Since March, 2020, the world has witnessed unprecedented countrywide lockdowns, of different periodicity and stringencies. By early April, half the world’s population was under some form of lockdown.
On March 24, India announced its own nationwide lockdown, one of the most stringent in the world, which has since been extended twice.
The country has witnessed large-scale violations of the lockdown by desperate people, particularly stranded migrant workers finding themselves unemployed overnight on March 25, trying to get home to their villages.
A big debate continues worldwide on the necessity and efficacy of these lockdowns, as researchers attempt to explore whether a lockdown could even prove counterproductive in terms of its own stated aims. It’s evident that lockdowns have sweeping implications, causing many difficulties to a very large number of people; hence its only justification is its stated predominant aim of reducing the anticipated high mortality from the COVID-19 infections caused by the novel coronavirus.
However, what happens if a prolonged lockdown of over a month itself leads to more deaths than it saves?
Let’s focus on India, which has thousands of patients for non-COVID-19 ailments, including heart disease, stroke, cancer, kidney ailments, diabetes, respiratory infections, maternity and child-birth related care and complications, serious injuries, other infectious diseases etc., who need emergency or frequent medical care, some of which is only possible in hospitals. The prolonged lockdown has created serious problems for such patients to access medical services and medicines.
Already, fixed surgeries and procedures have been cancelled.
There do exist some general provisions for serious patients to obtain special passes, and also to maintain supply of medicines. Despite this, many patients are facing great difficulties in accessing essential medicines and medical services. Even when passes are obtained and transport arranged, people have faced inability to pay for medicines and services, as livelihoods have been disrupted by the lockdown.
Several hospitals and medical facilities are not functioning at earlier capacities and others have been diverted as exclusive COVID-19 facilities. Thus, even several patients who can afford to, may not have been able to access essential medical care.
The World Health Organisation has pointed out, citing two specific studies, that during the 2014-16 Ebola outbreak in West Africa, health systems were overwhelmed and as a result the extra deaths (over and above the normal number) related to diseases likes measles, malaria, HIV/AIDS and tuberculosis (TB) were higher than deaths caused by Ebola itself. The number of institutional child births also drastically reduced.
Second, prolonged lockdowns have led to disruption of livelihoods, particularly in developing countries like India with a predominantly informal sector workforce, unprotected by job security and social security. This has in turn led to higher levels of poverty, hunger and malnutrition – which will cause deaths well after the lockout eventually ends.
This has also led to increasing physical and mental stress. Jobless, cashless parents are locked in with hungry children. Researchers have already warned about the possibility of a significant rise in suicide rates.
Many people are facing a double whammy, lockdown-related poverty and reduced availability of medical care and treatment for non-COVID diseases and medical problems.
The most obvious example is of TB patients. TB causes 4.4 lakh deaths a year in India alone. During the first seven weeks of the COVID-19 outbreak in India, the per day COVID-19 mortality in India was around 8, while during the same seven weeks the per day tuberculosis mortality in India was 1,090.
There are also increasing risks of multi-drug resistant TB. TB is certainly curable but TB patients have to take medicine very regularly over a period of several months. Most TB patients are poor and need free medicines.
Experience has shown that regular contact with patients plus regular motivation is necessary, apart from access to free medicines, to ensure completion of the entire course of TB treatment. If the lockdown and related factors lead to accentuation of poverty for TB-affected households and if this in turn reduces or disrupts treatment for TB patients, there is likely to be a significant rise in TB-related mortality.
Another aspect of the debate relates to whether lockdowns actually succeed in reducing even COVID-19 deaths significantly, particularly in developing like India. In these countries, a significant number of people live in cramped and congested housing conditions, where social distancing is all but impossible. Managing a prolonged lockdown in such conditions itself distracts from the original aim of reducing COVID-19 infection risk.
Hence, the lockdown turning counterproductive certainly exists. There is a very real possibility of lockdowns causing a very significant increase in mortality relating to poverty, hunger and denial of critically needed medical care for non-COVID patients. At the same time, reports of increasing hunger, undernutrition and malnutrition, mental stress and exhaustion are only increasing.
These factors need to inform planning to reduce the widespread distress and mortality people may suffer in the short, medium and longer term due to the effects of the prolonged lockdown.
Bharat Dogra is convener, Save the Earth Now Campaign, and author of Planet in Peril and Saving Earth for Children.