The effects of India's COVID-19 lockdown on critical non-COVID health care and outcomes: Evidence from dialysis patients

Abstract

India's COVID-19 lockdown, one of the most severe in the world, is widely believed to have disrupted critical non-COVID health services. However, linking these disruptions to effects on health outcomes has been difficult due to the lack of reliable, up-to-date health outcomes data. We identified all dialysis patients under a statewide health insurance program in Rajasthan, India (N = 2110), and conducted surveys to examine the effects of the lockdown on non-COVID care access and health outcomes. Post-lockdown mortality was our primary outcome and morbidity and hospitalization were secondary outcomes. 63% of patients experienced a disruption to their care. Transport barriers, hospital service disruptions, and difficulty obtaining medicines were the most common causes. We compared monthly mortality in the four months after the lockdown with pre-lockdown mortality trends, as well as with mortality trends for a similar cohort in the previous year. Mortality in May 2020, after a month of exposure to the lockdown, was 1.70 percentage points (95% CI 0.01–0.03) or 64% higher than in March 2020 and total excess mortality between April and July was estimated to be 22%. A 1SD increase in an index of care disruptions was associated with a 0.17SD (95% CI 0.13–0.22) increase in a morbidity index, a 3.1 percentage point (95% CI 0.012–0.051) increase in hospitalization, and a 2.1 percentage point (95% CI 0.00–0.04) increase in probability of death between May and July. Females, socioeconomically disadvantaged groups, and patients living far from the health system faced worse outcomes. The results highlight the unintended consequences of the lockdown on critical, life-saving non-COVID health services that must be taken into account in the implementation of future policy efforts to control the spread of pandemics.

Men smoke less under the COVID-19 closure policies: The role of altruism

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The rapid and efficient strategy for SARS-CoV-2 Omicron transmission control: analysis of outbreaks at the city level

“…Thus, implementing positive control measures (dynamic zero-COVID strategy and restriction measures) can protect vulnerable populations and help to cope with the uncertainties associated with emerging variants and the lingering effects of COVID-19 in future. Although critical health services were exempt from the strict suppression strategy, widespread disruptions to routine and emergency non-COVID care due to transport and curfew barriers for patients and health workers, hospitals turning patients away, and supply chain disruptions that affected medicine access and costs [41]. It should be emphasized that life-saving services must be taken into account in the implementation of lockdown.…”

A survey of patient and public perceptions and awareness of SARS-CoV-2-related risks among participants in India and South Africa

“…Employed participants may be more likely motivated to maintain good health or hesitant to confirm illness, for fear of losing money or work, resulting in fewer visits to healthcare facilities, than those unemployed. While lockdown measures can reduce patient presentation to healthcare facilities [33,34], such a decline in presentation may also be associated with later presentations with more severe consequences. Initiatives are required to address gaps in patient care necessitated by public health promotion strategies such as lockdowns in this and future pandemics.…”