Competing Health Risks Associated with the COVID-19 Pandemic and Early Response: A Scoping Review

Abstract

BackgroundCOVID-19 has rapidly emerged as a global public health threat with infections recorded in nearly every country. Responses to COVID-19 have varied in intensity and breadth, but generally have included domestic and international travel limitations, closure of non-essential businesses, and repurposing of health services. While these interventions have focused on testing, treatment, and mitigation of COVID-19, there have been reports of interruptions to diagnostic, prevention, and treatment services for other public health threats. We conducted a scoping review to characterize the impact of COVID-19 on HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition.MethodsA scoping literature review was completed using searches of PubMed and preprint servers (medRxiv/bioRxiv) from January 1st to October 31st, 2020, using Medical Subject Headings (MeSH) terms related to SARS-CoV-2 or COVID-19 and HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. Empiric studies reporting original data collection and mathematical models were included, and available data synthesized by region. Studies were excluded if they were not written in English.ResultsA total of 1604 published papers and 205 preprints met inclusion criteria, including 8.2% (132/1604) of published studies and 10.2% (21/205) of preprints: 7.3% (68/931) on HIV, 7.1% (24/339) on tuberculosis, 11.6% (26/224) on malaria, 7.8% (13/166) on sexual and reproductive health, and 12.1% (16/132) on malnutrition. Thematic results were similar across competing health risks, with substantial indirect effects of the COVID-19 pandemic and response on diagnostic, prevention, and treatment services for HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition.DiscussionCOVID-19 emerged in the context of existing public health threats that result in millions of deaths every year. Thus, effectively responding to COVID-19 while minimizing the negative impacts of COVID-19 necessitates innovation and integration of existing programs that are often siloed across health systems. Inequities have been a consistent driver of existing health threats; COVID-19 has worsened disparities, reinforcing the need for programs that address structural risks. Data reviewed here suggest that effective strengthening of health systems should include investment in public health with adequate funding to ensure continuity of care for emergent and existing public health threats.

COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection

“…This occurred because the earliest research on COVID-19 predominantly focused on the immediate and direct consequences of interventions such as reducing SARS-CoV-2 transmission. Currently, a growing number of reports substantiate the socioeconomic and psychological impact of both the COVID-19 pandemic and response, in addition to competing health risks [ 8 , 27 , 88 ].…”

“…Discontinuation of clinical services and prevention efforts regarding chronic non-communicable diseases [ 96 , 97 ] and infectious diseases other than COVID-19 (e.g., HIV infection, tuberculosis, malaria) has been reported [ 88 , 98 , 99 ]. Because the current pandemic is risking decades of progress in other infectious diseases and existing public health threats, strengthening of healthcare systems and a reassessment of global health funding and policies are urgently needed [ 88 ].…”

“…Adverse effects of stringent public health measures include financial downturn, unemployment, mental illness, child abuse, domestic violence, hunger, and disruption to education, child development, immunization programs, contraception, and family planning [8,27,[89][90][91][92][93][94][95]. Discontinuation of clinical services and prevention efforts regarding chronic non-communicable diseases [96,97] and infectious diseases other than COVID-19 (e.g., HIV infection, tuberculosis, malaria) has been reported [88,98,99]. Because the current pandemic is risking decades of progress in other infectious diseases and existing public health threats, strengthening of healthcare systems and a reassessment of global health funding and policies are urgently needed [88].…”

Family medicine provision of online medication abortion in three US states during COVID-19

“…Women, and women of color in particular, are bearing the brunt of the social and economic consequences of the pandemic, making them more vulnerable during this time of crisis [45] . As people defer their healthcare and access to contraception, societies with unequal access to care like in the US, are expected to experience more unintended pregnancies, and suffer from additional maternal deaths [46] . Evidence shows the benefits of having access to comprehensive reproductive health services in modern society.…”

Descriptive Epidemiological Assessment of the Relationship between the Global Burden of Influenza from 2017-2019 and COVID-19

“…This heterogeneity likely stems from differences in underlying population structure with respect to age distribution, population and housing density, access to health care, burden of comorbidities, socio-economic and structural barriers to engagement in health, environmental factors, and the breadth and intensity of public health interventions. Furthermore, there remains active investigation into the heterogeneity of effects of both COVID-19 and the associated response on potential syndemics including infectious diseases such as HIV and tuberculosis and non-communicable conditions including mental health, reproductive health, and malnutrition [4].…”