A new modeling study suggests that disruptions to health services caused by COVID-19 could lead to an increase in HIV, tuberculosis, and malaria deaths.
Experts around the world expect the 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 The 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 5 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% reduction in R0 for 6 months
- suppression-lift, leading to a potential 75% reduction in R0 for 2 months
- suppression, leading to a potential 75% reduction in R0 lasting for 1 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%, deaths from tuberculosis by 20%, and deaths from malaria by 36% over the next 5 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 signifcant 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 3 years, and without this, malaria deaths could increase by 36% over the next 5 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.”
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.
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