Researchers warn against national strategies for new normal with COVID-19

Researchers are warning political and health leaders against national strategies for a new normal of life with COVID-19. They say doing so fails to incorporate important lessons from the first two years of the pandemic: the significant role of noncommunicable chronic diseases in exacerbating COVID-19 and the disproportionate burden on underserved populations and communities of color.

The warning was published in the Journal of General Internal Medicine.

Jun Ma, of the University of Illinois Chicago, is a co-author states that together, the COVID-19 pandemic and the chronic disease crisis create what is called a synergistic endemic, or syndemic — overlapping epidemics that interact, increasing the burden of disease and the likelihood of poor outcomes. Recent proposals for a new normal national strategy in the U.S. focus too much on the SARS-CoV-2 virus and too little on the context in which the virus’ impact is most burdensome, she said.

Ma and her co-author, James Sallis, of the University of California San Diego, cite data published in medical literature showing how noncommunicable chronic diseases have created high susceptibility to severe and fatal COVID-19 outcomes and contributed to racial and ethnic inequities. For example:

• Nearly 95% of U.S. adults hospitalized with COVID-19 between March 2020 and March 2021 had an underlying condition.
• Vaccinated people with breakthrough infections were 44% to 69% more likely to suffer severe outcomes if they had a chronic disease.
• Noncommunicable diseases and risk behaviors such as smoking, substance abuse and physical inactivity conferred a higher risk for severe COVID-19, according to the CDC based on conclusive evidence.

The authors also recommend “practical, immediately actionable steps” for incorporating the prevention and control of chronic diseases into existing COVID-19 policies and infrastructure. For example:

• Health care systems could prioritize screening, including at COVID-19 vaccination and testing locations, for medical and psychological chronic conditions that are highly treatable but often undiagnosed and poorly managed.
• The national infrastructure mobilized for vaccine promotion and distribution could be leveraged to also disseminate proven lifestyle and behavioral health programs.
• Campaigns for COVID-19 vaccination and masking could expand messaging to also promote healthy lifestyles and mental well-being.
• Partnerships between medical systems and community-based organizations and efforts by public and private insurers for the COVID-19 emergency response could be expanded to include behavior change interventions in routine health care delivery and coverage.

Agencies like CMS and state and local governments would need to prioritize supportive reimbursement and funding policies for these steps to be realized, but that the benefits would be felt by individuals and communities through more awareness, information and opportunity for managing their health, according to Ma.