Managing Multimorbidity During COVID-19: What Physicians Learned About Chronic Disease Care

What Is Multimorbidity and Why Did COVID-19 Make It Harder to Manage?

Multimorbidity is defined as the coexistence of two or more chronic health conditions in a single patient, such as diabetes alongside hypertension, cardiovascular disease, or chronic respiratory illness. The World Health Organization estimates that noncommunicable diseases (NCDs) account for approximately 74% of all deaths globally, and patients with multimorbidity represent one of the most vulnerable populations in any health system. When COVID-19 struck, these patients faced a dual threat: increased risk of severe infection outcomes and sudden loss of access to the routine care that kept their conditions stable.

A longitudinal qualitative study published in Nature examined physician experiences in Odisha, India, documenting how frontline doctors struggled to maintain continuity of care for multimorbid patients. During lockdown periods, outpatient clinics were closed or operating at minimal capacity, medication supply chains were disrupted, and patients themselves feared visiting healthcare facilities due to infection risk. Physicians reported that many patients with diabetes and hypertension went weeks or months without follow-up, leading to deteriorating glycemic control and blood pressure management. The study underscores that pandemic preparedness must explicitly account for chronic disease continuity — not just acute infectious disease response.

How Did Physicians Adapt Their Care Strategies During the Pandemic?

The Odisha study revealed several adaptive strategies that physicians developed, often with minimal institutional support. Telemedicine emerged as a critical tool, with doctors conducting phone consultations to monitor symptoms and adjust medications remotely. Many physicians reported prescribing longer durations of chronic disease medications — extending 30-day prescriptions to 90 days — to reduce the need for pharmacy visits. Community health workers, known as ASHAs (Accredited Social Health Activists) in India's public health system, became essential intermediaries, delivering medications and relaying patient concerns to physicians.

However, the study also documented significant limitations of these workarounds. Telemedicine was hampered by poor internet connectivity in rural Odisha, and many elderly multimorbid patients lacked smartphones or digital literacy. Laboratory monitoring — essential for conditions like diabetes and kidney disease — was largely suspended during peak pandemic periods, forcing physicians to make clinical decisions with incomplete information. The researchers noted that physicians experienced considerable moral distress, knowing that suboptimal monitoring could lead to preventable complications. These findings align with broader WHO guidance emphasizing that health systems must integrate NCD management into emergency response frameworks rather than treating chronic care as expendable during crises.

What Lessons Does This Research Offer for Future Pandemic Preparedness?

One of the study's most important conclusions is that pandemic preparedness planning has historically focused almost exclusively on infectious disease containment — surveillance, isolation, vaccination — while neglecting the ongoing needs of patients with chronic conditions. The researchers advocate for what they call 'dual-track' health system resilience, where emergency response protocols explicitly include continuity plans for NCD management. This means pre-positioning essential medications, establishing telemedicine protocols before a crisis hits, and training community health workers in basic chronic disease monitoring.

The implications extend well beyond India. According to WHO data, multimorbidity prevalence is rising globally, driven by aging populations and increasing rates of obesity, diabetes, and cardiovascular disease. Low- and middle-income countries, where health systems are already resource-constrained, are particularly vulnerable to the kind of care disruptions documented in this study. The researchers call for policy reforms that recognize multimorbidity management as an essential health service that must be maintained even during emergencies — a position increasingly supported by international public health bodies. The study serves as both a record of physician resilience and a warning that the next pandemic could cause even greater collateral health damage if chronic disease care remains an afterthought in emergency planning.