Next six months crucial for India in dealing with COVID-19 pandemic
Based on results of extended SIER model, and a potential status quo in infection control and prevention measures, a UNICEF study projects over 490,000 deaths between October 2020 and September 2021
The unprecedented spike in COVID-19 infections in India one year after the lockdown was imposed on March 24 is an alarming threat not only in terms of infection and death but lives in general due to the impending economic disruption if India does not plan for the crucial next six months, up to September 2021. The latest UNICEF report on “Direct and indirect effects of the COVID-19 pandemic and response in South Asia” contains the warning the country must pay heed to.
Based on the results of the extended SIER model, and a potential status quo in infection control and prevention measures, over 490,000 deaths are projected in the study in India between October 2020 and September 2021. It means that India needs additional mitigation measures to prevent such a large number of additional deaths.
With a sharp rise of infections, the number of hospitalizations and ICU admissions in the country are also going to see a spike, from the lowest level of infections and deaths in February 2021, as we can see in the latest trend in the country. To handle this, we urgently need to strengthen the healthcare system in the country.
The report says that instituting all mitigation strategies could reduce the numbers of deaths due to COVID-19 by 83 per cent. In absolute numbers, it may be reduced to 85,821 deaths from 491,117 deaths under the no-additional mitigations scenario. ICU admissions could similarly be reduced by 75 per cent with additional mitigations strategies apart from the present deployment.
India would need to spend a huge amount of money to prevent such a large number of additional deaths by September 2021. The study has estimated that India is expected to bear the largest share of these costs in South Asia, with the country having to spend more than US$ 7.8 billion on testing, and US$ 1.7 billion on healthcare utilizations due to COVID-19 infections leading to death.
Although there will be costs associated with implementing COVID-19 mitigations strategies, such as households having to spend money out-of-pocket in purchasing masks and hand sanitizers, these cannot be measured with any specificity. However, any costs associated with increased use of masks and hand sanitizers will likely be much lower than what will be needed to spend on COVID-19 healthcare utilization.
Even if the government of India decides to stick to no additional mitigation, it would have to spend US$2.3 billion on testing. Hand hygiene would cost the country around US$659 million, smart lockdowns (i.e. local lockdowns) US$ 1.1 billion and masks US$ 845 million. The additional strategies would cost the country about US$404 million.
It is clear that India would need an additional amount, much more than what is provisioned in the Budget 2021-21, which had not visualized the deteriorating conditions ahead. States are financially in very bad shape and it has already been reported that some of the states are not able to spend what is required in successfully containing the spread of the disease. The Union government would thus need to enhance the centre’s financial support to the states.
Private hospitals are now leading the vaccinations programme in the country, and therefore, many people who could afford it may prefer the private sector. People should also be ready for such a scenario in which they may need to spend from their own pocket.
Maternal and child mortality and nutrition are also going to deteriorate. Even before the WHO declared COVID-19 a pandemic on March 11, 2020, the coverage for essential SRMNCH services for children and women were being affected. The observed and estimated disruption is expected to have substantial impact on women and children’s mortality.
The anticipated deaths in India would be greatest in South Asian countries with a 15 per cent increase, which is 154,020 in absolute terms. The number of stillbirths is also predicted to increase. Again, the largest increase in the number of stillbirths is expected in India, which is going to increase by 10 per cent, about 60,179 in number.
The highest number of maternal deaths is also anticipated for India which will increase by 18 per cent, about 7,750 in absolute numbers.
Due to the observed and expected reduction in coverage of modern contraceptive methods during the pandemic and its containment measures, more than 3.5 million additional unintended pregnancies are expected in the region, with the highest number in India, which would be around 3 million. The number of unsafe abortions is also expected to increase by more than 50 per cent, because healthcare facilities would not be available during the pandemic.
The report has tried to explain the COVID-19 challenge in 2021. The authors have made conservative estimates due to the continued gradual upsurge in India during the initial months of 2021, which has lately been rising sharply, since mid-February. It has also noted the deployment of vaccines which is not widely available for the people of the country.
The report has assumed that service coverage across SRMNCH services could see an increased somewhere only between 10 to 20 per cent in the first half of 2021.
School-age child and adolescent mortality among 15-19 age group females is also going to increase, because many of they would be married off during the pandemic. They are out of school because of closure. The greatest increase in death is anticipated in India. Nutrition-related problems would also increase due to closure of schools and unavailability of mid-day meals. A rise in communicable disease-related adolescent mortality would also likely increase.
As a result of prolonged school closures in response to COVID-19, almost 9 million primary and secondary school-aged children are expected to permanently drop out of schools in South Asia, with the highest number of over 7 million being from India. The disruption will have a considerable economic cost over the long term. It would lower their lifetime earnings by 15 to 23 per cent. It would cost India US$ 52.8 billion.
In this scenario, India needs many additional measures to tackle the challenge ahead, which has already impacted lives and livelihoods enormously. Millions of people have been pushed to extreme poverty and millions have been uprooted in terms of livelihoods. It is time to act fast.
Views expressed are personal