There are two pandemics going on

Malaysia is currently facing the burden of two synergistic pandemics. On the one hand, we keep seeing new high records of COVID-19 cases while the number of daily reported deaths shows a frightening upward trend. On the other hand, a staggering 1.7 million Malaysian adults have all three main non-communicable diseases (NCDs) – diabetes, hypertension, and high blood cholesterol.

Professor Dr Noran Naqiah Hairi, Professor Dr Moy Foong Ming, and Dr Wan Kim Sui (our Doctor of Public Health candidate) wrote to the media describing the interaction between COVID-19 and NCD, which have been published in The Star. They also suggested precision public health as a mean to address the synergistic epidemics.

The interaction between COVID-19 and NCDs pose a dire situation in term of health, psychosocial and economic ramifications. Let’s take diabetes as an example. People living with diabetes have more severe COVID-19 and death than those without diabetes. Emerging evidence also suggests that COVID-19 could induce new-onset diabetes by damaging the pancreatic cells – those responsible for producing insulin in our body.

Interruption of routine health service and fear of attending clinic visits can affect the availability of medicines. Psychological issues like stress, depression and anxiety can negatively impact medication adherence and diabetes control. People’s livelihood is a critical factor here. Under pressure to secure income, health may get deprioritised. Patients may stop buying apparatus such as test strips for self-monitoring of blood glucose. Some under the care of private doctors may not afford to purchase medicines due to unemployment etc. The changing social norm, such as reduced physical activity and poor nutrition, may further aggravate suboptimal diabetes control.

The COVID-19 response in many parts of the world seems to treat COVID-19 as a single disease. While we rightfully focused on treating the sick and protecting the vulnerable populations, it would be an oversight for not acknowledging that COVID-19 is more than an infectious disease. The full ecosystem, particularly the burden of the NCD pandemic, needs to be considered.

With finite resources, precision public health, which aims to deliver the right intervention to the right population at the right time, is a key tool in managing the double pandemic. Precisely, we should:

  1. Move from treating COVID-19 as a single disease to recognising this as a synergistic pandemic. Hence, there is a need to build a seamless linkage between NCD and infectious disease approaches.
  2. Leverage better data to focus on interventions, especially risk reductions among the highly susceptible populations
  3. Targeting highly vulnerable groups such as those from lower socioeconomic background.