The ripple effects from COVID-19 may substantially raise the death toll from HIV, tuberculosis and malaria, according to a new study.
The pandemic is disrupting services aimed at controlling these three diseases in low- and middle-income countries. Health authorities are concerned it will set back progress against these diseases by years.
"It looks to us like a big part of minimizing the entire impact of the COVID-19 epidemics in these countries is going to be maintaining services for these key diseases," said Imperial College London global health professor Timothy Hallett, co-author of the new study in The Lancet Global Health.
Experts have seen this before. In other epidemics, people have avoided seeking care out of fear of the outbreak disease, and overwhelmed health systems have been unable to provide services.
One study estimates that the disruption of health care systems in the 2014-15 Ebola outbreak in West Africa may have resulted in more deaths from HIV, TB and malaria than from Ebola itself.
COVID-19 has already disrupted 85% of HIV programs, 78% of tuberculosis projects and 73% of malaria programs administered by the Global Fund, a $4 billion public-private partnership aimed at fighting these diseases.
Difficult decisions
Hallett and colleagues used mathematical models to estimate how different COVID-19 control scenarios would affect health care systems, and how those impacts would affect patients with HIV, TB and malaria.
Taking no action leads to COVID-19 overwhelming the health care system and disrupting delivery of services for the other three illnesses.
The modelers predict that the disruption would interrupt access to antiviral medications for HIV patients, increasing the number of deaths by as much as 10% over the next five years. Discontinued distribution of insecticide-treated bed nets would raise deaths from malaria by up to 36%.
On the other hand, a total lockdown would suppress COVID-19, but it would affect services for the other three diseases, especially tuberculosis. TB deaths increase the most under this scenario by 20% over the next five years, as untreated patients spread the disease.
"Our results underscore the extraordinarily difficult decisions facing policymakers," the study authors write. "If the interventions are not well managed, they could lead to a large spike in deaths from other causes."
Reversing gains
The death rate increase "could potentially be even worse than this study suggests," possibly exceeding the toll from COVID-19 in some countries, Global Fund chief Peter Sands wrote in an accompanying commentary.
"In countries heavily affected by HIV, tuberculosis, and malaria, COVID-19 could result in many years of hard-won gains being reversed," he wrote. "We cannot let this happen."
Programs are racing to adapt. In some places, HIV patients can pick up prescriptions at a community pharmacy locker rather than traveling to a clinic. Pharmacy clubs let one person pick up prescriptions for several others. Malaria programs are buying motorcycles and protective gear so workers can deliver bed nets house to house.
The Global Fund estimates it needs $28.5 billion to adapt programs to deal with the consequences of COVID-19.
Study co-author Hallett said the program changes are good news.
"I'm optimistic because this paper is showing what would be the impact were there to be no mitigations. But we are seeing mitigations, and that's really encouraging," he said.
"On the other hand, it might be that the biggest threat to progress on HIV, TB and malaria doesn't come this year at all, but comes next year if funding isn't made available," he added.
