This article is not about the 1.06 crores of migrant men, women and children, who were forced to trudge hundreds of miles to their villages, because they were short changed by an ill-conceived 4-hour notice of a lockdown, supposedly to bring the pandemic under control in 21 days. Nor is it about the 515 doctors who died looking after COVID patients; whose names, photographs and locations have been made public by the IMA in response to the health ministers claim that there was no data available for such doctors; thereby absolving himself of any compensation to the families, announced shortly before that. After all, if you don’t have data, you needn’t pay out anything. Nor is it about the estimated 200 million families pushed back into poverty due to closed establishments, cancelled trade licenses, job losses and financial pecuniary. All this is a matter of public record.
This is about the unseen fallout of the pandemic; the havoc caused amongst non-COVID patients. Every survey, whether by UN agencies or NGOs, repeat the same chorus; non-COVID healthcare has stalled or totally collapsed. UNICEF has stated that as a result of the pandemic, malnutrition amongst children will increase by about 18-20% due to defaulting nutrition schemes. Preventive healthcare programs have been badly hit. Of the 1.49lakh children surveyed in the tribal district of Nandurbar in Maharashtra, 3710 were found to be in acute malnutrition and 18644 in moderate malnutrition because the nutritional support systems had ground to a halt. In the same district, a young man who became paraplegic following a fall from a tree has been waiting more than 6 months for corrective spinal surgery. A young girl in a similar situation died from infections from her bed sores. Both were unable to access any healthcare facility, being refused admission by covid dedicated hospitals which had put all other procedures on hold. In India, 7000 cardiovascular patients and 1200 t.b. patients die every day. With the pandemic, there is even less access to follow-up. India reported 3.3 lakh malaria cases in 2019,and 21 lakh people were living with HIV/AIDS. These patients now face neglect, along with 1lakh dengue cases, 1.3 cr acute diarrhoeal cases, 2.2 lakh cases of typhoid, and 7.5 lakh cases of pneumonia. Since March this year, Maharashtra has seen a 60% decline in immunisations, 92% in cataract surgery, and 70% in both male and female sterilization procedures. Hospital childbirth rates have dropped by 18.7% partly due to pandemic related lack of transport at the critical time. A pre-pandemic National Mental Health Survey estimated that 10% of Indias’ population had mental health issues; of which 90% did not seek/get help. These figures will skyrocket with quarantine and isolated hospital care. COVID-19 has already spawned a new clinical entity in mental health – “coronophobia”, with associated depression and suicidal tendencies, among other features.
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There are multiple reasons for this. An overburdened system is unlikely to entertain a patient with a small breast lump, till the lesion goes beyond treatment; joining the 2000 daily cancer deaths in India. The drop in cancer follow-up is in fact estimated at 70%. Over 2 lakh end stage renal disease patients are added to dialysis lists every year; these now have nowhere to go. Most patients are just too scared to attend hospital OPDs or get admitted for fear of contracting the disease. Counselling and public education programs are needed urgently. If normal surgical volume is increased by just 20% after the pandemic, it would take approximately 45 weeks to clear the COVID related backlog.
The WHO published a survey report on the impact of COVID-19 on health systems, which said almost 90% countries have experienced similar disruption to its health services amidst the pandemic. Routine and elective services have been suspended, while critical care services such as cancer screening and treatment, and HIV therapy, have seen high-risk interruptions in low-income countries. Emergency services were disrupted in almost 25% of the responding countries. Urgent blood transfusions were disrupted in 23% countries. The key redeeming factor is, that many of these countries already have SOPs’ in place to cope with the problem.
The pandemic is a rapidly evolving situation, and quite rightly there are committees in place to monitor the situation and develop/update protocols. A similar exercise is urgently required to deal with the non-covid healthcare pressure cooker. Supply shortages should be anticipated and contingency plans and policies must be in place to prevent a repeat of the migrant worker type fiasco. If we know that the cost of vaccinations is going to be about Rs 80,000 crores, emergency plans should be in place right now to make arrangements for such funds. Clear and effective leadership is crucial. Experienced medical personnel should take leading roles to guide their teams. Tele-health should be used where possible, to contain the coming storm, for new consultations, follow-ups, and provide rehabilitation guidance. Surgical training programs should include technology to help trainees engage in remote knowledge and skill acquisition. This country must break out of its political cocoon and restore its credibility in the international scientific community. The Lancet in a scientific editorial (and Trump in one of his many rants) seriously questioned the validity of statistics released by government sources. These are believed to be doctored, to camouflage failures and score political points.
Even the ICMR which is supposed to be the apex research regulating body has “messed its pants” so to speak by publishing a research paper fudging figures on the impact of the lockdown. We sincerely hope that government sponsored bureaucratic rottweilers like the ED, IT, NSA, UAPA, CBI, NCB etc., etc. are not unleashed upon the whistle blowers just because their scientific integrity did not permit them to countenance such fraud.
(The writer is a founder
member of VHAG)
