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When cure is worse than disease

UNICEF warned in a message that millions of mothers and babies born during Covid-19 will be threatened by a strained health system and disruptions in health services.

Bharat Dogra | New Delhi |

According to recent research conducted by an international group of surgeons and published in the British Journal of Surgery, based on a 12-week period of peak disruption in hospital service due to Covid-19, some 28.4 million elective surgeries worldwide are likely to be cancelled or postponed.

This will lead to patients facing a lengthy wait for their issues to be resolved. Around 2.3 million cancer surgeries are likely to be postponed, while some of these may have to be cancelled. Each additional week of disruption to hospital services will be associated with a further 2.4 million cancellations of various surgeries. In India 5,84,737 surgeries may be postponed or cancelled over a 12-week period of Covid19 peak.

On 6 May, Unicef warned in a message that millions of mothers and babies born during Covid-19 will be threatened by a strained health system and disruptions in health services. Counting nine months from the day of the recognition of Covid-19 pandemic, 116 million babies are expected to be born worldwide (20 million in India). Many of these mothers and babies will have to face the problems associated with lockdowns and curfews, or their after-effects, health centres overwhelmed by COVID response efforts, shortages of supplies and equipment and a lack of sufficient skilled birth attendants as health workers, including midwives, are redeployed to treat Covid-19 patients.

The World Food Program has warned of accentuation of hunger in a large area of the world, linked also to ongoing conflicts and other problems, but aggravated by various disruptions related to Covid-19, including loss of livelihoods. The International Labor Organization and Oxfam have warned about unprecedented levels of loss of employment and livelihoods in a very short time and huge numbers of people being pushed into poverty with all the attendant deprivations including hunger. These are only a few warnings from various international organisations and groups regarding how costly the various disruptions related to the response to Covid-19 may prove.

Prolonged lockdowns and curfews have thrown normal life out of gear in a hundred different ways, creating problems of food insecurity, lack of treatment for serious diseases and conditions, loss of jobs and earnings, tensions and distress for countless people. During the first five and a half months of the pandemic, about 166 days, on May 15 about 300,000 people were reported to have died worldwide from Covid-19, an average of about 1,700 deaths per day worldwide. However, during the same period mortality per day worldwide from all other causes averaged about 160,000 per day. Thus Covid-19 deaths worldwide per day have been about 1 per cent of deaths from all other causes.

Now let us assume that because of increased hunger, undernutrition and malnutrition; distress, tensions, stress and above all denial of essential medical treatment the mortality from all other causes goes up by 8 per cent or so. True, there will also be some reduction of mortality related to reduced pollution and (on the whole) fewer accidents in lockdown conditions, but it will still be reasonable to assume that after providing for this aspect there could be a net increase of about 8 per cent in mortality due to all causes other than Covid-19. In the context of normal mortality of 160000 per day worldwide this could lead to an increase of 12800 deaths per day.

In India till May 15, there were about 3,000 Covid-related deaths till May 15 over a period of about 77 days, or about 39 deaths per day. The number of daily deaths from all other causes in India is around 27000. Hence the number of Covid deaths in India is not even 1 per cent, it is less than 0.2 per cent of deaths from all other causes. So while asserting strongly the importance of all essential precautions like washing hands and maintaining social distance, a question needs to be raised about the extent to which it is desirable to shut down the entire country in the name of a disease which has so far accounted for less than 0.2 per cent of mortalities from other causes.

If as a result of the disruptions, mortality rises by 8 per cent then this leads to additional 2,160 deaths per day. A counter-argument may be given that lockdowns may still be necessary because of fears of higher mortality from Covid in future. Here it needs to be pointed out that while earlier fatality rate estimates put out by the WHO were indeed on the higher side, several eminent independent scientists, including some of the most cited and renowned experts, have since expressed the opinion that the fatality rate of Covid is likely to be substantially lower than the earlier WHO estimates and is unlikely to be significantly higher than that of seasonal influenza. It is true that there are several uncertainties associated with a pandemic related to a new virus. But it is after all a virus of the wider coronavirus family which has been known to scientists for several decades.

Even other coronaviruses have been known to have high risk in terms of a triggereffect for the death of aged residents of nursing homes having several other serious health conditions, but for the general population their fatality rate has not been high. In some Western countries a very significant share of recorded Covid deaths have involved elderly nursing home inmates (average age 79 or so in Italy) with several other serious ailments and also suffering from desertion of several caregivers due to Covid panic. Once more Covid deaths began to be reported from nursing homes, other deaths with somewhat similar symptoms also got recorded as Covid-related.

Mere presence of the virus made it the cause of death, while other pre-existing ailments were ignored. These are only a few of the factors that resulted in creation of panic conditions which were not justified by hard evidence and led to drastic actions with a worrying impact on vulnerable sections, such as migrant workers in India. Many scientists are now questioning the false, panic-driven over-reaction of draconian actions and are suggesting community-based responses which protect livelihoods. They are asking for evidence-based response so that the emerging tragedy of the cure proving worse than the disease can be checked.

(The writer is Convener of Campaign to Save Earth Now and author of recently published books Planet in Peril and Protecting Earth for Children)