The impact of COVID-19 on the double burden of respiratory diseases in India
Written by Caitlin MacMillan Maartens
In the previous blog posts, general concepts regarding respiratory health in India were discussed. However, something that is universally known is that the events this past year have a big influence on a country, including health status. This is due to the COVID-19 crisis that has the world in its grip, which is partly the reason we chose to discuss this topic in our blog. Another important reason we chose this particular topic is because the fact that COVID-19, as asthma, COPD, TB and lower respiratory infections, is a health problem affecting the respiratory system. Short-term consequences of a COVID-19 infection include pneumonia and respiratory failure. Long-term complications of COVID-19 are hard to determine as not many studies have been published and peer-reviewed, because it’s a recent health problem. However, many patients experience respiratory complications, such as chronic cough and pulmonary vascular diseases, for as long as months after their infection.
COVID-19 in India
In our blog post about the Indian healthcare system it was concluded that the Indian healthcare system is unable to provide quality healthcare for all its patients due to the lack of specialized medical professionals and high financial costs. By the end of May 2020, the Indian Ministry of Health and Family reported 89.000 active cases and over 5.000 deaths due to COVID-19, which meant healthcare capacities were reached. As of December 4th, 2020, there are over 9,5 million reported cases and 140.000 deaths in India.
Figure 1 shows the geographical distribution of active COVID-19 cases in India, showing many cases in the midwest of India, where Mumbai is located, which is India’s largest city (based on population) and financial capital.
But how does COVID-19 impact the development of the communicable and noncommunicable diseases prevalent in India?
Figure 1: Geographical distribution of COVID-19 cases in India
COVID-19’s influence on the double burden of respiratory diseases in India
In a previous blog post, pollution was identified as a risk factor for development of lower respiratory infections and COPD. During the COVID-19 pandemic and lockdown period in India, air pollution status has improved due to, for example, a decrease in traffic. The consequences of the improvements in air pollution regarding respiratory diseases has not yet been disproved or approved by peer-reviewed published literature. Overall, it is recommended that individuals suffering from respiratory diseases continue their regular treatment methods, to ensure the respiratory disease is controlled and co-existence with COVID-19 will have minimal health effects.
Tuberculosis (TB) and lower respiratory infections
As both COVID-19 and the double burden of disease in India concern the respiratory system, it can be expected that these influence each other. Both tuberculosis (TB) and COVID-19 are very prevalent communicable diseases in India. An assumption can be made that people with a co-infection with COVID-19 and TB were at higher risk of poor outcomes, such as higher mortality rates. This can be explained by the fact that both TB and viral respiratory infections hinder the immune response, due to which co-existence causes more severe health outcomes. India had the goal to be TB free by the end of 2025, however, this is hindered by the COVID-19 pandemic. As mobility decreased due to the national lockdown, diversion of healthcare workers occurred and diagnostic capacity for TB was now focused on diagnosing COVID-19.
Asthma and COPD
COVID-19 triggers asthma exacerbations, as other viruses do as well, but asthma and COVID-19 exacerbations are difficult to differentiate in practice. Asthma control, including proper treatment with steroids, in combination with avoiding aerosols, is needed to prevent exacerbations. It is controversial whether asthma is a risk factor for infection with COVID-19, as some studies state that it is not a risk factor, while other studies state that individuals with asthma do have a higher risk of getting infected with COVID-19. COPD, contrary to asthma, is a well known disease with a higher risk of getting infected with COVID-19, which means a higher risk of severe pneumonia and poor health outcomes, possibly due to unavailability of adequate lung reserves.
In conclusion, COVID-19 has had a major impact on India, not only due to its own health effects, but also due to its coexistence with other respiratory infections, such as TB, LRI, asthma and COPD, leading to higher mortality rates and a high burden on healthcare systems. With the COVID situation we would like to end our blog. We hoped you enjoyed reading our posts and that you learnt new things about the double burden of respiratory diseases in India and its major risk factors, namely pollution and COVID-19.
