Food for thought: Sustaining nutritional resources throughout the crisis

Recently, reports mentioning malnutrition during COVID-19 pandemic appeared from unrelated sources:

1. 14^th May, 2020: Dr Matshidiso Moeti, WHO Regional Director for Africa, stated that “COVID-19 is unfolding in Africa against a backdrop of worrying levels of hunger and undernourishment, which could worsen as the virus threatens livelihoods and household economies. COVID-19 does not treat us equally, and whether or not we have a healthy, nutritionally balanced diet is a key factor in how our bodies respond to the virus. If we are not getting enough food, or not eating enough of the right sorts of food, our bodies will find it harder to fight off COVID-19 infection” [2].
2. 13^th May, 2020: The Age UK charity and the Malnutrition Task Force have warned that "dramatic increases in isolation and loneliness, combined with restricted access to shopping and reduction in essential care and support could leave many more older people malnourished or at risk of malnutrition" [3].
3. 22^nd April, 2020: A research report published in the European Journal of Clinical Nutrition assessed the prevalence of malnutrition in elderly patients with COVID-19 in Wuhan, China. The report concluded that “the prevalence of malnutrition in elderly patients with COVID-19 was high, and nutritional support should be strengthened during treatment” [4].

The above reports, opinions, and concerns can be construed as 1) that COVID-19 and malnutrition may be related - directly or indirectly; 2) that malnutrition during COVID-19 is not a regional issue; and 3) that malnutrition may affect both the infected and the non-infected irrespective of the age group.

In South Africa, emergency food parcels have been provided to the poor families during the lockdown with a total of 30kg of food content for a family of four. There are concerns raised about the number of calories available per person per day and also about the component nutritional balance. As mentioned in the reports above; the nutritional balance in the diet may also be compromised due to limited or no availability of the “nutritional variety” during the lockdown. This variety, including the supply and availability of food rich in vitamin A, E, and C, is essentially required to maintain the much needed “immune resources” in the body [5,6].

In an International Food Policy Research Institute (IFPRI) blog post; Derek Headey and Marie Ruel provided a well-thought 10-point approach for sustaining nutrition among individuals during the lockdown [7]. In addition, fortifying the usually dry food aid parcels with seasonal and locally available fruits and vegetables may make a big difference. Instead of supplying the food parcel once a month; biweekly schedule may be created to add more perishable food items.

Lockdowns are now beginning to ease around the globe – in phased or un-phased manner – and schools are opening their gates again after 2-3 months (e.g. Germany (11^th May) and South Africa (01^st June)). For countries with school feeding programmes such as the National School Nutrition Programme in South Africa or the Mid-day Meal Scheme in India; it becomes very important to provide meals fortified with macro- and micro-nutrients to replenish and strengthen the “immune resources” in children.

The elderly (over 65-70 years of age), however, have been instructed to stay under strict lockdown even if the lockdowns are being phased out. According to the WHO, “micronutrient deficiencies are often common in elderly people due to a number of factors such as their reduced food intake and a lack of variety in the foods they eat” [8]. Reduced physical activity and prolonged isolation may further aggravate the above two factors and need urgent interventions around the globe.

The global coronavirus cases are now approaching five-million and the infection rates are escalating in the developing world [9]. It is now urgent to draft or redraft the national nutritional policies and programmes for the eased or extended lockdowns and beyond.

In words of Dr Moeti, “Hunger and malnutrition heighten vulnerability to diseases, the consequences of which could be far reaching if not properly addressed.”

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1. Key SUN movement advocacy messages on COVID-19 and nutrition. Available at: https://scalingupnutrition.org/wp-content/uploads/2020/05/SUN-COVID-19-KeyMessages_ENG-1.pdf (Accessed on 20th June, 2020).
2. COVID-19 could deepen food insecurity, malnutrition in Africa, 14^th May, 2020. Available at: https://www.afro.who.int/news/covid-19-could-deepen-food-insecurity-malnutrition-africa (Accessed on 20th June, 2020).
3. Coronavirus lockdown anxiety fuelling malnutrition cases among elderly, 13^th May, 2020. Available at: https://www.telegraph.co.uk/news/2020/05/13/coronavirus-lockdown-anxiety-fuelling-malnutrition-cases-among/ (Accessed on 20th June, 2020).
4. Li T, Zhang Y, Gong C et al. Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. Eur J Clin Nutr (2020). https://doi.org/10.1038/s41430-020-0642-3.
5. Vermeulen H, Muller C, Schönfeldt HC. Food aid parcels in South Africa could do with a better nutritional balance, 22^nd April, 2020. Available at: https://theconversation.com/food-aid-parcels-in-south-africa-could-do-with-a-better-nutritional-balance-136417 (Accessed on 20th June, 2020).
6. Clifford C. Are emergency food parcels from the Gauteng government ‘enough for one month’? Available at: https://africacheck.org/2020/04/24/analysis-are-emergency-food-parcels-from-the-gauteng-government-enough-for-one-month/ (Accessed on 20th June, 2020).
7. Headey D, Ruel M. The COVID-19 nutrition crisis: What to expect and how to protect, 23^rd April, 2020. Available at: https://www.ifpri.org/blog/covid-19-nutrition-crisis-what-expect-and-how-protect (Accessed on 20th June, 2020).
8. Nutrition for older persons. Available at: https://www.who.int/nutrition/topics/ageing/en/index1.html (Accessed on 20th June, 2020).
9. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. https://coronavirus.jhu.edu/map.html (Accessed on 20th June, 2020).

Additional resources

1. Managing Adult Malnutrition. Available at: https://www.malnutritionpathway.co.uk/covid19 (Accessed on 20th June, 2020).
2. Laviano A, Koverech A, Zanetti M. Nutrition support in the time of SARS-CoV-2 (COVID-19). Nutrition. 2020; 74: 110834 (DOI: 1016/j.nut.2020.110834).