JulieB By: JulieB
Lecturer in Global Health
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12 Apr 2020 : All cause mortality

In a pandemic, people still die of other issues. For 3 months now the world's eye has been on coronavirus, first in China, then Iran, Italy and the Diamond princess ship that was stationed off Japan - and other cruise ships around the world. Next was France, Spain, UK, USA, and so on as it spread around the world. And rightly so, this is a major global health issue. Today though, I find myself ruminating on other health issues. People still get sick and die of non coronavirus issues. Some of these have increased already - I've read about an increase in heart attacks in NYC (perhaps coronavirus induced, or maybe anxiety induced and therefore indirectly due to coronavirus); in Oxford there is a rise in eye illnesses, including ones that require surgery, because of DIY projects that have taken place during the lockdown, without adequate DIY PPE/eye care. These are just two immediate examples - others may take months, if not longer, to come to light. Cancer treatment waiting times have increased, mental health has been hugely impacted pretty much universally, but I imagine especially among frontline staff who are at huge risk of PTSD. Intimate partner violence has increased due to the lockdown, as has excessive drinking (and these are of course related issues). There may be muscoskeletal issues particularly in the elderly who no longer get their daily walk to the supermarket. The list goes on. 

In LMICs, where much of my work is based, there are countless other issues including huge new challenges in the drive towards the elimination of polio, malaria, and other diseases. For malaria, we've already seen a rise in substandard medications, partly driven by President Trump's insistence on marketing chloroquine as a covid-19 treatment (despite the scientific evidence being mixed, at best). Family planning too will suffer - both in terms of access to birth control, and in terms of pregnancy and childbirth itself. 

The thing that worries me the most is the long-term consequences on the health system, especially already fragile and impoverished health systems. In Italy, I believe close to 100 healthworkers have already passed away. In the UK many are infected - including 50% of an ITU ward in Newport, Wales. And this is in places where, at least "in theory" PPE is available. Rural areas of poor countries will have none of those "luxuries" (it feels quite wrong to call access to PPE a luxury - indeed it should be a basic necessity for all healthworkers worldwide!)

How many community health workers / village health workers might we lose? These are men and women who have served sometimes for decades within their communities, and have built up so much tacit knowledge of the people and the issues they face. They are a KEY link to the health system at higher levels. In my research, we draw on village healthworkers enormously for many different things and I have always been impressed by the way in which many of them fulfill their (voluntary) duties! I worry about what the coming months will bring for them and their fellow village inhabitants, and on their colleagues who work in the health posts, clinics, hospitals and district offices nearby.

Perhaps the point I was reading yesterday in an article will help - Africa is a very young continent, maybe there is some defence in there since the virus doesn't affect the young as much as the elderly. But early data from South America did not look great and in South Africa too the situation is getting increasingly challenging. 

Health has always been one of the most important values to me. Now, slowly - or perhpas quickly - the world is coming to value it too. But health is not only the absence of coronavirus... but as I stress in day 1 of Semester, in my module Key Issues in Global Health, "health is not only the absence of disease or infirmity, it is a state of complete physical, mental and social well-being"... a lofty goal that has been out of reach for a long long time, and now appears so very much further away. 


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