Disruption in health services due to deadly Covid-19 pandemic will have a ripple effect causing a surge in HIV, tuberculosis (TB), and malaria deaths over the next five years in some low-and middle-income countries (LMICs), a study published in the Lancet Global Health journal has warned.
Some LMICs could see HIV, TB, and malaria deaths increase by as much as 10 per cent, 20 per cent, and 36 per cent respectively over the next five years due to services diversion to the ongoing outbreak and its response.
Modelling the public health impact of virus infection on HIV, TB, and malaria in LMICs over the next 5 years, researchers estimate the substantial disruptions by overwhelming already fragile health systems, or through response measures limiting routine programme activities and care-seeking, and interrupting medical supply chains.
“But maintaining core services for HIV, TB, and malaria--specifically access to antiretroviral therapy (ART), timely TB diagnosis and treatment, and early resumption of the distribution of long-lasting insecticide-treated nets (LLINs) and antimalarial treatment-could largely mitigate the broader health impact of the COVID-19 pandemic,” researchers said.
However, the authors caution that predicting the true impact of the ongoing pandemic and its response on other diseases is fraught with difficulty, especially when so much remains unknown about the virus and the extent to which other disease programmes may be disrupted, and how this might impact population health.
Malaria deaths worldwide have reduced by half since 2000, but progress has stalled as mosquitoes and parasites gain resistance to treatment. Around
“The pandemic and actions taken in response to it could undo the some of the advances made against major diseases such as HIV, TB, and malaria over the past two decades, compounding the burden caused by the pandemic directly”, said Professor Timothy Hallett from Imperial College London, UK, who co-led the research. “In countries with a high malaria burden and large HIV and TB epidemics, even short-term disruptions could have devastating consequences for the millions of people who depend on programmes to control and treat these diseases. However, the knock-on impact of the pandemic could be largely avoided by maintaining core services and continuing preventative measures.”
He said, “Our findings underscore the extraordinarily difficult decisions facing policy makers. Well managed, long-term suppression measures could avert the most COVID-19 deaths. But if these interventions are not well managed, they could cause people to stay away from hospitals and clinics and force public health programmes to be cancelled, leading to a large spike in deaths from other major infectious diseases that had been coming under control.”
The greatest impact on HIV is projected to be from interruption to the supply and administering of ART, which may occur during times of high health system demand. The researchers suggest that offering individuals receiving ART multi-month prescriptions or home delivery could ensure they can access treatment even in periods of highest health system demand.
For TB, the greatest impact is predicted to be from reductions in timely diagnosis and treatment of new cases, which could result from long periods of COVID-19 containment measures limiting access to services.
The model predicts that the greatest impact on malaria burden could result from interruption of planned net campaigns, which usually take place every 3 years. In the worst case, with COVID-19 disruptions coinciding with the malaria transmission season and planned LLIN distribution, malaria deaths could increase by 36% over the next 5 years-equivalent to 474 additional malaria deaths per million population in 2020-2024”, said co-lead author Dr Alexandra Hogan from Imperial College London, UK.
