Non-communicable diseases (NCDs) such as diabetes, hypertension and ischaemic heart disease are also “pandemics” as they are globally prevalent and their incidence keeps rising year on year. Today, in terms of disease burden, India is facing a double whammy of these and communicable diseases, though the former have a higher morbidity and contribute to over 60% of all deaths in the country.
With COVID-19 currently sweeping across the globe, all our attention has been focused on controlling this pandemic. However, we often tend to overlook the fact that COVID-19 can impact patients with diseases such as diabetes, and the effect is believed to be bi-directional. The SARS-CoV-2, which causes COVID-19, can also “cause”, precipitate or worsen diabetes. It can cause stress-induced hyperglycaemia compounded by the lockdown, which affects one’s lifestyle (diet and exercise), leading to weight gain. COVID-19 can unmask latent diabetes or cause faster conversion of pre-diabetes to diabetes. Indians convert the fastest from pre-diabetes to diabetes.
Diabetes lowers our immune function, thereby making us susceptible. If a person with uncontrolled diabetes gets infected by this virus, she is at risk of complications of not only that ailment but also more severe COVID-19 infection and worse outcomes, even increased mortality. Recently, a registry (COVIDIAB) has been set up internationally to document and follow up this bi-directional relationship.
When a patient with NCDs is infected and dies, one does not always know for sure whether the person has died with or due to the virus. In reality, patients do not come for their routine check-ups owing to the lockdown and the fear of infection. Even those with cardiac-related chest pain tend to delay visiting their doctor until it is too late.
Another problem is that many hospitals insist on knowing the COVID-19 status before admitting patients and often turn them away, leading to loss of precious time, which can have dire consequences.
The result of the RT-PCR test to diagnose SARS-CoV-2 takes two or three days. Hence, the patient with an NCD is able to access appropriate care only when it is too late, due to administrative and other issues. Ideally, regardless of COVID-19 status, a patient with an emergency needs to be treated immediately. The importance of the “golden hour” in treatment of heart attacks and strokes is well known.
Private and public hospitals are expected to keep a large proportion of their beds reserved for COVID-19 patients. As a result, patients with non-COVID-19 conditions do not get priority, especially in ICUs and operation theatres. Patients on dialysis find it difficult to reach their dialysis centres because of which their kidney condition worsens. Cancer patients and those with auto-immune disorders are vulnerable to COVID-19. Conversely, because the coronavirus provokes our immune system to react in an unregulated manner, it causes a “cytokine storm”, which leads to a worse prognosis in those with diseases such as diabetes.
To summarise, the COVID-19 pandemic has impacted treatment of NCDs and even some other chronic infectious diseases (for instance, TB) as these patients get sidelined, increasing the morbidity and mortality.
We have to adopt a balanced approach because the truth of the matter is that the mortality due to such diseases far exceeds that due to COVID. While in a few months, it is hoped, COVID-19 may become history, the NCDs are here to stay.
(The author is the chairman of Dr. Mohan’s Diabetes Specialities Centre)
drmohans@diabetes.ind.in
