From low child immunisation to untracked TB patients, COVID-19 takes its toll

Worrying trends --

• Decline in MMR vaccination in children
• Reduction in institutional deliveries
• Fall in clinic attendance and in-patient care  
• Untracked live tuberculosis cases
• Unattended and unwanted pregnancies
• Rising suicides and mental illness
• Problems of migrant labour

While a lot of issues around handling the coronavirus pandemic are going on, a serious health concern that has taken a backseat and seeks immediate attention is general healthcare services. Keshav Desiraju, the former health secretary of India and one who has been advocating for long the urgent need to bridge the gap in public healthcare delivery, points out there has been enormous non-COVID-linked health impact over the past few weeks.

Citing figures collated from various sources such as studies in Lancet journal, National Medical Health Survey, World Bank, NSSO, and Indian government data, Desiraju points at some worrying indicators, including fall in universal immunisation numbers. He says, in a country where 26 million babies are born every year (70,000 babies born every day), they all ideally need to get nine shots over the first 12 months under the government's immunisation programme, which has taken a severe hit because of the lockdown and frontline workers not being able to attend to these duties. There has been a 69 per cent reduction in the MMR vaccination in children. The seriousness of this, he fears, may be revealed if we end up encountering  measles and diphtheria outbreaks happen later in the year. It means hospitals need to focus energy on getting ready with the stockpile of the MMR  (Measles, Mumps and Rubella)  and DPT (Diphtheria, pertussis or whooping cough, and tetanus) vaccines so that they are prepared whenever it strikes.

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Desiraju discussed these issues in his talk at a recent webinar hosted by the Oxford India Centre for Sustainable Development.

The other data point that he cited was  21 per cent reduction in institutional deliveries (deliveries in hospital, not at homes), 50 per cent reduction in clinic attendance for acute cardiac events and 32 per cent fall in in-patient care for pulmonary conditions.  

He reminds us that this needs to be seen in the backdrop of the fact that at any point of time, even prior to COVID, we had a huge number of people with various conditions that needed continuous medical attention. The magnitude  of the problem is significant if you consider some other factoids that he shared. For instance, prior to COVID-19, there were 70 million adults with mental illness in the country and about 1.25 billion Indians at risk of malaria. Equally worrying, if not more, is people suffering from tuberculosis. Not only have their treatment schedules collapsed, they are living with their family during the lockdown with chances of them getting infected with the disease.  Over 28 million cases of tuberculosis were live pre-COVID-19.

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Besides, there are COVID-linked manifestations in rising number of suicides (among men, perhaps triggered by joblessless and no income), increased liquor consumption, domestic violence, unattended pregnancies and unwanted pregnancies. The full impact of all of it could be manifested in the next few months. To top it all, over 80 million migrants (as per the finance ministry) need help.

"A large number of them are on the roads, returning home and coping with challenges of hunger and exhaustion along the way," says Desiraju.

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