Non Communicable Diseases ( NCDs) have spiked in recent years globally and in Sri Lanka posing a major health problem to health officials striving to reduce them to a minimal degree by 2025. The emergence of a new contagious disease Covid-19 has aggravated the problem with the likelihood of NCD patients now at risk of this still little known disease.
The Sunday Observer spoke to the Director, Environmental and Occupational Health and Food Safety, Ministry of Health, Dr Thilak Siriwardana to find out how NCDs can be minimised to meet the global target of reducing the current rate of preventable chronic diseases to 25% by 2025. We also asked him what risks patients with NCD faced amid the Covid-19 outbreak and guidelines to patients on avoiding being infected by the disease.
Excerpts …
Q. NCDs have become a major public health problem accounting for a considerable share of the national health burden in Sri Lanka. The World Health Organization reportedly stated NCDs have become a huge crisis in Sri Lanka leading to over 75% deaths in the country as per statistics, a statement confirmed by leading health officials who reportedly said that NCDs caused more than three quarters of all deaths in Sri Lanka. What are the commonest NCDs in the country, and their present ranking?.
A. Heart attack, Stroke, Cancer, Diabetes are the commonest NCDs in the order of ranking.
Q. Do you see a growing incidence of these diseases in Sri Lanka in the past decade or so? If so why?
A. Yes, The lifestyle of the people gradually changed becoming unhealthy during the past few decades. Unhealthy food became more popular and available freely in the market, and marketing and promotion of such food became more frequent.
Q. Today, the novel Coronovirus is fast spreading in the world and in Sri Lanka. It has been said that persons with chronic diseases are especially vulnerable to the disease? Do you agree? If so who are most vulnerable to Covid-19?
A. It has been found that people with chronic diseases are more vulnerable to complications. Considering the whole population there is no such pattern seen other than age and sex differences. As the Coronavirus is new to the world, we need further studies to say anything definite about specific diseases that are prone to Covid-19.
Q. If patients with chronic diseases get infected by the Coronovirus, what are the symptoms to look out for? Are they the same as in patients who don’t have any NCDs?
A. There is no difference in symptoms between these two groups. However it is important that patients follow the instructions issued by the Government.
Q. Is the treatment the same?
A. No. Treatment differs between patients according to the symptoms and signs and at what stage they have advanced at the time they are admitted to hospital. Even while warded sometimes their condition may change and require different treatment according to the changed condition.
Q. Will it worsen their existing conditions?
A. The treatment usually does not affect existing conditions as doctors consider all their illnesses when prescribing drugs.
Q. Should they continue to take their usual prescribed tablets while being treated for Coronavirus?
A. Yes. But they need to divulge all information about the other diseases and the treatment taken to control them.
Q. Once cured of Covid-19 can a patient get the disease again?
A. The evidence we have about a second infection is not confirmatory. We need research here too. But those with NCDs don’t get cured by Covid-19. They need to continue treatment for NCDs after they are cured of Covid-19 as NCDs usually need lifelong treatment.
Q. If that happens what chances do they have to survive a second attack?
A. The so called second infections we have heard are from a very few countries. These cases are still being investigated and more details will be revealed later. We need further research to comment on it.
Q If a pregnant diabetic mother has Covid-19 what are the health consequences to the foetus?
A. According to reports, both mother and baby have recovered fully. Pregnant mothers with Covid-19 are in no danger if they follow the instructions issued by the Ministry of Health.
Q. Tell us about the interventions that the Health Ministry has put in place to protect those with NCDs from the Covid-19 virus.
A. 1. People are requested to restrict their movements to compulsory travel and to be in their homes.
2. Wash hands with soap and water or use a sanitizer for more than 20 seconds.
3. Keep a distance of more than a metre always when they are out in the public.
4. Patients and those living in the same house who return home after being out should avoid taking possibly contaminated clothes, shoes etc into the house , and to clean themselves before entering the house.
5. Those who go out must always wear a face mask.
Q. Diet- Our diet today is increasingly shifting to one high in fat and sugar, low in fibre as well as processed artificial foods . With the National New Year celebrations just over, what is the danger of such a diet especially to those with pre existing conditions in general?
A. It is encouraging to hear that during this National New Year people could not consume unhealthy meals as they usually do when they celebrate the event. Also they have built and strengthened healthy family relations and diets to unusual levels this year. If they continue to do so it will facilitate maintaining healthy mental lives which is also important at a time like this.
Q Alcohol and smoking- do you see an encouraging trend in the reduction of these two anti social habits that cause lung cancer, oral cancer, and other NCDs, due to the restrictions this year?
A. This is a year with minimal admissions to hospitals during the New Year season in the past few decades.
The main responsible agent may be alcohol, which was not available freely this year or minimal availability of it with minimal smoking.
It has been proved again that alcohol and tobacco are non-essential goods and the prices can be increased by adding a bigger tax for these products. This has also shown that all those addicted to tobacco and alcohol can give up their addictions easily after the country gets back to normalcy. This will ensure an NCD reduced country with a healthy population.
Q. We now live in a culture of junk food and take away instant food. If this unhealthy trend continues what could happen to the present and future citizens of the country?
A. We have shifted from the culture of junk foods and take away instant food to homemade food during the Covid-19 pandemic. During the last two months husbands and wives learnt to prepare food by themselves at home.
They did not find it difficult without junk food. Why can’t we continue this practice in the future? If we go back to the food culture before Covid-19 we may become ill and die of NCDs instead of Covid-19. People do not realise that the number of annual deaths due to NCDs are a thousand-fold higher than the deaths due to Covid-19. If we can reduce the cases and deaths due to NCDs by practising healthy lifestyles in the future there could be a positive outcome of Covid-19.
Q. Any gaps you see in the delivery of optimal health services to patients with non-communicable diseases in general?
A. The Ministry of Health has taken all necessary steps to provide drugs to the public and all hospitals were kept open even during curfew times. But there may be patients who needed to consult a particular physician and could not do so as private channeling centers were closed.
Q What is the procedure you adopt in preventing Covid-19 positive patients from infecting others?
A. Hospitals are working according to a plan when they attend to the patients. This is to stop or minimise passing infection from Covid-19 patients to the staff.
Q. The global targets are to reduce deaths from NCDs by 25% by 2025. Where does Sri Lanka stand in achieving this goal to date?
A. Sri Lanka is on the way to achieving this target. The support extended by the public is very important in achieving this. If the public, including the media support through a healthy lifestyle promotion we may be able to achieve the target before 2025.
Q. Interventions by the Health Ministry to realise this goal?
A. The Health Ministry is working to achieve nine global voluntary targets on NCD and one regional voluntary target which will be directed to achieve the NCD goal of the country. They work according to a five-year multi-sectoral plan to prevent and control NCDs in Sri Lanka at present.
Q. Your message to the public?
A. Change your lifestyle to a healthy lifestyle. That is, continue your good practices such as, no tobacco, no alcohol and eating healthy homemade food and not polluting the environment.
The public can add optimal physical activity when the curfew and other restrictions are lifted soon. This will reduce premature NCD mortality and morbidity in the country.