Countries and health care providers should hope for the best but prepare for the worst as a resurgence of COVID-19 is expected in the fall, just as the influenza season hits.

“We are not out of the woods,” Hans Henri Kluge, the World Health Organization (WHO) regional director for Europe, said in a media briefing Thursday. “Lockdowns and social distancing have gained us time,” he added.

However, those same precautions have disrupted services to manage noncommunicable diseases, creating a backlog of unattended health issues that could make more people vulnerable if COVID-19 picks up again as expected.

As it is, “22% of the global population – that’s 1.7 billion people around the world – have at least one underlying condition that puts them at increased risk of serious illness if infected with COVID-19,” Kluge said, citing a modeling study published in The Lancet this week.

The study found that “estimates of the number of individuals at increased risk were most sensitive to the prevalence of chronic kidney disease, diabetes, cardiovascular disease and chronic respiratory disease.”

With elective procedures and routine doctor visits put on hold when countries went into lockdown, 68% of the countries in the WHO Europe Region have reported disruptions in treating patients with noninfectious diseases. Specifically, 66% of services to manage hypertension and 58% of those to manage diabetes and its complications have been partially or completely disrupted in Europe, Kluge said. And in Spain, the cases of myocardial infarction treated by cardiology services dropped 40% compared with the weeks before the epidemic.

Other health care declines because of the lockdowns are equally troubling. Cancer screening programs have been suspended in several countries, with new cancer diagnoses dropping by 25% in the Netherlands. As a result, cancers may be at later stages when they finally are detected and will be more challenging to treat.

According to WHO, the response to the pandemic in Europe also has resulted in a 60% reduction in tuberculosis detection, which will lead to a late start of treatment and a higher death rate. Additionally, national immunization services were interrupted in some European countries, with some experiencing a significant drop in coverage. For instance, measles-mumps-rubella vaccination coverage dropped 20% in mid-April in the U.K., according to WHO.

“The data we have here is concerning,” Kluge said, adding that the declines in health services threaten to jeopardize the achievement of most of WHO’s sustainable development goals by 2030.

Noting the cost of lockdowns to patient and public health, Kluge said it’s “really important that authorities fully invest in having an aggressive track, test and trace surveillance system to avoid costly additional lockdowns in the weeks and months ahead should the virus rebound.”

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