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Published On: Mon, Aug 17th, 2020

Covid-19 is making other diseases worse too

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From Uche Uche, Damaturu

“Among the scariest unknowns of the Covid-19 calamity has been what the state of emergency, and the diversion of money and health care resources to fighting the new virus , will mean for other public health problems that long predated the pandemic,” wrote Dylan Matthewsin magazine.
Malaria, tuberculosis, and other infectious diseases, he stated, were huge problems before the crisis, and it stood to reason that the situation would get worse as outbreaks taxed health systems.
A new paper in Nature Medicine by a team of 29 authors, where the corresponding author is Imperial College’s Thomas Churcher, has some useful, if incredibly depressing, stats on malaria, specifically.
The new paper estimates how malaria prevalence and mortality will change depending on how bad Covid-19 gets in sub-Saharan Africa, and on which aspects of malaria control are disrupted.
The three central aspects of malaria control are insecticide-treated bed nets; seasonal malaria chemoprevention, SMC, in which people in malarial regions get drug doses meant to prevent infection; and treatment of actual diagnosed malaria cases once they happen.
Among the best-case scenarios they consider, is bed net distribution holding steady, while SMC and treatment are reduced but still ongoing, as public health systems are able to suppress the Covid-19 outbreak and keep deaths to a minimum. In that scenario, the authors estimate 200,000 additional malaria deaths across sub-Saharan Africa.
“If bed nets, prevention doses, and treatment are all interrupted during the Covid-19 outbreak, then we could see almost 700,000 additional malaria deaths,” the paper said.
Weaker responses to the pandemic see fewer additional malaria deaths but way more deaths overall. The authors consider a “mitigation” scenario, where Covid-19 spreads, with effective reproduction rate above 1, but at a slower rate than without any public health system intervention.
In that scenario, they estimate 2.9 million to 11 million Covid-19 deaths across the continent, an order of magnitude above annual malaria deaths in sub-Saharan Africa. Not just that, but there will still be hundreds of thousands of new additional malaria deaths, because the pandemic will still divert resources from malaria prevention, though less than a highly effective Covid-19 prevention campaign would.
Malaria isn’t the only disease whose control efforts are being disrupted by Covid-19. The New York Times’s Apoorva Mandavilli has an excellent, distressing piece on how the pandemic is diverting attention from tuberculosis and HIV as well.
Social distancing measures also have conflicting effects: They can reduce transmission of non-Covid infectious diseases, but also deter people from accessing treatment and preventive measures.
“The lockdowns, particularly across parts of Africa, Asia and Latin America, have raised insurmountable barriers to patients who must travel to obtain diagnoses or drugs, according to interviews with more than two dozen public health officials, doctors and patients worldwide,” Mandavilli writes. “Fear of the coronavirus and the shuttering of clinics have kept away many patients struggling with H.I.V., TB and malaria, while restrictions on air and sea travel have severely limited delivery of medications to the hardest-hit regions.”
She cites a modelling study that suggested a three-month lockdown could increase TB deaths by 1.4 million; a six-month disruption in access to HIV therapies could lead to 500,000 additional deaths.
“Whenever we get this done, we will have lost many years in malaria and polio and HIV,” Bill Gates warned in a recent interview.
Groups like the Global Fund and individual activists like former Bush aide Michael Gerson are calling for billions in additional aid to make sure that antiretroviral, bed nets, SMC drugs, and more are fully funded for the duration of this outbreak.

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