Strategies to minimize preventable morbidity and mortality resulting from pandemics like <scp>COVID</scp> ‐19

Abstract

The fundamental role of healthcare systems is minimisation of preventable morbidity and mortality in the population. Notwithstanding, despite their central role in promoting health and preserving and improving the well-being of society, budgetary constraints limit accessibility and services provided to the population, resulting in preventable disease (OECD, 2015). At times, for example, during the winter influenza season, health services may become overstretched, or even overwhelmed, due to a mismatch between case load and available capacity/resources. This does not usually lead to a significant reduction in routine and elective services. However, new infectious diseases, in particular those with unpredictable disease progression and outcomes and/or transmission characteristics, and that can lead to pandemics, may cause rapid and severe reductions in available capacity for routine clinical care: (i) health services may be re-focussed towards dealing primarily with the new health crisis, and (ii) frontline professionals can become infected and either become ill or need to self-isolate to minimize infection of others, thereby further reducing healthcare capacities. As a result, normal health services can become severely disrupted. Moreover, the consequences of public health measures to interrupt infection chains, compounded by the perceived (or de facto existing) threat posed by pandemics, can exacerbate chronic and mental health-related conditions, and even trigger new ones (https://unsdg.un.org/sites/default/files/2020-05/UN-Policy-Brief-COVID-19-and-mental-health.pdf). Crucially, some measures may formally disincentivise patients from seeking urgent or non-urgent essential healthcare. Such measures and their accompanying public announcements may also create public anxiety (https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/technical-guidance/mental-health-and-covid-19) about risks of becoming infected/infecting others during visits to health centres, and thereby induce reluctance to undertake such visits (a behaviour that might be termed clinical services hesitancy), which may lead to deterioration of some conditions. Pandemics entrain other hurdles to healthcare practice and access, such as disruption of supply chains for key medicaments and materials, and travel restriction measures that curtail vital health-related travel (of both patients and health professionals). Particularly worrying are prospects of increasing incidence of major endemic infectious diseases, such as tuberculosis, malaria and AIDS which, together, are responsible for annual deaths of ca. 2.4 million people, mostly in low- and middle-income countries (Editorial, 2020; Finn McQuaid et al., 2020; Glaziou, 2020; Sherrard-Smith et al., 2020). Recent reports suggest that 80% of care programmes for these three diseases have suffered severe disruptions to their activities (e.g. see Editorial, 2020; https://www.nytimes.com/2020/08/03/health/coronavirus-tuberculosis-aids-malaria.html?smid=em-share). The combination of pandemic-induced re-prioritization of healthcare services, reductions in clinical capacities and availability of diagnostics and clinical supplies, hindrance of travel to care facilities, disincentives to seeking care, and clinical services hesitancy, creates a perfect storm that severely interrupts diagnosis-prevention-(early)treatment care services. This can lead to a subsequent and unnecessary wave of potentially serious new or worsening non-pandemic-related disease cases, of cancer (e.g. Sud et al., 2020), cardio-vascular disease, infectious disease, psychiatric disorders, and so forth (e.g. Reza et al., 2020; https://unsdg.un.org/sites/default/files/2020-05/UN-Policy-Brief-COVID-19-and-mental-health.pdf), that could otherwise have been managed more appropriately by routine health services. We have previously discussed some of the logistical aspects of preventable morbidity and mortality (Timmis and Brüssow, 2020).