMEs and cushioning the economic fallout of the pandemic.
The deadly combination of COVID-19 and NCDs has devastated world economies and healthcare systems, particularly in LMICs where the burden of chronic diseases is high. This pandemic has highlighted an undeniable truth: NCDs are the single most deadly threat to global health, and any global health response must place a strong emphasis on combating these diseases. Though LMICs and countries across the globe face a long, arduous path to recovery, blended finance can catalyze a more efficient, sustainable response to not only rebound from the pandemic, but build healthier, more economically resilient societies.
Written by Thomas Roades, Debra Winberg, William Dunn, Vidhu Venkatesh, Yun Fu, Andrea Feigl, Erin Gregor, and Jenna Patterson