Cause or Effect? An Intriguing Connect Between COVID-19 and Non-communicable Diseases in India

Pranav Anam, Founder, The Gene Box discusses how Indians suffering from NCDs are predisposed to COVID-19 as India is also the hub of non-communicable diseases and how the post COVID-19 world will see seismic changes to our lives

Before this year, the last time we had referred to a pandemic was in course of a historical study or discussion. Few of us could have thought that we will live a pandemic as contagious and widespread as the ongoing one caused by SARS-CoV-2 virus that has affected more than a million people globally. In India, it has claimed more than 200 lives – Maharashtra has the highest number of affected and dead till date. According to the World Health Organisation (WHO), people of all ages can be infected by the virus that is a new strain and the epidemiological studies are ongoing, but, it is the elderly and immunocompromised that are apparently more vulnerable. In India, this is seemingly not the trend – as many as 42 per cent of the positive cases in India are in the age group of 21-40 years while 33 per cent of the affected people are between 41-60 years of age.

One of the most common causes cited for this reversal in trend in India is that a large number of people in this age group who travel extensively, both for work and leisure. What most of them miss is that India is also the hub of non-communicable diseases (NCDs), which have been identified as a risk factor for contracting the virus and aggravation of the disease. As much as 53 per cent of Indians have lost their lives to non-communicable diseases namely cardiovascular diseases, stroke, diabetes mellitus, chronic lung diseases and cancer, and one in four Indians have a risk of dying from an NCD before they reach the age of 70. The Indian youth are susceptible to COVID-19 infection not only due to the rising share of co-morbidity factors but due to the large number of population that smokes – the National Family Health Survey of 2015-16 shows that nearly 45 per cent of men and about 7 per cent of women in India aged between 15 and 49 years consume some kind of tobacco. This means that all these people, including children, are potential patients of COVID-19 as the WHO finds conditions that increase oxygen needs or reduces the ability of the body to use it properly will put patients at higher risk of the consequences of bilateral viral pneumonia.

It will be interesting to note that most of the non-communicable diseases that affect the Indian population have their roots in the genes of the individual. The most common comorbidities in patients who died due to the virus infection were also suffering from diabetes, hypertension, kidney or cardiovascular disease. The chances of developing one or more of these diseases are not only dependent on your lifestyle. To an extent, your genetic makeup has a say in whether you develop these conditions. For example, incidence of myocardial infarction (MI), commonly known as heart attack, is a common health emergency in India and has a genetic root – research shows that a variant found on chromosome 9p21 is the strongest genetic impact on the risk of myocardial infarction. The CDKN2A/B gene located within the CDKN2B-CDKN2A gene cluster in this chromosome bears a significant genetic susceptibility for cardiovascular disease but has also been linked to a number of other health problems, including several cancers, intracranial aneurysm (a cerebrovascular disorder), type-II diabetes, and periodontitis (a severe gum infection). The CDKN2A gene is a tumour suppressor involved in the regulation of cell proliferation, cell ageing, and apoptosis and has an important role to play in the process of atherogenesis (forming of plaques in the arteries). The influence of genes on non-communicable diseases can be understood from the fact that in fact, hereditary influence on coronary artery disease (CAD) susceptibility accounts for between 40 percent and 50 percent of cases.

NCD challenges of the post-COVID-19 world: Genomics can help

Is that all? No, apparently, for the massive and sudden changes brought by the pandemic will bring seismic changes to our lives. On one hand, the loss of work and wages will cause immense stress among a section of the society, while the other part that is under constant adjustment mode due to an unprecedentedly-long work-from-home arrangements. Together, a huge surge in mental health cases is the most imminent and likely fallout. It is well-known that stress is a trigger for a host of inflammatory conditions such as coronary diseases or rheumatoid arthritis and other conditions that damage and weaken the immune system. Besides, stress has a severe impact on mental health which is a cause of serious concern for a country like India with an existing burden of 7.5 per cent. Women are probably the worst affected – at 37 per cent, the suicide rate for women comprises a third of the world numbers and reports of a rise in domestic violence cases during the lockdown has already started emerging with the National Commission for Women (NCW) receiving 58 complaints between March 23 and March 30. Treatment for mental health conditions is inadequate in India not only due to the want to experts but due to the deep-rooted stigma against the conditions, considering them to be a mark of lunacy. The connection between non-communicable diseases and stress is also well documented and one can only imagine the collective disease burden stress could cause in India, for which we are underprepared, at best.

The new frontiers of scientific studies have also opened fresh approaches to both treat and prevent non-communicable diseases, including mental health. Since genomics can predict the predisposition of a person to develop non-communicable diseases such as chronic kidney disease, cardiovascular diseases, as well as depression, anxiety, bipolar disorder, or schizophrenia, getting tested as early as possible can help one plan their life. The Indi-Gen initiative undertaken by the CSIR can work as the perfect platform to allay the apprehensions related to genetic tests and garner the requisite genetic information of Indians. Armed with the scientific information based on predictive genomics, India can manage the health and diseases of its people better in a world that is already going to be unchartered territory.