Those living with chronic illnesses are at higher risk of serious complications from COVID-19.

This may be due to issues such as reduced immune response owing to their condition, or the medications they are on.

“A chronic illness is any illness which lasts greater than three months,” explains Dr. Candise Price, who specialises in internal medicine with the Health Services Authority.

“These [illnesses] include hypertension, diabetes, coronary heart disease, dyslipidemia, obesity, renal failure, asthma and chronic obstructive pulmonary disease (COPD).”

Researchers at the Centers for Disease Control and Prevention found that about 47% of US adults have an underlying condition which could lead to severe COVID-19 illness.

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Even without the stress of a pandemic, chronic illness patients deal with many day-to-day challenges, and these vary between patients and by individual diagnosis.

“In general, perhaps the greatest challenge is compliance with medications and lifestyle modifications, namely dietary restriction, exercise and weight reduction,” says Dr. Price.

The pandemic has elevated these challenges by adding emotional stress, increased anxiety and possible depression to their burden as they try to navigate dealing with their illness while avoiding COVID-19.

For those that do contract COVID-19, the serious complications they are at risk from are varied.

“These complications include respiratory failure, clots in the legs, lungs, strokes, and heart failure, to name a few,” explains Dr. Price.

Further CDC research found that hospitalisations were six times higher, and deaths 12 times higher, for COVID-19 patients with reported underlying conditions such as cardiovascular disease, diabetes and chronic lung disease.

Change in treatment

For many suffering from chronic illness worldwide, the pandemic caused difficulties and delays in seeking treatment due to social distancing, shelter-in-place rules, limited access to outpatient care, or general fear of venturing into public.

A small study published online in the ‘Diabetes & Metabolic Syndrome: Clinical Research & Reviews’, using responses from 202 healthcare professionals in 47 countries, found diabetes, COPD and hypertension were the most impacted conditions due to reduction in access to care. In addition, 80% of respondents reported that their patients’ mental health has worsened during the pandemic.

The effects of the pandemic on care access have caused a rapid transition away from in-person care.

Here in Cayman, the HSA adapted to this new normal quickly at the start of lockdown.

“There were several services offered including telemedicine consultation, and scripts were provided on paper and/or electronically,” says Dr. Price. “The pharmacist would

dispense the medications orders within a timely manner, usually within 24 hours.”

Prescription delivery to the vulnerable, including chronic illness patients who were immunocompromised, and the elderly, was a service the HSA rolled out at the onset of the COVID-19 shelter-in-place provisions.

Long-term issues

As compliance is a concern and challenge with chronic illness patients, there may be an increase in chronic illness exacerbations in the months following lockdown in those who had interruptions in their care or treatment.

“With poor compliance with medications and other lifestyle modifications, then certainly there will be progression in these illnesses,” says Dr. Price.

However, the pandemic, and the higher risk of complications for chronic illness patients, may have shifted a spotlight onto the prevention of these diseases, which will hopefully lead to a brighter future in terms of public health.

“Certainly, the pandemic has highlighted the need for governments everywhere, not just in the Cayman Islands, to take greater steps to tackle chronic or non-communicable diseases,” says Dr. Price. “The prevention of chronic disease would be more broadly and appropriately addressed by policies and programmes at the level of the Ministry of Health/Public Health.”

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