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The COVID-19 pandemic has taken the world by storm, Low- and Middle- Income Countries (LMICs) not withstanding. Cabore et al modelled best estimates for peak prevalence of the virus on the African continent to be projected at more than 37 million symptomatic cases, requiring 4.6 million hospitaliations. Current estimates by Africa CDC show over 1 million cases as of August 6th, 2020, and more than 22,000 deaths . South Africa has the highest prevalence with more than half a million reported cases, followed by Egypt and Nigeria, respectively. While the actual incidence and mortality rates may be evasive given limited access to testing globally , it is clear that the disease has not been forgiving on African soil either.
Non-Communicable Diseases (NCDs) constitute the backdrop for worse outcomes among those infected with COVID-19 , and those with poorer access to care fare worse. While NCDs have gained increasing attention in the last decade, the current pandemic illuminates the alarming gap in data on the double burden of disease that is threatened by a continued lag in focus on NCDs – an improved understanding of which would have been critical in effectively addressing our current plight.
A prime example of this is in the case of research addressing NCDs in the emergency care setting, an area of research in global health that is virtually non-existent in many resource-variable settings like Kenya, which has the highest number of COVID-19 cases in Ea...
A prime example of this is in the case of research addressing NCDs in the emergency care setting, an area of research in global health that is virtually non-existent in many resource-variable settings like Kenya, which has the highest number of COVID-19 cases in Eastern Africa. As with any pandemic, emergency care acts as the receptacle for patients in extremis, with severe cases of illness, including those with imminent oxygen needs and breathing support with COVID-19 - two needs highlighted by Cabore et al. This has occurred with COVID-19 , as in other public health crises before it. The spotlight on emergency care as a priority for government agendas globally in the 2019 WHA 72.16  resolution was a step in the right direction for the progress needed in countries where neglect of emergency care infrastructure has been appalling, and even fatal. Further research on best practices for emergency care in LMICs, including responsiveness in crises, understanding burden of NCDs in the emergency care setting, and the effect of the double burden in populations seeking care there cannot be overstated. To that end, our recent study in the largest public emergency department in East Africa  called Kenyatta National Hospital, shows equal or worse outcomes for all NCDs and leading risk factors outlined by the WHO’s 2013 action plan . All the same, the capacity to handle emergency cases in Kenya, like most African nations, remains dismal at best due to lack of prioritization: lack of basic resources like oxygen, lack of adequately trained emergency professionals, and lack of health system infrastructure that facilitates timely access for patients.
For the first time, the global health community may have realized the crux of emergency care: as the front-lines to our healthcare systems. Communicable disease pandemics, and NCD co-afflictions alike. The WHO’s emergency care office is home to many initiatives that advance this agenda. I would hope that the remainder of the global health community follows suit.
1. Coronavirus Disease 2019 (COVID-19): Africa CDC Dashboard. 2020; Available from: https://africacdc.org/covid-19/.
2. World Health Organization. (2020). Laboratory testing strategy recommendations for COVID-19: interim guidance, 21 March 2020. World Health Organization. https://apps.who.int/iris/handle/10665/331509. License: CC BY-NC-SA 3.0 IGO.
3. Yang, J., et al., Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis, 2020. 94: p. 91-95.
4. Giving Oxygen to COVID-19 Patients in Kenya. 2020 August 8th, 2020]; Available from: https://www.emergencymedicinekenya.org/oxygenmanifold/.
5. World Health Assembly, Resolution 72.16. Emergency Care Systems for Universal Health Coverage: Ensuring Timely Care for the Acutely Ill and Injured. 2019.
6. Ngaruiya, M., MSc, DTMH, Christine, et al., The last frontier for global Non-Communicable Disease action: the Emergency Department - a cross-sectional study from East Africa. medRxiv, 2020: p. 2020.07.29.20164632.
7. World Health Organization. WHO global action plan: for the prevention and control of noncommunicable diseases 2013-2020. 2013; Available from: http://apps.who.int/iris/bitstream/10665/94384/1/9789241506236_eng.pdf.