A system for providing specialized medical care for comorbidities including gout and hyperuricemia during Covid-19

Abstract

The purpose of the study was to examine the features of organising specialised care for patients with coronavirus infection and chronic diseases, followed by an assessment of its effectiveness and possibilities for improvement. The study had a theoretical-analytical character and included a comparison of six clusters: Kyrgyzstan as an example of a country with limited resources, the USA, European states (France, Germany, Italy, Spain, Poland), Asian countries (Thailand, Singapore, Indonesia, South Korea, India, Malaysia), as well as China and Japan with the centralised organisational models. The analysis was based on publications, statistics and clinical guidelines from 2020-2025; cross-country comparison was applied with a conditional points-based assessment of severity in comorbid patients and the development of recommendations for improving care. The analysis showed that in multimorbidity the severity score reached 16 points, and in cardiovascular, respiratory diseases and immunodeficiencies - 15. Two or more chronic pathologies increased the risk of severe course and death by 2-3 times. In China and Japan, in-hospital mortality was 5.5-6%, with severe renal failure in Japan - up to 28%. In the USA the mortality among patients with several chronic diseases exceeded 12% with an overall rate of 2.5%, the load on emergency departments reached 25-30%. In Europe the increase in mortality in peak periods was about 20%, with resource deficits - up to 50-60%, among oncology patients in Italy and Spain - more than 25%. In Kyrgyzstan with multidrug-resistant tuberculosis, the indicator reached 34-36%. The obtained data confirm the dependence of outcomes on the severity of comorbidities and health-care resources, which requires risk stratification, adaptation of protocols and strengthening of staffing and infrastructure potential. The results can be used by health authorities and medical institutions to optimise care for patients with coronavirus infection and chronic diseases.