The Covid-19 pandemic has disrupted treatments for noncommunicable diseases. The Simón Bolívar Hospital in Bogotá is pictured above. // File Photo: EEIM via Creative Commons.

Treatments for noncommunicable diseases, such as cancer and cardiovascular disease, have been severely disrupted worldwide since the pandemic began, according to a recent World Health Organization survey. At the same time, people with pre-existing noncommunicable diseases appear to be more at-risk of severe Covid-19 symptoms and death. How has the pandemic affected health care oriented toward noncommunicable diseases in Latin America and the Caribbean, and how can hospitals ensure that treatment of such illnesses continues amid the pandemic? What flaws in the region’s health services for noncommunicable diseases has the health crisis laid bare? How can the region strengthen related health services, and how can governments fund such efforts given the current economic downturn?

Rolf Hoenger, area head for Latin America at Roche Pharmaceutical: “The pandemic has intensified the debate on making health systems more resilient to manage the double burden of rising infectious and noncommunicable diseases (NCDs), especially in low- and middle-income countries. In Latin America, Covid-19 has exacerbated the lack of access to health care, jeopardizing treatment continuity for patients with NCDs. Cancer patients, for example, are delaying infusions due to social-distancing measures and a fear of being exposed to the virus. This, coupled with decisions to partially or completely disrupt NCD services, can lead to an epidemic of NCDs. In fact, 20 of the 28 member states surveyed by the Pan American Health Organization reported some level of interruption to outpatient services. This is especially concerning given that, according to the organization, before Covid-19, 81 percent of all deaths in the Americas were due to NCDs. At Roche, we are partnering with entrepreneurs, suppliers, patient organizations and academic institutions to develop solutions that ensure continuity of care during these unprecedented times. For example, in Argentina, Chile, Ecuador and Peru, we implemented programs for home infusions and direct delivery to patients, as well as safe transport to health centers. Public-private partnerships have tremendous potential to address some of the challenges we are facing due to Covid-19. The private and public sectors must work together to evolve regulations and generate the necessary incentives to foster the development and implementation of innovative solutions for the needs of patients today. The work we have been doing has shown that when we join forces, we are stronger.”

Julio Frenk, president of the University of Miami, Felicia Knaul, director, and Michael Touchton, researcher, at the university’s Institute for Advanced Study of the Americas: “The disruptions to prevention and treatment of noncommunicable diseases (NCDs) wrought by Covid-19 are of particular concern in Latin America and the Caribbean (LAC). NCDs account for 80 percent of deaths and disproportionately affect the poor, who lack access to insurance and care. Covid-19 has laid bare longstanding disparities based on poverty, ethnicity and sex. Health systems in the region face layers of exacerbated challenges, including shortages of medicines and staff. For instance, even before the pandemic, the region did not have sufficient pain medication to meet even one-third of patient need for palliative care. Professional and unpaid caregivers are at particular risk, with poor women suffering the most as they struggle to earn an income while caring for children, the elderly and the sick. These systemic problems are compounded by patients lacking services early in the continuum of care. Faced with severely reduced income, interruptions in public transportation and fear, patients are not accessing screening services. One example: reports indicating that the incidence of breast and cervical cancer in Mexico is down by more than 25 percent can only be explained by lack of diagnostic capacity and delays in seeking care. Late diagnosis and excess mortality from NCDs were already rampant in LAC and will now increase. To address NCDs we must harness alternative strategies such as telemedicine, especially during the pandemic. The complexity of challenges in the region make one thing certain: now is the time to shore up, not divest of, anti-poverty and universal health care programs.”

María Luisa Ávila, chief of the infectiology service at the National Children’s Hospital in San José and former Costa Rican health minister: “The Covid-19 pandemic has undoubtedly affected people with noncommunicable diseases. Despite efforts by health services through virtual consultations and home delivery of medicines, the lack of doctor-patient contact and laboratory tests can be detrimental to patients with underlying diseases. We must keep in mind that people with chronic diseases are at high risk of complications and even death due to a SARS-CoV-2 infection, so strengthening primary care at the local level should be a priority that counteracts the pandemic’s negative effects. Without adequate primary care, hospitals will be a monument to the failure of public health. The Covid-19 pandemic has been a critical test for Latin America and the Caribbean’s public health systems, most of which are overburdened and underfunded. Our region suffers from serious inequalities, and public health systems are the only source of medical care for a large sector of the population. Some Latin American leaders’ political use of the pandemic has created additional tensions that contribute to the erosion of a basic sense of community and principles of solidarity necessary for the public support of mitigation strategies. There are many collateral effects of the pandemic, of which there has been little talk, with the effects on patients with noncommunicable diseases being one of them.”

Alicia Bárcena, executive secretary of the U.N. Economic Commission for Latin America and the Caribbean (ECLAC): “The pandemic has caused a shift in the control of noncommunicable diseases (NCDs) in Latin America, especially relating to screening services and the management of hypertension and diabetes. Care has been postponed or interrupted due to the need to reassign health workers and budgets to address the onslaught of the pandemic on the generally weak and underfunded health systems in Latin America. Public health expenditure in the region is low, with an average of expenditure of 3.7 percent of GDP, far from the 6 percent target recommended by the Pan American Health Organization. Likewise, there are problems in the allocation of resources, including the deficient financing of the primary level of care, which is essential for the prevention, detection and control of NCDs, particularly for those of low socioeconomic status, who generally have a higher prevalence of NCDs. It is also true that many people are forgoing treatment due to their fear of infection. Access to services for sexual and reproductive health, mental health and maternal and child health have also been limited. This phenomenon is contributing to an increase in excess mortality across the region, the full extent of which has not yet been characterized. Countries must urgently adopt alternative strategies to ensure that services to detect and treat NCDs continue, even as they fight Covid-19. The use of telemedicine, adopting novel mechanisms to deliver medications and the use of wearable technology to monitor biomarkers relating to NCDs are all examples. Even in the context of a severe economic downturn, governments in the region must prioritize health spending, including to address NCDs, in order to avoid a wave of premature death and disability unrelated to Covid-19.”

Anselm Hennis, director of the Department of Noncommunicable Diseases and Mental Health at PAHO: “The Americas remain at the epicenter of the Covid-19 pandemic. Noncommunicable diseases (NCDs), including cardiovascular diseases, diabetes, cancer and chronic respiratory diseases, account for 80 percent of deaths in the region annually. These conditions also increase the risk of severe Covid-19 illness and death, with nearly 325 million people at increased risk in the Americas. Stay-at-home measures, disruptions in provision of health services, staff reassignments for Covid-19, as well as the fear of going to care facilities, have resulted in reduced elective clinic visits, lower access to renal dialysis and cancer care and delays in high priority treatments for patients with NCDs. Some countries have experienced disruption of supply chains and distribution of medicines and health products, putting patients at higher risk of complications and death from diseases that are eminently treatable. Health systems must fully address these challenges, or there will be a subsequent epidemic of preventable NCD-related complications and deaths. It is critical to implement safe methods of delivering care for people with NCDs, which include scheduled appointments to avoid crowded waiting areas and providing services in novel ways, such as telemedicine. Services for cancer and chronic kidney disease must be prioritized to ensure continuity of care. People with NCDs must be provided with the knowledge, resources and support system necessary for them to protect themselves. Addressing NCDs must be integral to the Covid-19 response. There must be timely and comprehensive access to care for chronic diseases to prevent life-threatening complications.”

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