As Covid-19 gripped the nation with 88054 confirmed cases and 2872 deaths as of 17th May, 2020, the lockdown which was initiated on 25th March 2020 and then extended till 17th May 2020 has negatively impacted people’s access to essential health care services, especially for the elderly and chronically ill populace. With chronic non-communicable diseases (NCDs) like cardiovascular ailments, cancer, diabetes, chronic respiratory ailments and other NCDs accounting for 63 per cent of the total deaths in India , the threat they pose to households and the healthcare system in non-pandemic times is outrageous. Our estimates from the most recent National Sample Survey (NSS) 75th round (2017-18) data show that around 8.6 per cent of the population are aged 60 years and above and approximately 3.7 per cent of the Indian population are chronically ill; with Kerala having the highest share of chronically ill population (18.2 per cent), followed by Andhra Pradesh (10.4 per cent) and West Bengal (9.0 per cent).
With a scarcity of population-based data, one has to rely on sample surveys like NSS and National Family Health Survey (NFHS 4- 2015-16) to get estimated prevalence of chronic ailments in India. Our estimates on the incidence of select chronic ailments from NFHS-4 data shows that 4 – 4.4 per cent of men and women aged below their mid-50s suffer from any three chronic diseases (viz. diabetes, heart disease, asthma). In a similar fashion, estimates from NSS 75th round data reveals that for people aged above 50s, the rate is as high as 11.6 per cent for India with Kerala having the highest burden, followed by Andhra Pradesh, West Bengal, Punjab, Maharashtra, Gujarat and Tamil Nadu. Estimates from both the data sources further suggest that prevalence of cancer is not very low in India. States such as Tamil Nadu, Jharkhand and Madhya Pradesh dominates in prevalence rates of cancer for the men aged below mid-50s, while Bihar, Tamil Nadu and Karnataka have higher prevalence rates of cancer for women aged below 50s. For people aged 50 years and above, Kerala, West Bengal, Uttarakhand, Haryana, Punjab and Rajasthan exhibit cancer prevalence rate higher than the national average. These figures clearly portray the enormous section of Indian population in need of regular healthcare. Unprecedented lockdown and its eventual repetition to arrest the spread of Covid-19 have blatantly deprived this section from availing regular healthcare services such as chemotherapy, dialysis, blood transfusions or even life-saving drugs. The brunt is fueled from multiple shortfalls in anticipation and planning.
The secondary and tertiary hospitals primarily in charge of providing chronic healthcare services are now clogged with Covid-19 patients. Credible prints and online news portals reported night shelters near AIIMS swarmed with unattended cancer patients for days. The closure of all OPD and speciality services in AIIMS from March 24th onwards has left them stranded without either treatment or food. According to a senior oncologist at Mumbai-based Tata Memorial Hospital, there has also been a sudden dip in inter-state inflow of patients. Although follow-ups are being done telephonically and via online, many people do not have the know-how or access to those means. The situation is equally grim for patients requiring dialysis as they are facing similar problems due to mobility restrictions and non-availability of public transport services. The dialysis centres are struggling with staff crunches and irregular supplies of essential utilities such as dialyser, needles and anticoagulants. Besides, there are several reports that HIV patients are unable to reach local ART centres for medicines. Missing regular doses would probably bring down their immunity and make them more susceptible to getting co-morbidities like TB. Life-saving drugs and essential diagnostics are far-fetched as laboratories are also not operational in the lockdown.
The lockdown has further affected the provision of medicines and medical devices to healthcare facilities and pharmacies. In fact, few district administrations in various states/ UTs have given directions to close the manufacturing operations of pharmaceutical and medical device industry as part of measures to contain the spread of coronavirus. The lockdown has also seriously impacted the volume and frequency of blood donations. With 3321 licensed blood banks, there already exists a documented imbalance between its demand and availability in the non-pandemic times which has only aggravated in the present times.
Despite assurance from central and state governments that essential services would continue amidst lockdown, the limited resources cannot conform to this while prioritizing Covid-19 cases. The central ministry of health issued detailed guidelines on 17th April 2020 regarding non-elective surgery and medical interventions and mentioned several measures which includes conducting infant check-ups at home and delivering medicines. It also envisaged that states should ‘ensure uninterrupted availability of dialysis and cancer treatment services’ and facilitate ‘easy movement of these patients to access care.’ The reality is multiple hospitals located nearby containment zones or in general had to shut their OPD services and defer surgeries over concerns of coronavirus infection in the hospital premises. The remaining hospitals have been turned into specialised units for treating Covid-19 cases, with chronic non-Covid patients nowhere to go.To add further insult to the injury, Covid-19 tests have been made mandatory before receiving any kind of treatment, irrespective of no contact or symptoms of the patients. This is happening even though the Union Health ministry has directed hospitals not to deny treatment to any patients who are not Covid-19-positive. In fact, there have been reports of deaths due to hospitals’ refusal to admit patients fearing they might be infected with the virus. While Covid-19 deaths are being tracked on an hourly basis, there are no official death counts from other sources which are attributed to the lockdown itself. But anecdotal evidence from media reports, doctors, and activists suggests they have been happening quite a lot. Cardiac specialists are puzzled by the sudden dip in emergency heart attack cases in the lockdown phase and they fear that patients being afraid of getting infected, prefer to die at home.
Estimates from the health surveys clearly indicate that section of the population which requires regular chronic care is huge but it is almost evident from print/online newspapers/portals that chronic care has been jeopardised in the current times. An excessive focus on the Covid positive patients while neglecting the chronic healthcare need, will only aggravate the net disease burden to mammoth levels in the future. Country’s health sector must find a way where access to regular essential healthcare services is not restricted along with its continuing emphasis on identification, isolation and treatment for Covid-19 cases.
Subrata Mukherjee is an Associate Professor and Priyanka Dasgupta is a Ph.D Scholar at the Institute of Development Studies, Kolkata.