COVID-19 disruptions could lead to surge in infectious disease deaths, studies find

*Preventing pandemic 500 times cheaper than
responding to one, researchers find

A new modeling study suggests that disruptions to health services caused by Coronavirus disease (COVID-19) could lead to an increase in Human Immuno-deficiency Virus (HIV), tuberculosis, and malaria deaths.

Experts around the world expect COVID-19 pandemic to have a significant impact on society. This includes not only the illness and deaths caused by the disease itself but also the economic consequences of global lockdowns and disruptions to essential services.

Experts indicate that the pandemic’s knock-on effects are likely to be most severe in low and middle-income countries, where health systems are less robust and economic reserves are more limited.

A particular concern is the impact of the pandemic on countries with high burdens of infectious diseases, such as HIV and tuberculosis (TB), which depend on regular, large-scale programs of control and treatment.

A study published in Lancet Global Health modeled the impact of disruptions caused by COVID-19, such as increased demand on healthcare systems and reductions to disease control programs, in low- and middle-income countries.

The study estimates that deaths due to HIV, TB, and malaria could increase over the next five years as a result of COVID-19 and could, in the worst-case scenario, occur on a similar scale to the direct impact of the pandemic.

The researchers based the study on a model that assumes a reproduction number of 3 for SARS-CoV-2, the virus that causes COVID-19.

The reproduction number, or R0, indicates the average number of new people who will contract the virus from one person who has it.

Using R0 as a starting point, the researchers modeled the impact of four different policy scenarios for COVID-19: taking no action; mitigation, leading to a potential 45 per cent reduction in R0 for six months; suppression-lift, leading to a potential 75 per cent reduction in R0 for two months; and suppression, leading to a potential 75 per cent reduction in R0 lasting for one year.

The researchers then used models of transmission for HIV, TB, and malaria to estimate the impact of the COVID-19 policy scenarios on these diseases.

Potential impacts included COVID-19 interventions limiting routine program activities, and COVID-19 cases overwhelming the health system.

The results showed that disruption to health services caused by COVID-19 could increase the number of deaths from HIV by 10 percent, deaths from tuberculosis by 20 per cent, and deaths from malaria by 36 per cent over the next five years.

The impact varied according to the disruption to activities and the success of interventions in reducing COVID-19 transmission.

The model predicted that the most significant impact for HIV would be interruptions to the supply of antiretroviral treatment due to the high demand on the healthcare system. To combat this, the researchers suggest giving people multiple prescriptions at a time or delivering them to their homes.

The researchers indicated that disruptions to diagnosis and treatment were likely to have the most significant impact on TB cases.

The model predicted that interruptions to the delivery of mosquito nets could be devastating in terms of the number of malaria cases. Planned net campaigns usually take place every three years, and without this, malaria deaths could increase by 36 per cent over the next five years.

“Many of the gains made in malaria control over the past decade have been due to the distribution of long-lasting insecticide-treated nets in sub-Saharan Africa, where the vast majority of malaria deaths occur. However, the COVID-19 pandemic will likely disrupt these distributions in 2020, resulting in more malaria deaths”, explains co-lead author Dr. Alexandra Hogan from Imperial College London in the United Kingdom.

The researchers say that the disruptions caused by COVID-19 could, in the worst-case scenario, lead to a loss of life years (the expected number of years a person might have lived had they not died of a particular cause) on a similar scale to the direct impact of the pandemic itself.

However, there is still time to reduce the death toll. The researchers say that authorities and other organizations must maintain critical services, such as providing antiretroviral treatments for HIV and insecticide-treated nets for malaria.

“In countries with a high malaria burden and large HIV and TB epidemics, even short-term disruptions could have devastating consequences for the millions of people who depend on programs to control and treat these diseases. However, the knock-on impact of the pandemic could be largely avoided by maintaining core services and continuing preventive measures,” said Prof. Timothy Hallett from Imperial College London, who co-led the research.

There are some important limitations to note about this modeling study. The authors say the scenarios they modeled are not “exhaustive” and do not account for the impact of long-term global changes, such as an economic recession.

Meanwhile, new research indicates that responding to a pandemic, such as the current spread of COVID-19, is 500 times more expensive than taking preventive measures.

A new policy brief published in the journal Science has found that preventive measures that would significantly reduce the risk of a pandemic would cost roughly 500 times less than responding to a pandemic.

The research makes clear that a worldwide shift toward preventive action is necessary if we are to avoid the profound damage wrought by the global spread of disease.

COVID-19, the illness at the heart of the ongoing pandemic is a type of zoonotic disease. These spread from nonhuman animals to humans. In the case of COVID-19, the disease is caused by a coronavirus known as Severe Acute Respiratory Syndrome Coronavirus Type 2 (SARS-CoV-2).

Many other serious illnesses, including HIV, SARS, Middle East Respiratory Syndrome (MERS), and swine flu, have emerged from this type of transmission.

Infection requires situations where humans come into contact with animals or their meat. Some key sites are the edges of tropical forests, which contain rich, dense, and diverse ecosystems — and wild meat markets.

According to the present research, limiting these opportunities for contact is an important way to reduce the transmission of zoonotic diseases and the consequent risk of pandemics.

However, research has shown that the world is moving in the opposite direction. A range of socioeconomic and environmental factors is contributing to an increase in points of contact between humans and other animals.

Prime among these island conversion, which can involve the deforestation of rainforests.

This typically happens by cutting out patchworks of the rainforest —significantly increasing the amount of forest edge and resulting in more possible points of contact between organisms within the rainforest ecosystem and those outside of it.

In addition, deforestation often requires the presence of large numbers of people near the edges of rainforests, as well as the creation of infrastructures such as roads and dwellings. These factors each increase the chances of a disease spreading from wild animals to humans, possibly via farmed animals.

As Les Kaufman, co-author of the research and professor of biology at Boston University, in Massachusetts, observes: “Much of this traces back to our indifference about what has been occurring at the edges of tropical forests.”

The policy brief also highlights that the global trade in wild animals is a significant driver of human and nonhuman animal contact.

Wild animals are typically captured for their meat. This is sold in wet markets, such as that in Wuhan, China where experts believe the ongoing pandemic originated.

The desire for exotic pets is also a key driver of the global trade in wild animals, of which the United States is a major importer.

The world currently has firsthand experience of the phenomenal costs of responding to a pandemic, to say nothing of the profound loss of life.

The policy brief highlights that the current pandemic is likely to end up costing around $8.1 to $15.8 trillion globally.

By contrast, investing in preventive measures that would significantly reduce the chances of a pandemic occurring would likely cost 500 times less than the projected cost of the current pandemic: around $22–31 billion each year, the researcher’s estimate.

These preventive measures could include expanding programs that monitor the trade in wildlife, ending the wild meat trade, reducing deforestation by 50 per cent, and investing in programs to reduce the transmission of disease from wildlife to domestic, farmed animals.

The researchers make clear that the preventive response needs to be global, even if the investment is targeted at issues in specific countries.

“The pandemic gives an incentive to do something [to address] concerns that are immediate and threatening to individuals, and that’s what moves people,” said Kaufman. “There are many people who might object to the United States fronting the money, but it’s in our own best interest. Nothing seems more prudent than to give ourselves time to deal with this pandemic before the next one comes.”