Stopping the syndemic: Covid-19 plus other deadly diseases

December 30, 2020 steven

With Covid-19 vaccines beginning to be distributed in the United States and other countries, and with health care professionals more knowledgeable about the virus, there’s hope we’ll be able to manage the new spike in cases and chart a course to recovery. But it will take a lot more than that to undo the damage this pandemic has caused.

As the pandemic rips across the world, taking lives and devouring health resources and economies, it is also creating a void in which other debilitating and deadly diseases are left undiagnosed and untreated. That means we aren’t merely facing a once-in-a-century pandemic. We’re facing a syndemic: the confluence of several epidemics.

In the U.S. alone, more than 40% of Americans have reported postponing medical care due to Covid-19. Preventive cancer screenings have plummeted during the pandemic, along with visits to ambulatory practices. Vaccination rates for diseases like mumps and measles are also down. Other countries report similar trends.

To address these unmet needs and meet the syndemic head on, we need to reimagine our approach to health care. Digital health technology can help cover a large percentage of patients’ needs, such as routine consultations, screening for many diseases, and follow-ups after some surgical procedures, to name a few, though certainly not all of it: a clinician can’t deliver a baby or administer a vaccine over Zoom.

The U.S. government has recognized this opportunity, dedicating several hundred million dollars to support telehealth programs through the pandemic with targeted support from the U.S. Department of Health and Human Services to cover rural areas.

But these advances shouldn’t disappear once the Covid-19 emergency is over. Policymakers need to ensure a supportive policy framework that maximizes the potential for telehealth. Public and private insurers should recognize and cover patients’ use of telehealth services on par with in-person visits to a doctor’s office. And antiquated and prohibitive laws restricting clinicians from practicing across state lines and with the full scope of their practices must be reassessed.

The syndemic also provides opportunities to use new smartphone applications, wearable devices, and software platforms driven by artificial intelligence to improve detection, treatment and contact tracing for Covid-19 as well as to enable massive leaps forward in patient-centered and remote care. Public-private partnerships like the Broadband Commission for Sustainable Development are working to expand access to these innovations.

More broadly, the global health community needs to collectively support health systems in low- and middle-income countries, which are disproportionately affected by Covid-19 and other streams of the syndemic. As long as SARS-CoV-2, the virus that causes Covid-19, continues to spread in some of these countries, it will continue to pose a global threat. The good news is that these countries, which have historically grappled with systemic challenges such as shortages of health workers and medical supplies, poor access to medical information, and rapid urbanization, have the most to gain from innovative health technologies and are often quite nimble at adopting them.

Take São Paulo, Brazil’s largest city, where one in four people live with cardiovascular disease. Working with the Novartis Foundation, a philanthropic organization supported by the company I lead, the city implemented the country’s first digital training on heart disease for health care workers and pharmacists. It involved various topics including improving blood pressure measurement, hypertension diagnosis, and patient empowerment. It used digital technology to bring screening services into communities where people live, rather than have them trek to doctors’ offices or medical centers. This program tripled the number of people treated for high blood pressure.

Then, when Covid-19 hit, the city worked quickly to develop an artificial intelligence application that is now being used to screen people for Covid-19 in hospitals across the country, freeing up health workers to provide critical in-person care.

Middle-income countries aren’t the only ones poised to benefit from a tech-driven revolution in health care. So are some of the lowest-income countries in the world. A virtual health consulting service in Rwanda already covers one-third of the adult population. Hospitals in India are using artificial intelligence to predict heart attacks several years before they happen. And the Africa Medical Supplies Platform integrates African and global medical suppliers through a central, online hub to ensure cost-effectiveness and transparency in procuring and distributing health supplies.

The global health community must encourage and support government investments that mainstream these initiatives, as they are vital to increasing access to care.

As a physician-scientist who led efforts to produce a successful vaccine for the swine flu pandemic in 2009 and who has helped develop more than 30 vaccines and novel medicines, I’ve been truly amazed at the rapid progress industry, governments, and nonprofit organizations are making on Covid-19 therapies and vaccines. But narrow management of the crisis risks neglecting other important population health needs.

Policymakers and the global health community must accelerate the digital revolution in health, pursue community-based care models, and support data-driven health solutions in low- and middle-income countries. With quick, coordinated action, we can save more lives from being taken by the syndemic.

Vas Narasimhan, a physician-scientist, is the CEO of Novartis.

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