Will the COVID-19 third wave lockdown measures not lead to a resurgence of non-communicable diseases in South Africa?

Dear Editor,

Between 1990 and 2017, a shift from disease-burden profiles dominated by communicable diseases and childhood illnesses to profiles featuring an increasing predominance of non-communicable diseases (NCDs) was noticed in Sub-Saharan Africa [1]. The ongoing COVID-19 pandemic has been a reminder of how deep South Africa (SA) is concerned by NCDs. It is the country with the highest number of infection cases and deaths in Africa. On the 7th July 2021, 2,075,409 cases and 62,171 deaths had been reported, which means half of the values reported in the whole Africa (4,224,102 cases and 98,718 deaths) [2]. The high prevalence of NCDs in the country is certainly one of the reasons behind the high mortality observed. Indeed, COVID-19 has been established worldwide to be more lethal for people already suffering from NCDs [3]. Cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes are the most common. Those NCDs accounted for 51% of the total deaths registered in SA in 2016 [4]. The country is the most obese in Sub-Saharan Africa with two-thirds of women and about a third of men overweight or obese. At the same time, 25% of South African children are undernourished, indicating a double burden of malnutrition where members of a family can suffer from undernutrition and obesity at the same time [5].

The country is facing a third wave of the COVID-19 since May 2021 after the first two that were in the period of March–November 2020, and December 2020–April 2021 [6]. Like in many other countries, lockdown strategies have been adopted to control the spread of the disease, going from partial lockdown to strict lockdown measures that request populations to stay at home [7]. These measures quite often lead to stress, sedentary lifestyle, smoking, alcohol consumption, and malnutrition (in terms of quantity and quality) which are factors promoting NCDs [4], [8], [9]. In SA, lockdown measures generally include the prohibition of alcohol sales, but one should not ignore that unhealthy diets nowadays generate more disease compared to physical inactivity, alcohol, and smoking combined [10]. A recent national survey made by Pharma Dynamics with almost 2000 South Africans revealed an increase in the weight of half of them after the first two COVID-19 waves. They reported their change of eating habits as due to stress and anxiety over what the future holds, higher snacking and impulsive eating, or eating out of boredom. Dysfunctional eating and sedentary behaviours appeared and need to be overturned [11].

From the systematic review conducted around the impact of COVID-19 lockdown on snacking habits, fast-food and alcohol consumption at an international level, Bakaloudi et al. [12] have pointed out the long-term health effects that could arise in cases of repeated lockdowns in the future relating to an increase in unhealthy snacking and alcohol consumption. The adoption of promoting healthy eating lifestyles in South Africa in this COVID-19 context is imperative to avoid the above-described snowball effect between COVID-19 and NCDs.

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