Services for the prevention and treatment of noncommunicable diseases (NCDs) have been critically affected since the onset of the COVID-19 pandemic in the Region of the Americas, according to a survey conducted by the Pan American Health Organization/ World Health Organization (PAHO/WHO).

The virtual rapid assessment of service delivery for NCDs during the COVID-19 pandemic in the Americas, completed by 158 countries around the world, including 28 member states of PAHO, during a four-week period in May, confirmed that the pandemic has had a global impact and that the disruption of routine health services poses a threat to the health of people living with noncommunicable chronic diseases.

“This situation is very troubling because it puts people living with NCDs at greater risk of becoming critically ill or dying if they have COVID-19,” said Anselm Hennis, Director of the Department of Noncommunicable Diseases and Mental Health at PAHO, during a media teleconference organized by the NCD Alliance, the Healthy Latin America Coalition, and Mexico Salud-Hable.

When the pandemic began, routine health services were reorganized or interrupted and many stopped providing care to people in treatment for cancer, cardiovascular diseases, and diabetes, among others. Many of the health workers who usually provide this kind of care were reassigned to the COVID-19 response. Treatment and care for these people must continue, Dr. Hennis said. “Countries should seek innovative ways to ensure continuity while at the same time addressing COVID-19”.

Before COVID-19, 81% of all deaths in the Americas were due to NCDs. An estimated 62 million people in the Americas are living with diabetes and 1.2 million in Latin America and the Caribbean are living with cancer. Around a quarter of people in the Americas have a chronic disease and are at greater risk of becoming critically ill or dying if they are infected with COVID-19. At the end of May, the Director of PAHO, Carissa F. Etienne, warned that failure to provide care for NCDs during the pandemic could lead to “a parallel epidemic of preventable deaths” in people with chronic diseases.

Limited access to services
Outpatient services were partially interrupted in 18 surveyed countries (64%), two countries (7%) closed their NCD services completely, and in seven countries (25%) they have remained open. These disruptions have affected all types of care for people with NCDs, but more so for diabetes, hypertension, dental care, and rehabilitation services. The main reasons cited for disruption of NCD services include cancellation of elective care services (58%, 14/24), clinical staff being reassigned to COVID response (50%, 12/24), and patients not presenting (50%, 12/24).

Reassignment of staff
In the majority (89%) of countries in the Americas that responded to the survey, ministry of health staff designated to work on NCD services have been partially or totally redirected to work on the COVID-19 response. Postponement of screening programs (e.g., for breast and cervical cancer) has also been widespread (43% of countries), in accordance with WHO’s initial recommendation to minimize non-urgent care in health facilities during the pandemic. The most common reasons for interrupting or reducing services were: cancellation of scheduled treatments, reduced availability of public transportation, fear of visiting health care centers, and staff shortages due to reassignments to support the COVID-19 response. Also, some countries experienced disruptions in their supply chains and faced challenges in the distribution of drugs and health products, all of which has affected patients’ access to services.

Alternative strategies for continuity of care
The encouraging conclusion of the study was that most countries have adopted alternative strategies to ensure that the most vulnerable people continue to receive treatment for NCDs. Among the countries that reported disruption of services, 61% are now using telemedicine (technical assistance by telephone or digital media) to replace in-person consultations; 70% report triaging patients and prioritizing care; 57% have adopted novel dispensing for NCD medicines, and 52% have redirected patients to alternative locations. “These disruptions will probably have an impact on health outcomes for these vulnerable populations,” said Dr. Hennis, who urged “greater efforts to ensure that NCDs are included in national COVID-19 response plans and to ensure safe methods for providing essential clinical care to people living with NCDs during the pandemic.”