COVID-19, other crises prove existence of several epidemiological transitions

The global spread of the novel coronavirus disease (COVID-19) has created grave fear for people in countries that are already affected by food security and climate-related disasters

By Akancha Singh, Alka Chauhan
Published: Tuesday 07 July 2020

The year 2020 has, so far, proved to be a challenge to the status quo. With bushfires in Australia, to locust attacks in eastern Africa and south Asia to the novel coronavirus disease (COVID-19) pandemic, this year has taken the world by storm.

This global pandemic has brought the world to its knees, with even the most developed countries bearing the brunt of its severity.

The theory of epidemiological transition proposed by Abdel Omran in 1971 discussed changes in disease patterns where infectious diseases are replaced by degenerative and man-made diseases as the primary source of morbidity and cause of death.

The three stages of the transition as proposed by Omran are;

  • The Age of pestilence and famine
  • The Age of receding pandemics
  • The Age of degenerative and man-made diseases

A fourth stage — The Age of delayed degenerative diseases — was later added by Olshansky et al in 1983.

Another stage added much later by Martens in 2002 was the Age of re-emerging infectious diseases. The world is experiencing the last three stages of the epidemiological transition simultaneously.

The past two centuries have seen many improvements in the control of infectious diseases like small pox, plague and cholera.

Once the leading cause of death globally, these diseases are now a matter of the past. Prime contributors towards this decline were improvements in public sanitation and food safety, the discovery of antibiotics and enhanced nutrition.

The 21st century has seen progressive steps towards curtailing the incidence rates of other infectious diseases such as the acquired immunodeficiency syndrome caused by the human immunodeficiency virus (HIV), malaria and tuberculosis.

The sixth goal of the Millennium Development Goals was about combatting the above diseases.  The incidence of HIV was 2.1 million in 2013, down from 3.4 million in 2001, according to the World Health Organization (WHO) in 2018.

Despite significant reductions in both the incidence rate and mortality rates of tuberculosis and malaria, there is still a long way to go. The world has had skirmishes with several outbreaks, including the 2009 swine flu pandemic and the 2003 SARS outbreak, to name a few.

COVID-19 — the latest addition to the list — has wreaked havoc globally.

The global outbreak

China informed the WHO about a number of pneumonia-like cases, the reasons of which could not be identified in China’s Wuhan city. The outbreak consequently spread to China’s other provinces and then to the rest of the world.

The disease has since affected 216 countries and about 11.4 million people, claiming nearly 540,000 lives across the world.

A recent study in The Lancet journal said there will be 1,157,000 additional child deaths and 56,700 additional maternal deaths in the next six months in a worst-case scenario.

Most parts of the world were put under either complete or partial lockdowns to curb the spread of the virus. According to an estimate by the Harvard TH Chan School of Public Health, the fatality rate of COVID-19 is about 30 times more than that of swine flu.

The re-emergence of an infectious disease has confronted the world with a perilous situation.

Famines amid locust attacks

Desert locust attacks in several parts of the world have added to an already-disrupted food supply chain due to the pandemic.

The locust outbreak raging since last year has already pushed around 20 million people to acute food insecurity in parts of Somalia, Tanzania, Sudan and Uganda, according to the Food and Agriculture Organization (FAO).

The World Bank has reportedly said the outbreak will spread to new areas and the locust population will substantially increase mid-year.

Pesticide shipments are delayed due to the pandemic, with the damage becoming relentless. The locust attack is not just a concern for urban areas, but a real threat to kharif crops and the rural economy.

Bihar, Gujarat, Haryana, Madhya Pradesh, Maharashtra Punjab, Rajasthan and Uttar Pradesh are among the most-affected.

India is under threat of the biggest locust attack in 25 years, amid the COVID-19 pandemic. The FAO has warned of food shortages posing severe problems soon. Border closures and quarantines may lead to supply chain disruptions in high-value commodities like fruits, vegetables, milk, etc, according to the United Nations body.

The global spread of the virus has created grave fear for people in countries that are already affected by food security, malnutrition and climate-related disasters.

Climate change has been a significant issue that the world is dealing with as well: Droughts, erratic rainfall schedules and cyclones have further added to the misery faced by several people.

The prevalence of hunger has significantly increased, with the world likely to experience a substantial increase in malnourishment in coming years due to the combined consequences of the pandemic and severe locust attacks.

Early arrival of degenerative diseases

The world currently experiences an increasing burden of non-communicable diseases (NCDs). The COVID-19 crisis has severely disrupted preventive and curative aspects of non-communicable diseases.

This is a precarious situation because people living with NCDs, especially the elderly, are at a more serious risk of COVID-19-related illnesses and death.

Data from China showed comorbidities escalate the risk of dying from COVID-19. Scientists have estimated that COVID-19 kills an estimated 13.4 per cent of patients 80 years and older, compared to 1.25 per cent of those in their 50s and 0.3 per cent of those in their 40s.

With more than 9 per cent of the world’s population over the age of 65, the fatality rate for the elderly requires attention.

Population with comorbidities including cardiovascular diseases, chronic respiratory diseases, hypertension, diabetes and cancer are at higher risk of deaths attributed to COVID-19.

The already encumbered health system is causing a disruption in healthcare for NCDs, especially cancer care, reproductive and child health services, availability of health workers and hospital beds for ailments not pertaining to COVID-19.

A survey conducted by the WHO in 155 countries revealed nearly 53 per cent of countries surveyed partially or completely, disrupted services for hypertension treatment, 49 per cent for treatment for diabetes and related complexities, 42 per cent for cancer treatment and 31 per cent for cardiovascular impasse.

There are also serious problems in rehabilitation services in almost 63 per cent of the countries, despite rehabilitation being paramount to a healthy recovery, post-COVID-19.

The pandemic has been tagged by several other issues. One is mental illness. Mental illness will be a raging health concern after this pandemic, according to reports.

In addition to the fear of contracting the disease, small, yet significant changes in daily lifestyles may engender apprehension and thus, mental health and well-being.

In places with a history of pandemics, post-traumatic stress disorder was observed in survivors and families of survivors. A parallel can be drawn with the current pandemic as well.

Stigma and suspicion related to the pandemic may trigger panic and trepidation. Staying indoors constantly may lead to disrupted sleep cycles and all this, in totality, may hamper the mental well-being of individuals.

Mental health experts warn this may escalate into another pandemic that we may not be ready to deal with.

Conflict between countries

Another issue that threatens global accord is the likelihood of a cold war between the United States and China.

US-China ties plunged to an all-time low with President Donald Trump threatening to cut off the country’s relationship with China over the COVID-19 pandemic.

He has labelled the virus a ‘Chinese virus’ and threatened to demand compensation from China for the damage caused by it.

Escalating tension between the two superpowers have spawned speculation among experts of a probable cold war. Meanwhile, UN Secretary General Antonio Guterres has lamented a lack of leadership by the global powers and a divided international community in the fight against COVID-19.

The world, thus, seems to be experiencing several stages of an epidemiological transition. There are famine-like situations due to erratic weather conditions, pest attacks and disturbed supply chains induced by the current pandemic.

There is a rise in the incidence of new communicable diseases without any decline in the incidence of degenerative and non-communicable diseases. The world lacks the strong global partnership in dealing with the virus and its aftermath.

Amid all ensuing problems, it is unlikely for nations will to adhere to Sustainable Development Goals. There are, however, several clinical trials going on and there is hope that these attempts may lead to a successful vaccine discovery.

Despite burgeoning inequalities in the developing world and disparities in access and benefits of health resources, an iota of hope has emerged from several interventions at national and international levels.

International cooperation seems to be the only effective way out of these crises and, thus, all the nations must strive to achieve this if a way out of these predicaments is to be found.

Views expressed are the author's own and don't necessarily reflect those of Down To Earth.

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