Medical services under government health insurance programs across the country decreased by 51% and the national Health Management Information System (HMIS), which collates monthly reports from the public health system, reported dramatic decreases in preventive and curative care ( IndiaSpend, 2020a Smith et al., 2020).Ī second wave of COVID-19 infections engulfed India in 2021, with the country reaching close to 400,000 new cases daily in early May 2021, far exceeding the first in magnitude ( Johns Hopkins 2021). National restrictions were eased 10 weeks later, at the beginning of June, but localized restrictions continued in areas with high case counts.Īlthough critical health services were officially exempt from the lockdown, the media reported 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 ( Indian Express, 2020 IndiaSpend, 2020 New York Times, 2020). The lockdown was announced with 4 h’ notice, barred people from leaving their homes, required non-essential commercial establishments and transport services to close, and was enforced strictly with penalty of arrest ( Ministry of Home Affairs, 2020). On March 24, 2020, the Government of India ordered one of the most stringent nationwide COVID-19 lockdowns in the world to control virus spread ( Hale et al., 2020). 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. Females, socioeconomically disadvantaged groups, and patients living far from the health system faced worse outcomes. 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. 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%. 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. Transport barriers, hospital service disruptions, and difficulty obtaining medicines were the most common causes. 63% of patients experienced a disruption to their care. Post-lockdown mortality was our primary outcome and morbidity and hospitalization were secondary outcomes. 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. However, linking these disruptions to effects on health outcomes has been difficult due to the lack of reliable, up-to-date health outcomes data. India's COVID-19 lockdown, one of the most severe in the world, is widely believed to have disrupted critical non-COVID health services.
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