What We Lost in the Fire: Endemic Tropical Heart Diseases in the Time of COVID-19

Andrew Y. Chang Department of Epidemiology and Population Health, Stanford University, Stanford, California;
Stanford Cardiovascular Institute, Stanford University, Stanford, California;
Center for Innovation in Global Health, Stanford University, Stanford, California;

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Liesl Zühlke South African Medical Research Council, Cape Town, South Africa;
Division of Paediatric Cardiology, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa;
Cape Heart Institute, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa;

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Antonio Luiz P. Ribeiro Telehealth Center and Cardiology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil;
Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil;

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Michele Barry Center for Innovation in Global Health, Stanford University, Stanford, California;
Department of Medicine, Stanford University School of Medicine, Stanford, California;

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Emmy Okello Department of Adult and Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda;

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Chris T. Longenecker Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington;
Department of Global Health, University of Washington, Seattle, Washington

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ABSTRACT.

The COVID-19 pandemic has profoundly influenced the effort to achieve global health equity. This has been particularly the case for HIV/AIDS, tuberculosis, and malaria control initiatives in low- and middle-income countries, with significant outcome setbacks seen for the first time in decades. Lost in the calls for compensatory funding increases for such programs, however, is the plight of endemic tropical heart diseases, a group of disorders that includes rheumatic heart disease, Chagas disease, and endomyocardial fibrosis. Such endemic illnesses affect millions of people around the globe and remain a source of substantial mortality, morbidity, and health disparity. Unfortunately, these conditions were already neglected before the pandemic, and thus those living with them have disproportionately suffered during the time of COVID-19. In this perspective, we briefly define endemic tropical heart diseases, summarizing their prepandemic epidemiology, funding, and control statuses. We then describe the ways in which people living with these disorders, along with the healthcare providers and researchers working to improve their outcomes, have been harmed by the ongoing COVID-19 pandemic. We conclude by proposing the path forward, including approaches we may use to leverage lessons learned from the pandemic to strengthen care systems for these neglected diseases.

Author Notes

Address correspondence to Andrew Chang, Alway Building, Stanford University, 300 Pasteur Dr., Mail Code 5405, Stanford, CA 94305. E-mail: aychang@stanford.edu

Authors’ addresses: Andrew Y. Chang, Department of Epidemiology and Population Health, Stanford University, Stanford, CA, Stanford Cardiovascular Institute, Stanford University, Stanford, CA, and Center for Innovation in Global Health, Stanford University, Stanford, CA, E-mail: aychang@stanford.edu. Liesl Zühlke, South African Medical Research Council, Cape Town, South Africa, Division of Paediatric Cardiology, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa, and Cape Heart Institute, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, E-mail: liesl.zuhlke@mrc.ac.za. Antonio Luiz P. Ribeiro, Telehealth Center and Cardiology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, and Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, E-mail: alpr@ufmg.br. Michele Barry, Center for Innovation in Global Health, Stanford University, Stanford, CA, and Department of Medicine, Stanford University School of Medicine, Stanford, CA, E-mail: michele.barry@stanford.edu. Emmy Okello, Department of Adult and Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda, E-mail: emmyoks@gmail.com. Chris T. Longenecker, Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, and Department of Global Health, University of Washington, Seattle, WA, E-mail: ctlongen@uw.edu.

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