COVID-19 has hogged headlines and monopolised our screen space over the past six months. As India crosses one lakh COVID-19 related deaths, we are yet to learn more about the fallout of the virus on non-COVID diseases.
With the lockdown, two laws were applied in the current pandemic across the country, namely, The Epidemics Diseases Act, 1897 and The Indian Penal Code, 1860. These two laws, which are penal in nature, gave unbridled power to the State, and from there on flowed a slew of orders and diktats, some of which were indeed confusing and had far-reaching effects on the healthcare delivery system. In the next few months, these were to shape the health of the Indian populace.
How Those Suffering From Terminal / Chronic Illnesses Like Cancer Were Impacted
The hospital OPDs and stand-alone clinics were ordered to shut in several states. Some others reversed these orders, sending very confusing signals to the public at large. On top of all this, the general public, during the lockdown, had the impression that the hospitals were only looking after COVID patients, and that these were the places to be abandoned lest they catch the ‘deadly’ coronavirus.
The need to keep people out of hospital, and to protect both patients and clinicians from exposure to COVID-19, accelerated a shift from an interventional to a conservative approach in several diseases.
As a result, chronic and cold cases were relegated to the ‘pending list’ – both by patients and doctors alike. And the maximum harm came to patients suffering from cancer who were not the ‘urgent’ list. Several such patients progressed beyond the stage of operability. Similarly, patients who were suffering from chronic kidney disease and were on dialysis, went on from an early stage to an advanced stage, and some even to the final stage of kidney disease.
COVID Impact On Sexual & Reproductive Health: Unwanted Pregnancies, Unsafe Abortions
The pandemic also affected sexual and reproductive health nationwide in more ways than one. Home isolation and fears of contracting the virus appear to have led to reduced access to safe abortion care. While in several countries access to various forms of contraception was regulated, and the healthcare agencies followed a scientifically system laid out, to make contraceptives available to the public at large, in India, the ubiquitous neighbourhood chemist would deliver any and everything for the asking over the counter.
As a result, many women took to a rather unsafe way to abort, by taking oral abortion pills without actually knowing the implications or the proper time to take it.
Several of them landed up in complications that required surgical intervention, at times resulting in the removal of the uterus, thus jeopardising their capacity to conceive ever again. Many others, on the other hand, waited without realising the period of gestation and went past the period to carry out the safe medical termination of pregnancy.
Nearly 50,000 Preventable TB Deaths Occurred During Initial Lockdown
No organ system and no geographical region was able to escape the implications of deferring proper medical treatment due one reason or the other. DOTS delivery for the treatment of Tuberculosis, especially in rural India, suffered badly. According to an estimate, this led to entirely preventable deaths of about 50,000 patients suffering from tuberculosis, in the first two months of lockdown.
What is of immediate importance is the conversion of important procedures from the elective to the urgent list.
Most of the surgeries being done currently are those that can no longer be postponed.
As per an IANS report, on 22 September, “a single judge bench of the Delhi High Court stayed the Delhi government's order directing private hospitals in the national capital to reserve 80 percent of ICU beds for COVID-19 patients only.”
This was in complete disregard of the health of other non-COVID patients.
Any Health ‘Benefits’ Of The Pandemic?
It is not that the fallout has only been negative – we have also reaped some great health benefits amid the pandemic-induced environment. For example, the road traffic accidents have come down by huge numbers, for obvious reasons. Similarly, the admissions in the hospitals due to pollution-related diseases saw a southward trend. Travel and eating out was curtailed to a large extent; hence there was a perceptible decrease in the gastrointestinal infections including acute gastroenteritis, hepatitis A&E, as also typhoid fever.
Reports suggest that India may achieve its target of eradication of tuberculosis earlier than 2025 only because wearing a mask has been universally adopted.
The current global pandemic presents an unparalleled opportunity to make well thought-out scientific healthcare policies to shore up our collapsing healthcare delivery system.
(Dr Ashwini Setya is a Senior Gastroenterologist and Programme Director in Delhi’s Max Super Speciality Hospital. He endeavors to help people lead a healthy life without medication. He can be reached at firstname.lastname@example.org. This is an opinion piece. The views expressed above are the author’s own. The Quint neither endorses nor is responsible for them.)