Chronic Diseases Kill, Not COVID

Debbie Peters

The first patient to test positive for Coronavirus in the US was in Seattle, where I was living at the time. I remember the frequent sound of sirens around March to May as ambulances rushed patients to hospital. Tragically, many of the COVID-19 deaths occurred in senior citizens, many of them in assisted-living facilities. Gradually Washington State, where Seattle is, managed to contain the spread of Coronavirus but the numbers are surging in other states. These current infections are taking place in younger patients as Americans ignore warnings to social distance. When I have seen pictures of younger victims of COVID-19, I noticed that many of them were overweight. America suffers from an obesity problem and even their comedians make jokes about that. High rates of poverty amongst the African Americans and Hispanic Americans leads them to eat poor quality food like fast food which causes obesity. To add to that, they are the ones that work retail and services jobs where it is difficult to social distance which makes them more likely to come into contact with Coronavirus. Black and Latino Americans are dying of COVID-19 in larger proportions to other racial groups. In Washington DC, where I moved a month ago, I see some Black and Brown people walking around with no masks on. At the start of the pandemic, Black people believed they were less likely to catch it until the data came out that proved that they were more likely to catch Coronavirus. On the other hand, most White Americans work in white-collar jobs where they can work remotely. Microsoft, based in Seattle, has told all their employees that they can work from home forever. Amazon is allowing their staff to work virtually for the rest of the year. I have several friends who recently left Seattle to move back to their hometowns where rent is cheaper. I have one friend who is even working from Zimbabwe now. All she has to do is work during the night to make up for the 9-hour time difference.

As Africans, we must think about how COVID-19 affects us and try to learn from other countries’ experiences. American fast-food chains are now present on the African continent and obesity is becoming a challenge. We are moving away from the traditional African diet, which included unrefined foods in favour of the Western diet which has refined sugars and carbohydrates that leads to an increase in chronic diseases in Africa. As Africans become more prosperous, they are less inclined to do manual labour, leading to an unhealthy sedentary lifestyle. In African society being seen running is undignified for adults and almost everyone who can afford it has domestic workers to do their housework. My family was the same way when I grew up in Zimbabwe. I had a nanny who also did household chores, so the lady of the house just gave instructions. My early years were spent living with my grandmother because my mother had me at 18 and wanted to pursue her successful modelling career. What I remember about my granny and all her friends is that they all gradually developed high blood pressure, so they made regular visits to the clinic for checkups and medication. It seemed inevitable that at some point all the women in the neighbourhood would become hypertensive. There was also a genetic disposition in the area for diabetes which my grandmother developed and she ended up becoming insulin-dependent. Some of the medications give for chronic hypertension in developing countries like hydrochlorothiazide have nasty side effects and my grandmother’s health deteriorated. I was sent to boarding school by the age of 10 where I eventually developed a bowel irritation that needed a special diet of protein, vegetables, and fruit only, which fortunately made me slim throughout my school years. By the time I was in college and went to visit my grandmother, the doctor had to teach how to lift a debilitated patient as she eventually needed a wheelchair in the years before her death. My mum, on the other hand, has been naturally slim all her life but she too developed hypertension and so did her sister who eventually died after two strokes. They say the second stroke in the one that kills you. Her daughter, my first cousin, is hypertensive and suffered renal failure so she needs twice weekly dialysis now. Despite this family history, my blood pressure was always normal until a check-up in December 2019 where my systolic pressure was elevated. I thought it was an anomaly, but I bought a blood pressure monitor anyway and ignored it for a couple of months until the global Coronavirus pandemic started then we were in lockdown at home for 3 months. Hearing that hypertension was one of the factors killing Coronavirus patients made me finally use my new blood pressure monitor and I discovered that my blood pressure was c elevated. The monitor became my new toy as I checked my blood pressure several times a day. I was determined not end up on medication for chronic hypertension like all the women in my family, so I worked out up to 3 times a day and carefully monitored my diet. I will not lose weight for vanity’s sake, but I lost almost 15 kgs over 3 months and got my blood pressure back to normal again. The women in my family were not too heavy but somehow are prone to chronic diseases so that was my wake-up call. All over Africa, a middle-class is developing that is changing its diet as stores offer more Western foods and fast-food chains enter the African market. I remember the excited lines when Domino’s Pizza, Johnnie Rockets and KFC opened in Lagos. Parents want to give their children treats, but they are also making them vulnerable to chronic diseases.

Chronic diseases are the leading cause of death globally, responsible for about 70% of annual deaths worldwide; about 40 million. In this pandemic, it is not COVID-19 by itself that kills, patients with underlying chronic diseases are more likely to die from COVID-19 or end up intubated in the intensive care unit. Almost every patient who is seriously affected by COVID-19 has a secondary factor such as obesity, smoking, asthma, hypertension, kidney disease, diabetes, or cancer. The pandemic has hit every region of the world differently, but one undeniable constant has been the fact that chronic diseases dangerously exacerbate the pandemic, compounding the economic, social, and physical impacts of the virus. Having a chronic disease is one of the strongest predictors of severe outcomes like hospitalization for those who contract the virus. The way to ensure better outcomes for COVID-19 is to combat chronic diseases. Asymptomatic patients who test positive for Coronavirus tend to be fit and healthy. Hospitalizations to be six times higher, and mortality to be twelve times higher, among COVID-19 patients with underlying conditions in the U.S. The most common underlying conditions are some of the deadliest chronic diseases such as cardiovascular disease, diabetes, and lung disease. These diseases lead to longer hospitalization periods as well in patients that survive. With healthcare systems overwhelmed by COVID-19 cases or limiting in-person care for fear of spreading the virus, millions of people with chronic diseases have been unable to access treatment in recent months. Or patients are just too scared to go to hospitals and clinics for normal check-ups. I know I have cancelled healthcare appointments when the pandemic was raging in Seattle. Most countries have reassigned government healthcare staff working on chronic diseases to focus on COVID-19 instead. When New York was in the middle of their crisis, they called for retired medical workers and volunteers from all over the country to come to their aid. The pandemic is a global emergency which is taking up all healthcare resources and funding. Postponement of normal screenings and treatment of other diseases is widespread as patients shelter at home.

Africa also faces the double burden of chronic diseases and COVID-19 and given that health system capacity is lower, disease burden is higher, and patients’ ability to pay for care will be stretched thin. Most people pay for healthcare with out-of-pocket spending and while the pandemic slows economies down, it will be even more difficult for Africans to access healthcare.

Developing countries face a perfect storm of COVID-19, growing chronic disease burdens, worsening poverty, and inequality. Unfortunately, many African countries like Nigeria spend less than 10% of their budget on healthcare which is worsening the COVID-19 crisis as there is inadequate healthcare. The pandemic will have an impact in economies for years to come due to loss of productivity as global economies remain shut down. Countries are scrambling to address underinvestment in their health systems to mitigate the loss of lives and economic productivity.

•  Debbie Peters has just formed a non-profit in Washington DC to promote health and education in Africa. Her contacts are deb.n.peters@gmail.com& Twitter @debbie_nyasha