Neglecting HIV and other diseases during Covid-19 pandemic will have ‘devastating impact’, warn experts
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A six-month interruption of supply of antiretrovirals across the whole population of HIV patients on treatment in South Africa would lead to an approximately two-fold increase in HIV-related deaths over a one-year period.
This amounts to an excess of between 83 800 and 140 900 adult HIV deaths, should such a high level of disruption occur. This is among the possible impacts of “privileging Covid-19” on the country’s quadruple burden of disease, according to a Covid-19 statement by the standing committee on health of the Academy of Science of South Africa, published in the latest issue of the SA Journal of Science.
Disruption to maternal and child health (MNCH) services could have a similarly devastating impact, the researchers warn. “A 9%-18% reduction in MNCH coverage over a six-month period would lead to an additional 2 160 child deaths at a minimum, despite children being at extremely low risk for severe Covid-19 illness.”
Of all MNCH services, sustaining routine childhood immunisation is particularly important. “Measles in particular is a highly contagious disease that mostly affects children under the age of 5. The basic reproductive number (the number of people who could be infected on average by every one person with measles) of measles in a susceptible population is between 12 and 18.
“In contrast, while we do not know with certainty, the reproductive number of symptomatic cases of Sars-CoV-2 is thought to be approximately 2.5.”
Previous local research in 2010, says the committee, shows what can happen when health workers are diverted to focus on a single issue – in this case a catch-up campaign for measles.
“In 2010, over this same three week period in 52 districts, there was a 30% decrease in children completing the primary course of immunisation, a 10% decrease in antenatal visits and a 12%-17% decrease in use of injectable contraceptives.”
The researchers describe how, with few exceptions, little has been discussed about the pandemic’s disruption to routine, essential health-care services.
“Hospitals have reprogrammed care units to accommodate Covid-19 patients, while others have temporarily closed.” It’s crucial that the National Coronavirus Command Council, and the structures reporting to it, ensure that by focusing on Covid-19, “we do not lose sight of the opportunity costs of shifting priorities”.
Among the recommendations are that advisory bodies need to engage with experts who “are focused on priority setting to ensure that we think more carefully about how many lives we are losing or saving from Covid-19 in contrast to lives that could be lost” by disruption of essential services, and who are able to understand both the indirect and direct effects of the pandemic on comorbidities.
The associated loss of income from the lockdown has also increased hunger and “will have an impact on malnutrition”.
The human resources shift to Covid-19 has resulted in limited services for diagnosis, treatment and prevention of other health issues. “The public has avoided health facilities, and has been affected by transport restrictions.
“For example, since the lockdown, the National Institute for Communicable Diseases has shown a 48% decline in testing for TB and 33% reduction in newly-diagnosed positive cases over a five-week period, compared to the sixweek period preceding the lockdown.”
Until there is a vaccine or a cure, “Covid-19 might be among us for a while. Finite resources cannot be diverted solely to the pandemic. Careful priority setting, taking into consideration the costs and benefits of basic health interventions and services, are critical to the success and sustainability of public health gains of the past decades, while addressing the pandemic.”
Policymakers must consider the potential effects of Covid-19 on the country’s complex disease burden.
“We need to ensure the continuity of health promotion, disease prevention and treatment services to avert excess death from the top four conditions, and to prevent increases in their incidence during and after the
Covid-19 pandemic. “Even if the resources at health facilities were not crowded out by the focus on Covid-19, the economic impact of the pandemic, such as increased unemployment, has the potential to erode spending power of those who can no longer afford to pay their transport costs to the clinic.”
South Africa has high rates of Type 2 diabetes (12%), obesity and overweight (68% of women, 31% of men), and hypertension (35%).
“Control of these non-communicable diseases (NCDs) is critical since individuals with them are at greater risk for severe Covid-19 illness and death. “Any pandemic response needs to ensure that disruption to routine medical appointments and tests are minimised to prevent interruptions in NCD management and continuity of care.”
During the original lockdown, with alcohol sales restrictions, trauma admissions and motor vehicle injuries were reduced.
“Following the opening of alcohol sales there has been a surge of both intentional and unintentional harm. “At the same time, officially reported cases of gender-based violence (GBV) seemed to decrease, the number of GBV distress calls increased from 12 000 to almost 80 000 by week three of the lockdown, suggesting women could not access services... A loss of focus on the fight against GBV during the pandemic will be extremely detrimental for women and children.”