At this writing, some 8.6 lakh people around the world have been found infected with the coronavirus and over 42,300 people have died of it. In India, some 1,580 cases have been reported, and 47 deaths. There is no doubt that India had no choice other than the lockdown to avoid the colossal toll the virus could take on lives, or at least buy time as the country, with our poorly equipped and historically underfunded health system, prepares to face it. However, the lockdown was poorly conceived and declared without preparation. Considering the time lag since the first case was reported from China (84 days), and the first case was reported in India (54 days) to the country-wide lockdown, the preparation could have been much better. The sudden lockdown, including the closing down of a considerable number of private hospitals, essential medical services and pharmacies, are causing and will continue to cause a huge damage to demographic and health outcomes.
Data presented in February, when COVID-19 deaths were maximum in China, showed that it was still the 49th biggest cause of deaths in that country. More people die of TB, Malaria, HIV and other diseases annually than of COVID-19 (even if we account for the projected number of COVID-19 deaths). While these infections have been around longer and generally affect mostly lower-income groups, COVID-19 is affecting everyone.
Although we do not have reliable concurrent statistics of deaths for March 2020 in India, considering the Medical Certification of Causes of Death (MCCD) data from one of the highly affected states, Maharashtra, it is hard to believe that COVID-19 will rank among the top 20 causes of deaths in the country even after its lifetime run.
The lockdown to contain the spread of COVID-19 is having and will have a huge impact on other healthcare provisions and outcomes. Considering the high multiple and untreated morbidity prevalence in India, it will adversely a huge number of people. In fact, out of the total deaths caused due to COVID-19, most have been reported in co-morbid patients. Ignoring other healthcare services further aggravates the chances of a large section of the population whose immunity is compromised with existing ailments being infected with Covid-19.
The closing down of private healthcare facilities, especially in the smaller towns and cities that take care of a considerable proportion of the total healthcare burden will have severe implications for those with chronic diseases and those who need emergency care. At the national level, on an average, some 6.9 million people visit outpatient care on a daily basis, out of which, government hospitals, private hospitals, private doctors/clinics, and other (Charities and NGOs) healthcare service providers treat 30%, 23%, 43%, and 4% of cases, respectively. Thus, private healthcare service providers cater to 66% of daily healthcare needs. Further, the lockdown has hit hard the poor and lower middle-income classes who don’t have their own vehicles to reach hospitals in emergencies.
Mobility restrictions and excessive fear have also hit the attendance of frontline health workers to basic healthcare provisions during pregnancy, delivery care and new-born healthcare. The lockdown panic and crisis are certainly going to affect outcomes for pregnant women. For instance, the limited mobility and stigmatisation of frontline health workers are harming the nutritional needs of pregnant women and new mothers and their babies. As many as 49,481 births take place per day, of which private hospitals perform 55% of the caesarean and complicated deliveries.
Further, the lockdown may induce irregularities in obtaining Antenatal Care Services (ANCs), which have a potential risk of causing health complications and consequential maternal and child mortality. Even in normal times, the lack of access to healthcare services causes nearly 3,600 pregnancy-related deaths of women a month and 2,800 deaths of children under five years per day. The postponement of child immunisation can negatively affect child health outcomes. Though these essential services are available, the non-availability of transport facilities and the fear of infections hamper access to them. The lack of access to pharmacies will also affect menstrual hygiene practices.
Globally, China is the second-largest exporter of pharmaceutical products. The shutdown of drug-manufacturing plants in China has delayed supplies to Indian factories for producing generic medicines. Further, the lack of access to medicine and regular healthcare among patients with non-communicable and chronic diseases results in severe healthcare issues which might be more fatal than COVID-19 in the days to come.
The asymptomatic nature of the disease and isolation increase the fear and anxiety not only among the youth and older population, but children are also its invisible victims. Social disconnectedness is fuelling mental health issues among the older population while youth are suffering from a fear of an uncertain future, academic year and job losses. Many cases of mental health emergencies due to COVID-19 phobia have already been reported in India.
The global evidence suggests that there was a high demand for contraceptives and abortion services during the outbreak of Zika virus in 2015-16. Limited availability and accessibility of contraceptives impact unintended pregnancies, abortion and sexual and reproductive tract infections in large numbers in India, especially given that current supplies, as well as production, have been stalled as a result of lockdowns in many countries. Previous pandemic experiences have also shown a rise in intimate partner violence, divorce and separation rates in families.
Amidst the COVID-19 lockdown, therefore, it is critical that the Centre and states monitor the population’s other healthcare needs through public and private partnerships. The government must use the private sector services, which hold 62% of hospital beds in the country, instead of shutting them down. The government must subsidise other healthcare services in the private sector hospitals and clinics and ensure that these are available to people at affordable costs while it deals with the grim situation arising out of the coronavirus pandemic.
(The writer is NGN Research Fellow, Australia India Institute (AII), University of Western Australia)