An Ounce of Prevention Is Still Worth a Pound of Cure

The Chronic Disease Challenge was Large and is now Larger

Before the coronavirus disease 2019 (COVID-19) pandemic, about 6 in 10 adults in the United States had a chronic condition; 90% of the nation's health care expenditures were for people with chronic and mental health conditions, and chronic conditions accounted for 7 of the 10 leading causes of death in the United States.^[1–3]

The COVID-19 pandemic has only further emphasized the importance of chronic disease prevention and care — especially because many chronic conditions increase the severity of COVID-19 outcomes. For example, cancer, heart conditions, diabetes, and chronic kidney disease, in addition to being among the top 10 causes of death in the United States, are also established risk factors for severe illness from COVID-19.^[4] A study from 12 states reported that 73% of people hospitalized for COVID-19 had at least one underlying chronic condition, and rates of hospitalization increased as the number of conditions increased.^[5] Additional chronic conditions or risk factors such as obesity and smoking also increase the severity of COVID-19 outcomes.^[4] COVID-19 may also contribute to social isolation and mental health challenges such as anxiety and depression.^[6] Finally, chronic diseases, risk factors for chronic disease, and COVID-19 all tend to disproportionately affect people of lower socioeconomic status and certain racial and ethnic minority populations. As a result, African American, Hispanic or Latino people, and American Indian and Alaska Native people are all at higher risk than non-Hispanic White people of getting sick, being hospitalized, or dying of COVID-19.^[4]

Despite this relationship between chronic disease and COVID-19 and their related disparities, the pandemic has resulted in a decreased use of health services for emergencies and for ongoing preventive and routine health care. Although we cannot yet predict the effect of this trend on control of existing conditions, we do know that 4 in 10 Americans surveyed in June reported delaying or avoiding medical care during the COVID-19 pandemic and that delaying or avoiding care was even more common among people without insurance and among Black and Hispanic people.^[7] The extent to which control of chronic disease might mitigate a person's COVID-19 risk is currently unknown, but we do know that appropriate management of chronic diseases such as hypertension, diabetes, and cancer saves lives. Needed care can be safely accessed, even during the pandemic.

Preventive care — screenings, vaccinations, mental health assessments, and oral and vision health — remain important even in the context of the pandemic. Vaccinations for preventing outbreaks of other infectious diseases (eg, measles, pertussis) are particularly important this year because childhood vaccination rates have decreased. Influenza vaccination is needed to reduce respiratory disease burden on an already taxed health care system. Finally, as they become available, vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, will be a critical tool to help end the pandemic.

Throughout the COVID-19 epidemic, a great deal of anxiety has surfaced about safely accessing health care services. Health care providers have adopted a wide variety of strategies to mitigate risk. These strategies include measures to increase social distancing (eg, limits on waiting room capacity); mask wearing by all people in health care facilities; screening of patients for COVID-19 symptoms and, in some instances, for infection; and expanding the use of telemedicine. Patients now have a range of options for safely receiving care and should ask and be informed about these options when making appointments. Care that is needed acutely should not be delayed; vaccinations (for both children and adults) are essential services that should be given on time, and in-person nonurgent care (such as screenings) should be considered when risk of infection is low, based on local COVID-19 transmission rates, and when appropriate Centers for Disease Control and Prevention–recommended mitigation strategies are in place.