COVID-19 and non-communicable diseases in the Eastern Mediterranean Region: the need for a syndemics approach to data reporting and healthcare delivery

• Published in: BMJ global health Vol. 6; no. 6; p. e006189
• Main Authors: Nassereddine, Ghiwa, Habli, Samia, Slama, Slim, Sen, Kasturi, Rizk, Anthony, Sibai, Abla M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.06.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Chronic illnesses; Commentary; Continuity of care; Coronaviruses; COVID-19; Diabetes; Disease transmission; Displaced persons; Health care; Health services; Humanitarianism; Infectious diseases; Intensive care; Medical personnel; Monitoring systems; Mortality; non-communicable diseases (NCDs); Overcrowding; Pandemics; Population; Poverty; Public health; Severe acute respiratory syndrome coronavirus 2; Surveillance; Sustainable development; syndemics: Eastern Mediterranean Region; Lebanon; Iran; Mediterranean Area
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2021-006189

Up to this point in the pandemic, the five countries hardest hit with cumulative COVID-19 deaths per capita have been Lebanon, Iran, Tunisia, Palestine and Jordan and with the highest overall cumulative deaths have been Iran, Iraq, Pakistan, Egypt and Morocco.3 In tandem, as the COVID-19 pandemic disrupts the delivery of health services, the EMR has been reported to have the highest average disruption with 75% of essential health services (EHS) being compromised in 13 countries.4 Existing healthcare infrastructures in the EMR have been repurposed to respond to the pandemic, with many of the disruptions affecting services designed for the management, treatment and care of non-communicable diseases (NCDs). To take one example among many, mortality among Palestinian refugees in Lebanon has been reported to be three times higher than the Lebanese population, a finding attributed to pre-existing conditions such as pulmonary and cardiac diseases, all against a background of poverty and overcrowding.15 These factors will become even more challenging in the future as health systems in many countries run out of funding for the spillover effect of the NCD-COVID-19 syndemic on public health. Even before the COVID-19 pandemic, reduction in premature NCD mortality rates experienced a global slowdown in the past decade.16 During the pandemic response, funding and human resources have further shifted to cater specifically for the emergency, prioritising care for patients with COVID-19 over many other diseases, including NCDs.12 Hospital and clinic staff, including physicians from specialties that are not related to infectious diseases, as well as epidemiologists and nurses, have been redeployed to serve in emergency departments and intensive care to care for patients with COVID-19.12 Furthermore, lockdown measures in most countries have disrupted continuity of care for patients with NCDs and postponement of routing medical appointments and tests affecting healthcare service access and availability to people with NCDs.5 Restrictions to mobility due to lockdown measures have limited access to preventive and control services.12 This has resulted in diminishing returns of earlier investments towards achieving Sustainable Development Goals (SDGs) in reducing premature mortality from NCDs by one-third by 2030.17 Such a ‘covidisation’ of care will likely lead to unintended long-term consequences, even as the COVID-19 pandemic subsides. [...]the lack of reliable surveillance system for monitoring and control and the dearth in publicly available data have made building data infrastructures by regional governments vital going forward.19 Many health information systems are currently weak and do not capture NCD service utilisation and outcomes.20 It is impossible to appropriately plan disease outbreak response strategies without reliable, disaggregated, transparent and openly accessible data, and an extensive health database to track baseline measures of NCD burdens integrated into larger surveillance systems needs to be escalated to a regional strategic priority.18 21 Even where data are available, it is not often sufficiently used to inform policy responses to the pandemic.