A group of experts has published the first set of COVID-19-related healthcare recommendations for the millions of people living with Chagas disease, a neglected tropical disease. Six million people are affected by Chagas, a ‘forgotten’ disease known to impact the heart and other organs; they faced significant challenges in accessing healthcare even before the pandemic, and they are now facing an increased risk from COVID-19.
Because Chagas causes cardiac, gastrointestinal, and other complications that could increase susceptibility to COVID-19, a group of experts on Chagas and heart-related diseases from all over the world joined together to provide the best available guidance for healthcare providers. Their recommendations, which include testing and possible drug interactions, were published on 13 October in Global Heart.
‘COVID-19 disproportionately affects the most vulnerable either socioeconomically, due to age, or underlying health conditions; patients now face a double or triple plight as many are already at the social margins and are suffering from neglected tropical diseases such as Chagas disease that poses a medical challenge that deserves our attention and resources as much as any other,’ said Fausto Pinto, President-Elect of the World Heart Federation and one of the paper’s authors.
Caused by the parasite Trypanosoma cruzi, Chagas can take a multi-functional toll on the digestive system, the nervous system, and the heart. More than one million people suffer from chronic Chagas cardiomyopathy that diminishes the blood-pumping function of the heart, leading to heart failure, and often causing irreversible damage. Endemic to Latin America, the disease has a long asymptomatic phase, with many people unaware they are infected.
Diseases such as Chagas were already neglected before the pandemic; now, diversion of resources to fight the pandemic, strains on healthcare facilities, patient concerns about contracting COVID-19 when visiting clinics, and limited understanding of the interactions between diseases and their drug treatments are posing new challenges for confronting Chagas and other neglected diseases.
‘The current situation further exposes the underlying inequalities in access to care and calls for better healthcare solutions for all patients. The pandemic affects treatment provision to people with acute or chronic Chagas disease, and patients suffering from cardiomyopathy require special consideration because of COVID-19’s potential impact on the heart. The recommendations for healthcare workers outline ways to keep all Chagas patients protected and also to optimize COVID-19 care for Chagas patients directly affected by COVID-19,’ said Sergio Sosa-Estani, Head of Chagas Clinical Programme at DNDi and also one of the paper’s authors.
In both chronic Chagas cardiomyopathy and COVID-19, an inflammatory immune response and frequent co-morbidities increase the risk factors in patients. Questions to be studied further include the links between inflammation due to COVID-19 and due to Chagas disease, and the potential of the immune response in COVID-19 to worsen or reactivate Chagas disease. Based on currently available data, this new and important paper documents guidance as well as known information for different drug applications and interactions across both diseases. Also included are recommendations for screening and testing for people with different manifestations of Chagas disease, during pregnancy, and among those with compromised immune systems.
COVID-19 and Chagas disease share more than medical interactions and biological processes: both diseases affect some of the most vulnerable populations and raise urgent questions about accessible, affordable healthcare for everyone.
In addition to outlining detailed medical approaches and recommendations for Chagas disease patients with COVID-19, the authors of the paper therefore call for concerted, sustained action to address neglected diseases. By highlighting the gaps and needs in understanding the interaction between COVID-19 and Chagas disease, the authors hope to stimulate further research and public health investment and ultimately to bring out of the shadows diseases that have been ignored for too long.
Background on published paper
On 30 March 2020 the Inter-American Society of Cardiology (IASC) and World Heart Federation published a Roadmap on Chagas Disease with a comprehensive overview of Chagas disease and steps for improving healthcare access. In April 2020, the Drugs for Neglected Diseases initiative’s Chagas Research Platform reconvened some members of the Chagas disease roadmap writing group and other experts, including several members of the Chagas Coalition that has created a Q&A resource, to explore the impacts of COVID-19 on Chagas patients. Some members of the writing group have been on the frontlines of the pandemic, administering treatment or exploring new ones.
About the World Heart Federation
The World Heart Federation (WHF) unites the cardiovascular community and drives the agenda to reduce the global burden of cardiovascular disease and help people live longer, healthier lives. Together with our Members, we are working to end needless deaths and build global commitment for improved cardiovascular health at the global, regional, national and community levels. We believe in a world where heart health for everyone is a fundamental human right.
To learn more, visit www.worldheart.org
The Drugs for Neglected Diseases initiative (DNDi) is a not-for-profit, patient-oriented research and development organization working to deliver safe, effective, and accessible treatments for millions of people living in vulnerable conditions and affected by neglected diseases, notably Chagas disease, leishmaniasis, sleeping sickness, paediatric HIV, hepatitis C, filarial infections, and mycetoma.
Mihela Kralj, Communications Manager, WHF, firstname.lastname@example.org
Marcela Dobarro, Regional Communications Manager, DNDi, email@example.com
Photo credit: Ana Ferreira-DNDi