Modeling study predicts rapid increase in HIV, tuberculosis, and malaria deaths from the COVID-19 pandemic

However, by prioritizing the provision of the most important services, specifically antiretroviral therapy for HIV, timely diagnosis and treatment of tuberculosis, and long-term insecticide treated nets for malaria, death Researchers say there is still an opportunity to significantly reduce the number of people.

Some low Middle-income countries (LMICs) HIV, tuberculosis (TB), and malaria According to a new modeling study published in, the COVID-19 pandemic and the disruption in health care caused by its response have increased deaths by 10%, 20%, and 36%, respectively, over the next five years. Lancet global health journal.

Modeling the public health impacts of COVID-19 against HIV, TB, and malaria in LMICs over the next five years, the researchers found that destruction of COVID-19 in areas where the impact of these major infectious diseases was high. Estimating the impact on long-term loss of life (the number of years a person would have been expected to live if he/she did not die for a particular cause) is, at worst, similar to the direct impact of the pandemic itself. Could be of scale.

The COVID-19 pandemic can cause substantial disruption by overwhelming already fragile healthcare systems or by measures that limit regular program activities and caregiving and disrupt the healthcare supply chain. .. However, access to core services for HIV, tuberculosis and malaria, especially antiretroviral therapy (ART), timely diagnosis and treatment of tuberculosis, long-term insecticide treated net (LLIN) and distribution of antimalarial treatments. Maintaining early resumption, researchers say, mitigate the wider health effects of the COVID-19 pandemic.

However, the authors warn that it is difficult to predict the true impact of the ongoing COVID-19 pandemic and its response to other diseases. How does this affect the health of the population, especially when little is known about how disruptive the virus and other disease programs are? That their study aims to quantify the potential scale of the impact of COVID-19 and to guide how it is minimized, rather than providing an accurate estimate. Is pointed out.

Although the number of malaria deaths worldwide has halved since 2000, progress has slowed as mosquitoes and parasites become more resistant to treatment. Approximately 94% of deaths occur in sub-Saharan Africa and malaria claimed an estimated 380,000 lives in 2018. Similarly, worldwide HIV/AIDS mortality has been halved in 10 years due to the prevalence of ART. In 2019, the disease killed about 690,000 people worldwide and the majority of LMICs. An estimated 49 million lives were saved by the diagnosis and treatment of tuberculosis between 2000 and 2015, but 1.8 million lives were lost in 2018, with more than 95% of these deaths at LMIC. Has occurred.

“The COVID-19 pandemic and corresponding actions taken could reverse some of the progress made over the past two decades on major diseases such as HIV, tuberculosis, and malaria, directly addressing the burden caused by the pandemic. “It makes things worse,” says Professor Timothy Hallett of London, where he co-led the study. “In countries with high malaria burdens and a high epidemic of HIV and tuberculosis, even short-term disruptions can have devastating consequences for millions of people dependent on programs to control and treat these diseases.” But the spillover impact of a pandemic can be largely avoided by maintaining core services and continuing precautions.”

“Our findings underscore the very difficult decisions policymakers face. Properly managed long-term containment measures could avoid the majority of COVID-19 deaths. However, if these interventions are not properly managed, people can leave the hospital and they were forced to stop clinics and public health programs and were under control. The number of deaths from other major infectious diseases has increased significantly.”

Peter Sand, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria in Geneva, Switzerland, which is not involved in the study, discussing the impact of the findings in linked comments, said: States. , Tuberculosis, and malaria can be worse than this study suggests, and in some countries, even worse than the direct impact of COVID-19. The World Fund conducts bi-weekly qualitative surveys in more than 100 countries around the world The latest published results show that 85% of HIV, 78% of tuberculosis, and 73% of malaria control are confused. I am. 18% of HIV programs, 17% of TB control, and 19% of malaria control, or very high confusion. “

“In countries where the effects of HIV, tuberculosis and malaria are serious, COVID-19 can reverse the benefits that have been gained over the years. We cannot do this. More resources and Definitive action is needed and needs to be measured, not only in terms of minimizing the direct effects of COVID-19, but also its overall impact, including knock-on effects on HIV, tuberculosis and malaria. It was successful in minimizing the impact.”

In this study, the researchers found that the basic reproductive count (R0; the average number of individuals infected with a virus is likely to be infected) to develop four different policy-enabled scenarios for the COVID-19 pandemic. Was assumed to be 3 — no action, mitigation (which uses interventions such as physical distance to reduce R0 by 45% for 6 months, inhibitory lift (reduction of R0 by 75% for 2 months). ), or a 75% reduction in R0 for 1 year (see Table 1). Then, using HIV, TB, and malaria infection models, COVID-19 interventions limit the activity of routine programs and COVID-19 cases impose a burden on the healthcare system. We estimated additional health effects that could be caused by the situation (Table 2, Figure 2).

Overall, depending on the extent to which interventions against COVID-19 cause long-term disruption to activity, and how these measures reduce SARS-CoV-2 infections and avoid overwhelming the healthcare system, pandemic The findings suggest different impacts.

The greatest impact on HIV is predicted to be due to interruptions in ART supply and management that can occur during times of high demand on the healthcare system. In the worst-case scenario, assuming that there is no behavior or decontainment, some countries in southern South Africa have a high incidence of typical HIV (prevalence of 20% at ages 15-49 in 2018). ), more HIV will occur over the next five years without COVID confusion, and 612 additional deaths from HIV per million in 2020-2024. Researchers have suggested that by providing individuals to receive ART prescriptions or courier delivery for months, they can ensure access to treatment during periods of high demand for the healthcare system.

In the case of tuberculosis, the greatest impact is expected to be due to the timely diagnosis of new cases and diminished treatment, which may be a long-term consequence of COVID-19 containment measures that limit access to services. I will. In the worst case scenario, assuming repression in a very heavily burdened country typical of Southern Africa (520 new cases per 100,000 population in 2018), 20% of tuberculosis deaths will occur over the next five years. Potentially increased (equivalent to an additional 987) tuberculosis deaths per million population between 2020 and 2024 compared to when the service is functioning normally.

The model predicts that the greatest impact on malaria burden may result from interruptions in planned net campaigns, which typically occur every three years. In the worst case, malaria deaths could increase by 36% over the next five years, with COVID-19 disruption consistent with the malaria season and planned LLIN distribution, with a population of 1 million between 2020 and 2024. This is equivalent to an additional 474 deaths from malaria per capita.

“Most of the results of malaria control over the last decade have been due to the long-term distribution of pesticide-treated nets in sub-Saharan Africa, where the majority of malaria deaths occur. But COVID-19 The pandemic will probably be confusing, with these distributions occurring in 2020 and increasing deaths from malaria,” said co-author Dr. Alexandra Hogan of London, Imperial College London. “We must prioritize regular precautions to ensure that mosquito net distribution campaigns and prophylactic treatments such as mass drug distribution and seasonal malaria chemoprevention are maintained.”