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Opinion and Editorial

Special: Could Covid affect your health in the long term?

Ifeanyi M. Nsofor
Filed on September 1, 2020


The interplay between the leading NCDs and Covid-19 constitutes its own health emergency

Growing evidence shows that Covid-19 survivors can suffer from long-term health effects, not least heart-related complications. New research published in the Journal of the American Medical Association shows that many people who recover from the virus have heart inflammation (myocarditis). Of 100 survivors in the study, 78 had evidence of previous heart inflammation, and 60 showed ongoing inflammation at the time of observation.

This medical complication should worry us all. As of August 31, 2020, there were more than 25 million cases of the disease worldwide, 17 million recoveries, and more than 851,000 deaths. Using the JAMA study as a benchmark, we could conjecture that around ten million of those survivors have heart inflammation, implying a massive increase in the burden of non-communicable diseases (NCDs).

NCDs were already killing far too many people before the pandemic arrived. In 2016, 54 per cent of 56.9 million total deaths were due to at least one of the ten leading causes of deaths, starting with ischemic heart disease (the narrowing of blood vessels) and then stroke - both of which are NCDs of the heart.

Myocarditis is a serious condition with life-threatening consequences. When the heart is inflamed, its ability to pump blood is reduced, and it may beat irregularly. In either case, the supply of blood reaching other parts of the body is reduced, raising the likelihood of stroke.

Moreover, several NCDs are themselves risk factors for Covid-19. According to the World Health Organization, the elderly and people with pre-existing medical conditions such as asthma, diabetes, obesity, cancer, sickle cell disease, and coronary artery disease appear to be more prone to severe illness as a result of the virus.

Obesity is a major public-health problem globally, and tends to increase the risk for many other NCDs. Based on 2016 estimates, in 140 of 192 countries, at least 10 per cent of the population is considered obese (compared to 36 per cent in the US, 28 per cent in South Africa and the UK, 22 per cent in France, 20 per cent in Italy, and 9 per cent in Nigeria). These obesity statistics may be a factor in the relative severity of Covid-19 across countries, helping to explain why some high-income countries have higher Covid morbidity rates than low- and middle-income countries.

The interplay between the leading NCDs and Covid-19 constitutes its own health emergency, and requires urgent attention. First, there needs to be an even greater focus on preventing community transmission in higher-risk populations. Reducing the number of Covid-19 cases will also reduce the number of people with myocarditis after the pandemic has passed.

Governments and their partners in civil society must step up their efforts to prevent the virus from spreading in the first place. Public-health officials and media outlets should continue to emphasise the importance of wearing face masks, washing hands frequently with soap and running water, using hand sanitizer in the absence of clean water, and practising social distancing of at least six feet in public. If everyone were to adopt these practices, the number of new Covid-19 cases would likely fall dramatically, as would the number of people facing heart complications in the future.

Furthermore, public-health authorities need to start devising interventions to provide lifelong cardiovascular support to Covid-19 survivors. Given the new data on heart-related complications, the broader pandemic response must include provisions for continuing care. Although such interventions may require the reallocation or reprioritisation of existing resources, they would almost certainly be cost-effective when weighed against the costs of not addressing the additional NCD burden.

In fact, more attention should be focused on reducing the impact of NCDs more generally. The UK's experience offers lessons here. In 2018, the Scottish Shetlands authorised doctors to prescribe interactions with nature (hiking, bird watching, and so forth) as a means of preventing and managing NCDs. Similarly, the British government has pushed physicians to prescribe cycling as a way to address obesity. All countries with high rates of obesity should be considering similar programmes.

Meanwhile, more than three million Americans have now recovered from the virus, and among them are elderly survivors and other high-risk individuals who will need additional care, including home services. In Nigeria, the health-tech platform GeroCare provides affordable care to the elderly in the comfort of their homes through regular doctor visits. Its least expensive plan offers three home visits per month for just $50.

This approach to care needs to be scaled up significantly. The more we can reduce the heart-related and other complications of Covid-19, the more lives we will save.

Ifeanyi M. Nsofor is a medical doctor and Senior Atlantic Fellow for Health Equity at George Washington University. -Project Syndicate 


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