Noncommunicable diseases, climate change and iniquities: What COVID-19 has taught us about syndemic.

BACKGROUND: COVID-19 is generating clinical challenges, lifestyle changes, economic consequences. The pandemic imposes to familiarize with concepts as prevention, vulnerability and resilience. METHODS: We analysed and reviewed the most relevant papers in the MEDLINE database on syndemic, noncommunicable diseases, pandemic, climate changes, pollution, resilience, vulnerability, health costs, COVID-19. RESULTS: We discuss that comprehensive strategies must face multifactorial consequences since the pandemic becomes syndemic due to interactions with noncommunicable diseases, climate changes and iniquities. The lockdown experience, on the other hand, demonstrates that it is rapidly possible to reverse epidemiologic trends and to reduce pollution. The worst outcome is evident in eight highly industrialized nations, where 12% of the world population experienced about one-third of all COVID-19-deaths worldwide. Thus, a great economic power has not been fully protective, and a change of policy is obviously needed to avoid irreversible consequences. CONCLUSIONS: We are accumulating unhealthy populations living in unhealthy environments and generating unhealthy offspring. The winning policy should tackle structural inequities through a syndemic approach, to protect vulnerable populations from present and future harms.

Changes in Emergency Department Visits, Diagnostic Groups, and 28-Day Mortality Associated With the COVID-19 Pandemic: A Territory-Wide, Retrospective, Cohort Study.

STUDY OBJECTIVE: We aimed to evaluate and characterize the scale and relationships of emergency department (ED) visits and excess mortality associated with the early phase of the COVID-19 pandemic in the territory of Hong Kong. METHODS: We conducted a territory-wide, retrospective cohort study to compare ED visits and the related impact of the COVID-19 pandemic on mortality. All ED visits at 18 public acute hospitals in Hong Kong between January 1 and August 31 of 2019 (n=1,426,259) and 2020 (n=1,035,562) were included. The primary outcome was all-cause mortality in the 28 days following an ED visit. The secondary outcomes were weekly number of ED visits and diagnosis-specific mortality. RESULTS: ED visits decreased by 27.4%, from 1,426,259 in 2019 to 1,035,562 in 2020. Overall period mortality increased from 28,686 (2.0%) in 2019 to 29,737 (2.9%) in 2020. The adjusted odds ratio for 28-day, all-cause mortality in the pandemic period of 2020 relative to 2019 was 1.26 (95% confidence interval 1.24 to 1.28). Both sexes, age more than 45 years, all triage categories, all social classes, all ED visit periods, epilepsy (odds ratio 1.58, 95% confidence interval 1.20 to 2.07), lower respiratory tract infection, and airway disease had higher adjusted ORs for all-cause mortality. CONCLUSION: A significant reduction in ED visits in the first 8 months of the COVID-19 pandemic was associated with an increase in deaths certified in the ED. The government must make provisions to encourage patients with alarming symptoms, mental health conditions, and comorbidities to seek timely emergency care, regardless of the pandemic.

Excess mortality in Wuhan city and other parts of China during the three months of the covid-19 outbreak: findings from nationwide mortality registries.

OBJECTIVE: To assess excess all cause and cause specific mortality during the three months (1 January to 31 March 2020) of the coronavirus disease 2019 (covid-19) outbreak in Wuhan city and other parts of China. DESIGN: Nationwide mortality registries. SETTING: 605 urban districts and rural counties in China's nationally representative Disease Surveillance Point (DSP) system. PARTICIPANTS: More than 300 million people of all ages. MAIN OUTCOME MEASURES: Observed overall and weekly mortality rates from all cause and cause specific diseases for three months (1 January to 31 March 2020) of the covid-19 outbreak compared with the predicted (or mean rates for 2015-19) in different areas to yield rate ratio. RESULTS: The DSP system recorded 580 819 deaths from January to March 2020. In Wuhan DSP districts (n=3), the observed total mortality rate was 56% (rate ratio 1.56, 95% confidence interval 1.33 to 1.87) higher than the predicted rate (1147 v 735 per 100 000), chiefly as a result of an eightfold increase in deaths from pneumonia (n=1682; 275 v 33 per 100 000; 8.32, 5.19 to 17.02), mainly covid-19 related, but a more modest increase in deaths from certain other diseases, including cardiovascular disease (n=2347; 408 v 316 per 100 000; 1.29, 1.05 to 1.65) and diabetes (n=262; 46 v 25 per 100 000; 1.83, 1.08 to 4.37). In Wuhan city (n=13 districts), 5954 additional (4573 pneumonia) deaths occurred in 2020 compared with 2019, with excess risks greater in central than in suburban districts (50% v 15%). In other parts of Hubei province (n=19 DSP areas), the observed mortality rates from pneumonia and chronic respiratory diseases were non-significantly 28% and 23% lower than the predicted rates, despite excess deaths from covid-19 related pneumonia. Outside Hubei (n=583 DSP areas), the observed total mortality rate was non-significantly lower than the predicted rate (675 v 715 per 100 000), with significantly lower death rates from pneumonia (0.53, 0.46 to 0.63), chronic respiratory diseases (0.82, 0.71 to 0.96), and road traffic incidents (0.77, 0.68 to 0.88). CONCLUSIONS: Except in Wuhan, no increase in overall mortality was found during the three months of the covid-19 outbreak in other parts of China. The lower death rates from certain non-covid-19 related diseases might be attributable to the associated behaviour changes during lockdown.

Mortality from respiratory infections and chronic non-communicable diseases before the COVID-19 pandemic in Cali, Colombia.

INTRODUCTION: The COVID-19 disease pandemic is a health emergency. Older people and those with chronic noncommunicable diseases are more likely to develop serious illnesses, require ventilatory support, and die from complications. OBJECTIVE: To establish deaths from respiratory infections and some chronic non-communicable diseases that occurred in Cali, before the SARS-CoV-2 disease pandemic. METHODS: During the 2003-2019 period, 207,261 deaths were registered according to the general mortality database of the Municipal Secretary of Health of Cali. Deaths were coded with the International Classification of Diseases and causes of death were grouped according to WHO guidelines. Rates were standardized by age and are expressed per 100,000 people-year. RESULTS: A direct relationship was observed between aging and mortality from respiratory infections and chronic non-communicable diseases. Age-specific mortality rates were highest in those older than 80 years for all diseases evaluated. Seasonal variation was evident in respiratory diseases in the elderly. COMMENTS: Estimates of mortality rates from respiratory infections and chronic non-communicable diseases in Cali provide the baseline that will serve as a comparison to estimate the excess mortality caused by the COVID-19 pandemic. Health authorities and decision makers should be guided by reliable estimates of mortality and of the proportion of infected people who die from SARS-CoV-2 virus infection.

INTRODUCCIÓN: La pandemia de la enfermedad COVID-19 es una emergencia sanitaria. Las personas mayores y aquellos con enfermedades crónicas no trasmisibles tienen más probabilidades de desarrollar enfermedades graves, requerir soporte ventilatorio y morir a causa de las complicaciones. OBJETIVO: Establecer las defunciones por infecciones respiratorias y por algunas enfermedades crónicas no trasmisibles ocurridas en Cali, antes de la pandemia de la enfermedad por el SARS-CoV-2. MÉTODOS: Durante el periodo 2003-2019, se registraron 207,261 defunciones información obtenida de la base de datos de mortalidad general de la Secretaria de Salud Municipal de Cali. Las defunciones se codificaron con la Clasificación Internacional de Enfermedades y las causas de muerte se agruparon según las guías de la OMS. Las tasas se estandarizaron por edad, son expresadas por 100,000 personas-año. RESULTADOS: Se observó una relación directa entre envejecimiento y la mortalidad por infecciones respiratorias y enfermedades crónicas no trasmisibles. Las tasas de mortalidad específicas por edad fueron más altas en los mayores de 80 años para todas las enfermedades evaluadas. En las enfermedades respiratorias fue evidente una variación estacional en los ancianos. COMENTARIO: Las estimaciones de las tasas de mortalidad por infecciones respiratorias y enfermedades crónicas no trasmisibles para Cali proporcionan la línea de base que servirá de comparación para estimar el exceso de mortalidad que ocasionará la pandemia de COVID-19. Las autoridades sanitarias y los tomadores de decisiones deben guiarse por estimaciones fiables de la mortalidad y de la proporción de infectados que mueren por la infección del virus SARS-CoV-2.

Dietary changes in the NutriNet Brasil cohort during the covid-19 pandemic.

OBJECTIVE: To describe the dietary characteristics of participants in the NutriNet Brasil cohort immediately before and during the covid-19 pandemic. METHODS: Our data stem from an adult cohort created to prospectively investigate the relationship between diet and morbidity and mortality from chronic non-communicable diseases in Brazil. For this study, we selected the first participants (n = 10,116) who answered twice to a simplified questionnaire on their diet the day before, the first time when entering the study, between January 26 and February 15, 2020, and the second between May 10 and 19, 2020. The questionnaire inquiries about the consumption of healthy (vegetables, fruits and legumes) and unhealthy (ultra-processed foods) eating markers. Comparisons of indicators based on the consumption of these markers before and during the pandemic are presented for the study population and according to gender, age group, macro-region of residence and schooling. Chi-square tests and t-tests were used to compare proportions and means, respectively, adopting p < 0.05 to identify significant differences. RESULTS: For all participants, we found a modest but statistically significant increase in the consumption of healthy eating markers and stability in the consumption of unhealthy food markers. This favorable pattern of dietary changes during the pandemic occurred in most sociodemographic strata. We observed a less favorable changing pattern, with a tendency to increasing consumption of healthy and unhealthy food markers, in the Northeast and North macro-regions and among people with less schooling, suggesting social inequalities in the response to the pandemic. CONCLUSIONS: If confirmed, the trend of increased consumption of ultra-processed foods in underdeveloped regions and by people with less schooling is concerning, as eating these foods increases the risk of obesity, hypertension and diabetes, whose presence increases the severity and lethality of covid-19.

A renewed call for transdisciplinary action on NCDs.

Notwithstanding COVID-19, non-communicable diseases (NCDs) will be the leading cause of death in every region in the world by 2030. This contribution, which forms an introduction to our collection of articles in this journal, identifies elements for a transdisciplinary research agenda between law, public health, health economics and international relations aimed at designing concrete interventions to curb the NCD pandemic, both globally and domestically.

COVID-19 Pandemic and Burden of Non-Communicable Diseases: An Ecological Study on Data of 185 Countries.

BACKGROUND: The interaction between coronavirus disease 2019 (COVID-19) and non-communicable diseases may increase the global burden of disease. We assessed the association of COVID-19 with ageing and non-communicable diseases. METHODS: We extracted data regarding non-communicable disease, particularly cardiovascular disease, deaths, disability-adjusted life years (DALYs), and healthy life expectancy (HALE) from the Global Burden of Disease Study (GBD) 2017. We obtained data of confirmed COVID-19 cases, deaths, and tests from the Our World in Data database as of May 28, 2020. Potential confounders of pandemic outcomes analyzed include institutional lockdown delay, hemispheric geographical location, and number of tourists. We compared all countries according to GBD classification and World Bank income level. We assessed the correlation between independent variables associated with COVID-19 caseload and mortality using Spearman's rank correlation and adjusted mixed model analysis. FINDINGS: High-income had the highest, and the Southeast Asia, East Asia, and Oceania region had the least cases per million population (3050.60 vs. 63.86). Sub-saharan region has reported the lowest number of COVID-19 mortality (1.9). Median delay to lockdown initiation varied from one day following the first case in Latin America and Caribbean region, to 34 days in Southeast Asia, East Asia, and Oceania. Globally, non-communicable disease DALYs were correlated with COVID-19 cases (r = 0.32, p<0.001) and deaths (r = 0.37, p<0.001). HALE correlated with COVID-19 cases (r = 0.63, p<0.001) and deaths (r = 0.61, p<0.001). HALE was independently associated with COVID-19 case rate and the number of tourists was associated with COVID-19 mortality in the adjusted model. INTERPRETATION: Preventive measures against COVID-19 should protect the public from the dual burden of communicable and non-communicable diseases, particularly in the elderly. In addition to active COVID-19 surveillance, policymakers should utilize this evidence as a guide for prevention and coordination of health services. This model is timely, as many countries have begun to reduce social isolation.