Current Medicine Research and Practice

SHORT COMMUNICATION
Year
: 2021  |  Volume : 11  |  Issue : 6  |  Page : 298--302

Impact of lockdown on patients other than COVID-19 in India


Avadhesh Kumar Yadav 
 Department of Physics, F. A. A. Government P.G. College, Sitapur, Uttar Pradesh, India

Correspondence Address:
Dr. Avadhesh Kumar Yadav
F. A. A. Government P.G. College, Mahmudabad, Sitapur - 261 203, Uttar Pradesh
India




How to cite this article:
Yadav AK. Impact of lockdown on patients other than COVID-19 in India.Curr Med Res Pract 2021;11:298-302


How to cite this URL:
Yadav AK. Impact of lockdown on patients other than COVID-19 in India. Curr Med Res Pract [serial online] 2021 [cited 2022 May 19 ];11:298-302
Available from: http://www.cmrpjournal.org/text.asp?2021/11/6/298/334578


Full Text



 Introduction



The global health emergency due to the pandemic of COVID-19 has affected the lives the peoples for many perspectives such as medical facilities, education, economic growth, food facility/hunger[1] business, agriculture and public and private sector employment.[2] As per the report of World Health Organisation (WHO), COVID-19 has affected to 213 countries and territories including India (WHO 2020).[3] Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reaches in peoples in the form of respiratory droplets produced when an infected person coughs and sneezes.[4] According to the US Centres for Disease Control and Prevention, the reachability of SARS-CoV-2 droplets is below 6 feet distance.[5] The required distance among the peoples can be ensured by the social or physical distancing to control the COVID-19 which is the appropriate way in the absence of any medicine and vaccine.[5],[6] To ensure the social distancing among the peoples in India, the Government of India (GoI) has imposed the country lockdown from 25th March 2020 to 31th May 2020 in four steps.[7] During the lockdown, all public and private transports were not allowed to run. Moreover, outpatient department services in the hospitals were closed for general patients (other than COVID-19) during the lockdown. Several diseases such as hypertension, diabetes, joint and musculoskeletal collectively create bulk of patients. These patients were facing unprecedented sufferings due to limited health-care services.[8] Trauma and orthopaedic surgery services has been reorganised with significant cancellation of elective surgery to focus on acute clinical priorities on the coronavirus frontlines.[9] A patient with osteoporosis requires complete care, multidisciplinary intervention and patient centric rehabilitation plan and all these were affected due to COVID-19.[10] COVID-19 has also severely impacted deceased donor liver transplant (DDLT) programs throughout the India. This may be due to decreased liver donors due to the unknown risks associated with COVID-19 transmission or post-operative infection in the immediate post-transplant period. This risk is not limited to livers donors but the risk to the health-care workers in a multidisciplinary setting was underlined. DDLT has come to a standstill in the setting of a national lockdown.[11] The epidemiologist Amitav Banerjee quoted that 'Corona is queen! However, other pieces on the chess board matter as much.'[12] The telemedicine facilities are provided for medical suggestions in government hospitals during this period. However, due to the lack of information and proper literacy in the huge population in India, how effective is the telemedicine facility. Moreover, health-care providers including doctors who were connected with their patients through the digital ways of communication suddenly faced a heavy influx of messages, calls and mails.[13] In addition to above, poor internet connectivity, lack of proper hardware, improper handling of smart phones, poor understanding/poor hearing ability and background disturbances (noises) at from patient's place are also matters the medical access during the lockdown.[13]

Several reports published in Indian print and electronic media indicate about the disruption in medical facilities for peoples due to lockdown restriction. An article published in the Times of India marks the struggle of cancer, HIV and other patients. In this article, several interviews of patients were also reported.[14] The previous studies and surveys also represent the problem of medical treatments for general patients. Nair et al.,[8] Nasta et al.[15] and Prasad et al.[16] have reported the impact of lockdown restriction on regular medical services for ophthalmic, general surgical and kidney, respectively. The public health specialists have also pointed that the ambulances and other medical facilities were switched to COVID-19 patients.[17] Thus, the present study is an attempt to evaluate the impact of lockdown on patients other than COVID-19 to access the medical treatment, diagnosis, scheduled vaccination in terms of accessibility and cost.

 Materials and Methods



In the present study, we have tried to evaluate the impact of lockdown on patients other than COVID-19 by using the online survey that was also supported by media reports and existing data. For this purpose, online survey was carried by using questionnaire on Google forms. The questionnaire was prepared on Google form which consists of basic information sheet and sheet containing the questions to evaluate the impact of lockdown on patients other than COVID-19. The basic information comprises of demographics (city and country) and personal characteristics (email, name, age, gender, education, profession and income). The second part of questionnaire contains six questions and each question except 4th consists of two or three sub-questions. The respondent can select more than one answer in sub section i and ii of question 1 and subsection i of question 5. The survey questionnaire was translated into English and Hindi. The questionnaire was validated by three independent experts. The prepared questionnaires were circulated to people through E-mails. The participants were also encouraged to share the link of online survey to their friends and other known persons. The link of online survey (https://forms.gle/FrnzM6omhNjVHccc6) was E-mail verified to avoid the multiple responses by single respondent. The survey was started for responses from 1st June 2020 and closed to 20th July 2020 to share the experience during the lockdown. During this period, there are 1140 peoples participated in the online survey. The data collected from the online survey were used for further analysis.

 Results and Discussion



During the period of the survey, there were 1140 responses obtained and out of these, only 1105 responses were analyzed because they contain the complete and appropriate information submitted by respondents. Rest responses were omitted because the respondents had given responses for those questions which were not applicable to them as responded the previous question. Out of the 1105 respondents, 68.2% respondents were male and rest is females. In these responses, 63.7% responses were responded by participants of age group 25–45 years. The responses in online survey were obtained from 17 states and union territories of India, as shown in [Table 1]. The highest number of participants belongs to Uttar Pradesh which is also the highest populated state of India. During the lockdown, 25.6% respondents answered that they or their family member become ill as indicated in [Figure 1](a). The individual who become ill during this period has faced the problem in several steps. Moreover, many persons felt difficulty in more than one step. The maximum problem was observed in transport (47.3%) due to the absence of public transport. The closure of private hospitals is second major problem as 31.8% respondents have faced. Thereafter, 23.3%, 21.7%, 20.9% and 14% respondents have observed the difficulty in treatment due to the absence of doctor, government hospitals not accepting the patients, non-availability of medicine and diagnosis, respectively as shown in [Figure 1]a (i). Due to lockdown restrictions, 21.3% respondents reported that they did not receive the treatment and 41% respondents have taken the home treatment in form of either home remedies or medicine without consultation of doctor, whereas 17.2% and 35.2% respondents have used the emergency service in hospitals and telemedicine services, respectively as indicated in [Figure 1]a (ii). The similar problems are also reported in case of patients for ongoing treatments. The patients who have ongoing treatments share the contribution 35.9% in this survey, as shown in [Figure 1]b. Out of this, 15.2% cannot get treatment after the lockdown, whereas 9.1% respondents have faced the difficulty in reaching the hospitals. Moreover, 40.9% respondents fail to receive the proper treatment due to both reasons. Only 34.8% respondents have reported that they did not have any difficulty in getting medical treatments as indicated in [Figure 1]b (i). [Figure 1]b (ii) indicates that 45.2% respondents have not get proper pathological and diagnosis assistance due to closure of private pathologies and diagnostic centres during the lockdown. The lockdown has also impacted the scheduled vaccination to the children as shown in [Figure 1]c (i-ii). The children who cannot receive the vaccine during the lockdown share 51.9% in total scheduled vaccination. In addition, 54.4 respondents answered that their children were not getting the vaccination timely. Only 45.3% children for scheduled vaccination were able to access the vaccine timely in government hospitals (26.9%), private hospitals (12.5%) and in their home by inviting the doctors (8.7%). Inclusively, about 79.9% respondents (25.6% new patients + 35.9% patients having ongoing treatment + 18.6% vaccination cases) were impacted by lockdown to access the medical treatment or vaccine, but this number may be lower as two or three cases may exist in single family. The patients have spent more money for medicine and vaccine as agreed by 24.4% respondents and overall cost of medical treatment is also enhanced as responded by 48.9% respondents [Figure 2]a and [Figure 2]b. [Figure 2]b (i) indicates that the cost of treatment is increased in testing, medicine, transportation and fee of doctor as responded by applicable respondents (38.5%, 37.8%, 33.1 and 33.1%, respectively). 17.9% respondents have also responded that they or their family member had suffered by cold, sore throat or fever in the lockdown down period [Figure 2]c, and in this case, 20.3% respondents had feared for infection of COVID-19 [Figure 2]ci. In this situation, only 12.1% respondents have called to COVID-19 control room and 11.4% has wanted to call but finally decided to not call control room [Figure 2]ii. Thus, simple cold, sore throat and fever have also created the mental pressure due to limited access of medical facility during the lockdown.{Figure 1}{Figure 2}{Table 1}

The present study suggests that COVID-19 and lockdown led to the marked disruption of the entire medical facility either in government hospitals or in private hospitals and pathological/diagnosis centres. In addition, lockdown has also disrupted the inpatient services, outpatient services. As a result of lockdown, not only the patients having the ongoing treatment but patients during the lockdown were also highly impacted and unable to get the proper medical treatment. The significant disruption in the outpatient and other mental health services across the country was reported in the several studies that are consequence of lockdown restriction in movement and fear of getting infected. Moreover, the inpatient services were disrupted because the inpatients care is provided in open wards as per the instruction of general hospital psychiatry units.[18] Thus, in situation of COVID-19 epidemic, it is difficult to control the movement of patients, caregivers and other visitors. Another important positive aspect was seen in this survey that telemedicine services was used by 43% respondents and services are provided as per recent telemedicine guidelines from the GoI.[19] Telemedicine services are not useful who have need of medical diagnosis, surgical treatment and vaccination because in these cases the physical presence is essential. Thus, these services are not properly accessed during the lockdown after being the availability of telemedicine.

Limitations

The study is particularly based on the online survey which has certain limitations. The questionnaires are tried to circulate widely via all possible social media platforms for higher level of participation. Instead for being wide circulation, only limited rate of responses were obtained corresponding to circulation. Moreover, the survey was limited to those, who are able to access the smart phones and computer or laptop. Thus, it can be said that the study participants may not be representative of people from the various strata of the country. However, in the current situation of pandemic of COVID-19 and lockdown, this was best possible research methodology to reach at the people to understand and estimate the impact of lockdown on patients other than COVID-19.

 Conclusion



The entire world has faced a greatest medical emergency of this era that was arisen due to pandemic of COVID-19. The current pandemic has not only changes the lifestyle in medical aspect but also it affected the all scenario of business, education, economy, public relations, etc. India is also significantly affected by COVID-19. Due to unavailability of specific medicine and vaccine at the first wave of this pandemic for the proper treatment of COVID-19, the preventive measures become very important for health. At initial stages, social distancing was a significant way to control the spread of COVID-19. To ensure the social distancing measure, lockdown was imposed in India. During the lockdown period, all activities except the essential services were suspended. In the absence of routine medical treatment services, the regular patients and patients other than COVID-19, who are getting the treatment before the lockdown, were failed to take proper treatment. The scheduled vaccination of children was also delayed due to the lockdown. Transport was the major factor for accessing the medical treatment. Moreover, the most of the private hospitals are closed, government hospitals are not taking the general patients and regular outdoor patient departments' services were also suspended during this period. Most of the doctors were absent for giving the treatment for general patients because they were mainly concerned with COVID-19. The cancer patients, who are taking treatment in combination with monoclonal antibodies, were not able to take their systematic treatment. In addition to above, the cost of treatment of patients was also increased during this period. The cost of treatment was increased due to increase in testing/diagnosis cost, medicine, fee of doctors and transportation. The fear of COVID-19 infection was also a factor to take treatment in hospitals because COVID-19 care wards were established in the hospitals.

Acknowledgement

The author acknowledges the Google for using the online survey. The participants are also acknowledged for their participation in survey.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Yadav AK. Fight against novel coronavirus and hunger in India. Curr Med Res Pract 2020;10:198-200.
2Haleem A, Javaid M, Vaishya R. Effects of COVID-19 pandemic in daily life. Curr Med Res Pract 2020;10:78-9.
3World Health Organization; 2020. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public. [Last accessed on 2020 Jun 09].
4Ningthoujam R. COVID 19 can spread through breathing, talking, study estimates. Curr Med Res Pract 2020;10:132-3.
5US Centers for Disease Control and Prevention (CDC). Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/index.html. [Last accessed on2020 Nov 20].
6Yadav AK. Impact of lockdown to control over novel coronavirus and COVID-19 in India. J Family Med Prim Care 2020;9:5142-7.
7Ministry of Home Affaires, Governemnt of India. Available from: https://www.mha.gov.in/sites/default/files/MHADOLrDt2152020.pdf. [Last accessed on 2020 May 21].
8Nair AG, Gandhi RA, Natarajan S. Effect of COVID-19 related lockdown on ophthalmic practice and patient care in India: Results of a survey. Indian J Ophthalmol 2020;68:725-30.
9Stahel PF. How to risk-stratify elective surgery during the COVID-19 pandemic? Patient Saf Surg 2020;14:8.
10Riemen AH, Hutchison JD. The multidisciplinary management of hip fractures in older patients. Orthop Trauma 2016;30:117-22.
11Pahari H, Shellagi N, Nath B. Deceased donor liver transplantation in India in the COVID-19 Era: Current scenario and future perspectives. Transplant Proc 2020;52:2684-7.
12Word Press. Available from: https://intheedition.wordpress.com/2020/05/19/corona-is-queen-but-other-pieces-on-the-chess-board-matter-as-much/. [Last accessed on 2020 Jul 25].
13Ghosh A, Dutta K, Tyagi K, Gupta R, Misra A. Roadblock in application of telemedicine for diabetes management in India during COVID19 pandemic. Diabetes Metab Syndr 2020;14:577-8.
14Nagarajan R, Dhar S. Available from: https://timesofindia.indiatimes.com/india/how-covid-war-is-hurting-indias-non-covid-patients/articleshow/74949121.cms. [Last accessed on 2020 Apr 03].
15Nasta AM, Goel R, Kanagavel M, Easwaramoorthy S. Impact of COVID-19 on general surgical practice in India. Indian J Surg 2020;26:1-5.
16Prasad N, Bhatt M, Agarwal SK, Kohli HS, Gopalakrishnan N, Fernando E, et al. The adverse effect of COVID pandemic on the care of patients with kidney diseases in India. Kidney Int Rep 2020;5:1545-50.
17Bmj IC. Covid-19: India should abandon lockdown and refocus its testing policy, say public health specialists. BMJ 2020;370:m3422.
18Grover S, Mehra A, Sahoo S, Avasthi A, Tripathi A, D'Souza A, et al. State of mental health services in various training centers in India during the lockdown and COVID-19 pandemic. Indian J Psychiatry 2020;62:363-9.
19Ministry of Health and Family Welfare, Government of India. Available from: https://www.mohfw.gov.in/pdf/Telemedicine.pdf. [Last accessed on 2020 Jul 25].