Contracting Covid-19 in any of India’s neighbouring countries places you at an increased risk of death. India’s Covid-19 case fatality rate of 1.5% is close to half that of the global average of 2.8%, and considerably lower than China’s at 5.2%.
India’s success in keeping these rates low is not an aberration caused by limited testing. According to Our World in Data, 0.8 out of every 1,000 people are being tested daily in India, much more than in its large neighbours. An explanation for India’s success in keeping these rates low is found in a comparison of mortality data related to non-communicable diseases (NCDs).
There is increasing global evidence that if you have an underlying NCD, you are more likely to be severely affected by Covid-19 or to die from it. In April, NCDs were identified as the most common co-morbidities among Covid-19 patients hospitalised in the New York City area. The Indian Journal of Medical Ethics claims that 60-90% of people dying from Covid-19 also had an NCD.
An analysis of Covid-19 mortality data, compared alongside NCD mortality rates, acts like an X-ray revealing how the two are inextricably linked. According to WHO, in India, deaths related to NCDs stood at 524 per 100,000 population in 2016. This is 15-20 lower than its large neighbours. Various investments by India have led to these reduced figures.
Primary care for NCDs is now being provided in 120,000 newly established health and wellness centres. Ayushman Bharat and Pradhan Mantri Jan Arogya Yojana have expanded the scope of primary healthcare to include screening and diagnosis of NCDs, and eliminated out-of-pocket expenses related to NCDs for 100 million vulnerable people.
India was one of the first countries to launch a multi-sectoral action plan to reduce underlying NCD risk factors related to tobacco, salt and sugar, and uniquely targeted reduction of household pollution by replacing solid cooking fuel. This reduced chronic respiratory ailments among women, for example, through the provision of cooking gas to millions of rural households.
To reduce Covid deaths, we must prevent, reduce and treat NCDs. There are challenges. A reengineering of India’s primary health care systems is required, as the country’s disease burden has now changed. The proportion of NCD-related deaths has risen steeply from 37% in 1990 to 61% in 2016. This mirrors a pattern observed globally, and NCDs now account for more than 70% of premature deaths.
The Defeat-NCD Partnership was launched at the UN General Assembly in September 2018 as a practical response to tackle this global challenge of NCDs. At the World Health Summit in Berlin, the partnership brought Ecuador, Rwanda, the Gambia, Myanmar and Bhutan, together with the African Union and international development agencies such as the International Finance Corporation and Multilateral Investment Guarantee Agency. Also present were pharma giants such as Boehringer Ingelheim, Biocon, Pfizer and Serum Institute, with philanthropic foundations.
By mobilising actors like these in public-private-people partnerships, the partnership aims to stem the rising tide of NCDs, and achieve Sustainable Development Goal 3.4: to reduce premature mortality from NCDs by one-third by 2030.
Covid-19 has created the need to apply innovative telemedicine technologies. India, with its huge IT private sector, has a distinct advantage. Artificial intelligence (AI), paired with telemedicine, is powerful. For example, an AI screening tool analyses chest X-ray scans for a range of diseases and is invaluable for community-based screenings for NCDs. It was used in Mumbai, during the initial three months of the pandemic to accurately detect cases, and inform triaging and monitoring.
A legacy of reducing premature deaths by 25% by 2025 is now achievable, if Covid-19 responses are integrated with NCD screening and care, and if the IT and AI potential is maximised. GoI allocations for Covid and other investments should smartly dovetail with our national NCD action plan. NCD diagnostics should be established alongside Covid screening, and NCD care services augmented into health and wellness centres.
(The writer is global programme coordinator, The Defeat-NCD Partnership, United Nations Institute for Training and Research.)