Taking Heart: Noncommunicable Disease Detectives Stand Up to COVID-19 in India

India has made global headlines during the COVID-19 pandemic for its high number of cases and its discovery of the Delta variant in October 2020. Less well known is how the India Field Epidemiology Training Program Noncommunicable Disease (FETP NCD) fellows, sometimes referred to as residents, have worked through extraordinary challenges. They help local public health departments during the pandemic and maintain important noncommunicable disease (NCD) services for people with limited access to medical services and at higher risk for severe COVID-19 outcomes. For World Heart Day 2021 (celebrated on September 29), it is important to acknowledge how countries are including health services for NCDs, such as cardiovascular disease, into their COVID-19 pandemic responses.

NCDs cause 73% of deaths globally and are the world’s leading cause of death. As the pandemic has evolved, the relationship between NCDs and COVID-19 has become clear: people with NCDs, such as cardiovascular diseases and diabetes, have a higher risk of severe COVID-19 disease and are more likely to die from COVID-19 than people without NCDs. In India, NCDs were estimated to cause 64.9% of all deaths, and cardiovascular diseases caused 27.4% of all deaths in 2019.

The India FETP NCD program started in 2018 and currently has 26 fellows. They are trained to fight both NCDs and infectious diseases, and have continued to do so, even while the pandemic has disrupted regular health services. Their training and skills make them the ideal candidates to respond to a global health emergency and support overstretched local health staff and burned-out frontline workers. To that end, FETP NCD fellows and faculty are supporting the COVID-19 response by establishing screening and surveillance systems; testing suspect COVID-19 cases; training frontline workers; supporting external communication, such as media bulletins; and establishing systems for contact tracing, data analysis and COVID-19 vaccine rollout.

The second COVID-19 wave, which hit India in March 2021, resulted in lockdown restrictions that made it difficult for people with hypertension and diabetes to receive care. To ensure continuity of care through lockdown, the India Hypertension Control Initiative (IHCI) partnered with the FETP NCD program to make services to treat diabetes, hypertension, and other NCDs more convenient and closer to people’s homes. “We introduced a telemedicine feature in the SIMPLE app, a mobile-based application used to track follow-up of NCD patients. Community health workers used the app to connect people needing NCD services with local doctors,” says Dr. Abhishek Kunwar, FETP NCD graduate, and Dr. Ashish Krishna, FETP NCD fellow. Currently, this telemedicine feature has been operating in 1,225 health facilities in six states in India and over 20,000 teleconsultations were made between October 2020 and July 2021.

One FETP NCD fellow worked with the local government to introduce a project called “COVID Rakshak-Aapke Dwar” (Hindi for “COVID-19 caretaker at your doorstep”), a unique program that delivers essential NCD care through local volunteers. “I came across many people who were the victims of lockdown; they could not get even essential medicines for their chronic ailments. We assigned trained volunteers to take care of the needs of COVID-19 patients under home isolation,” says Dr. Piyush Jain, FETP NCD fellow.

“One morning I got a call from an elderly male suffering from uncontrolled diabetes and hypertension. He had been paralyzed on his left side for the last three years, and he was COVID-19 positive. He was in agony and living alone, dependent on his neighbors to provide for his daily needs and medicines. This had a devastating impact on his wellbeing and mental health. We connected through the caretaker program; I visited him with a trained volunteer who took care of him around the clock by connecting him with hypertension treatment. The volunteer took all the necessary COVID-19 precautions. I visited the houses of those with COVID-19 to provide additional medical support such as consultations and follow-ups and motivated the neighbors to help each other during this pandemic crisis. Fortunately, the elderly man’s condition improved, and he completed the home isolation period. He broke down in tears and expressed his gratitude for the support, and he encouraged his two grandsons to volunteer and spread joy to other houses. They ended up joining the COVID Rakshak volunteer team.”

Through these efforts to improve NCD-related health during the COVID-19 pandemic, the FETP NCD fellows are gaining skills in leadership, data use, and epidemiology, while also completing their program requirements. “We encourage our fellows to do activities that benefit the health system. They are working towards achieving uninterrupted NCD services during these disasters and building the capacity of the frontline workers,” says Dr. Mohankumar Raju, Consultant, India EIS, FETP NCD. Raising awareness of this work is a great reminder that the spirit of World Heart Day is alive throughout the world, even during a global infectious disease pandemic.