The COVID-19 pandemic has significantly increased the burden of non-COVID conditions, demonstrating the indirect effects on global health systems. This article explores the impact of these indirect effects published by Chen et. al., offering insights and recommendations for policymakers and healthcare professionals.

Context and Background

The rapid spread of the virus in 2020 overwhelmed healthcare systems worldwide, leading to resource shortages and disruptions in routine medical services. Programmes for disease prevention, such as tuberculosis screening and malaria control, faced setbacks. The World Health Organization reported that a 25-50% reduction in TB case identification during the pandemic could result in an additional 0.2-0.4 million deaths globally. Moreover, mental health conditions surged, with a 25% increase in anxiety and depression prevalence in 2020. These disruptions have disproportionately affected vulnerable populations, including women, children under five in low-resource regions, and older adults.

Key Analysis and Insights

• Mental Health Disorders: The Global Burden of Disease Study 2021 indicates significant increases in age-standardised disability-adjusted life years (DALYs) for depressive disorders (83.0 per 100,000; 12.2% relative increase) and anxiety disorders (73.8 per 100,000; 14.3% relative increase). Women experienced a higher burden, reflecting the impact of social isolation and limited psychological support during lockdowns.
• Malaria: Malaria saw the highest absolute increase in DALYs (97.9 per 100,000; 12.2% relative increase) and mortality (1.3 per 100,000; 12.3% relative increase), particularly affecting children under five in Africa. The disruptions in malaria control efforts have hindered progress towards the WHO’s 2030 goals.
• Cardiovascular Conditions: Stroke and ischaemic heart disease (IHD) showed notable rises in prevalence (IHD: 11.3 per 100,000; stroke: 3.0 per 100,000) and DALYs, primarily among individuals aged 70 and older. The prioritisation of COVID-19 care reduced capacity for acute interventions, delaying critical treatments.

Implications and Recommendations

The indirect effects of COVID-19 have set back global health targets, revealing systemic inequities and vulnerabilities. To address these challenges, health systems must adopt a syndemic-informed approach:

• Mental Health Integration: Incorporate mental health services into national emergency preparedness plans, focusing on primary care and digital interventions. Enhance surveillance and long-term outcome evaluation to address the disproportionate impact on women and high-risk groups.
• Disease Control Programmes: Reallocate resources to strengthen malaria and TB prevention in high-burden regions, ensuring service continuity through decentralised and mobile outreach models during crises. Integrate infectious disease control frameworks into pandemic response strategies to mitigate indirect health impacts.
• Preservation of NCD Care: Develop parallel service systems to separate infectious disease responses from critical non-communicable disease (NCD) care. Leverage telemedicine and enhance pre-hospital triage for stroke and IHD, ensuring sustained access for older adults.
• Integrated Surveillance Systems: Establish a multi-disease integrated surveillance system, beginning with high-burden respiratory infections and expanding to mental health and NCDs, supported by the WHO and regional partners. Utilise artificial intelligence (AI) for real-time data integration and predictive modelling to enhance early detection and targeted interventions, especially in resource-limited settings.

Conclusion

The indirect effects of the COVID-19 pandemic on mental health disorders, malaria, and cardiovascular diseases underscore the need for resilient health systems. By integrating mental health into emergency plans, reinforcing disease control efforts, preserving NCD care, and building advanced surveillance systems, policymakers and industry leaders can better prepare for future health crises. Further research into emerging conditions like long COVID and region-specific challenges is essential to inform robust, data-driven strategies.

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