The delivery of health services is of greatest importance and major concern in India particularly populous states like Bihar with imperfect and inadequate resources, lack of modern infrastructure and enormous demand on healthcare structure. The Census 2011 calculated that Bihar has population of 10.41 Crores, an increase from figure of 8.30 Crore in 2001 census. As per 2011 census there were 54,278,157 male and 49,821,295 female respectively. As per projection of census, population of Bihar in 2021 is 13.12 Crore
The SARS-CoV-2 pandemic had offered a challenge even for developed healthcare systems around the globe. A sense of panic engrossed the globe due to pandemic and the state of Bihar in India is not exclusion. The insufficient and inadequate healthcare resources including manpower, infrastructure, transportation (ambulance services) etc. have been largely utilized to tackle the situation of pandemic. This shift has tremendous effect of continuing various health programmes running formerly before the pandemic era (2).
The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) popularly known as COVID-19 pandemic,
first found in Wuhan, China which had spread globally and causing morbidity, mortality as well as huge economic losses. The SARS-CoV-2/ Covid -19 pandemic are not over globally as well as in India and Bihar. The current healthcare system is burdened more with this new diseases added with previous NCD (non communicable diseases) & CD (communicable diseases). The First human case of this global pandemic was reported from Wuhan city of China in December 2019 (3).The first case ofcovid-19 in India was found in January 2020 and Bihar reported first COVID-19 case from Munger on 22 March 2020, a 38-year-old tested positive for COVID-19, he was also the first victim.
As of June 17, 2021, 07:33 GMT, covid-19 has involved 220 countries and has infected 177, 819, 445, people with a mortality of 3,849,051 deaths (4). The median incubation period for COVID-19 is usually 5.1 days, and may be up to 14 days. The incubation period of COVID-19 is very significant in establishing lockdown, monitoring, surveillance and control of the disease spread. The high contagious nature of COVID-19 has led to panic situation across the globe stopping entry and exit across different boundaries and even upto lowest administrative levels by implications of containment zones. The world-wide population has been under lockdown and quarantined in their homes at some point. The lockdown and quarantine methods have been implemented by many nations and states to control the spread of covid-19. The lockdown order in Bihar issued by Home Department dated 04/05/2021 announced lockdown from 05/05/2021 to 15/05/2021 and then extended upto 1 June, 2021, includes several restrictions such as isolation at homes, travel restrictions, and termination of all public events etc (5). The lockdown strategies in Bihar have been enforced like all over the world in order to prevent the COVID-19 infection from spreading even further. On comparing the pattern of transmission rates observed in few countries at posterior estimated change points, it is found that partial implementation of lockdown (in the United States), delayed planning in lockdown (Russia, United Kingdom, and France), and inadequate implementation of the lockdown (in India and Italy) were found to be mainly responsible for the spread of covid-19 infections (6).
Vaccines are known to effectively prevent a COVID-19 infection and reduce morbidity-mortality but there are multiple factors and obstacles in running smoothly the vaccination programme such as frequent change and unavailability of vaccines, guidelines, policies, interdisciplinary conflicts of medical sciences, mistrust, evil propaganda over Government data, lack of communication and health promotion in rural areas of India (7). Hence in current scenario of Bihar and most of states in India, public health measures such as lockdown, masks, quarantine, and social distancing appear to be the only ways to control the outbreak. Lockdown and quarantine can either be applied on a voluntary basis, or if seems necessary, can be legally forced by the authorities, and may be implemented at individual or community levels. The home quarantine, when scientifically and adequately applied and exercised according to covid-19 principles, guidelines, protocols and practices, can be quite effective for preventing the spread of covid-19 diseases. Globally, many countries have imposed a lockdown, quarantine period for over several days to months for this purpose. There are great economic concerns as well as question on the effectiveness and risks of long-term implementation of a lock-down and or quarantine. Keeping in view the rapid spread of COVID-19 cases and rise in mortality and morbidity in Bihar, the present study aimed to investigate the impact of lockdowns for 13 days before, first and second 13 days during lockdown and 13 days afterward on international epidemiological trends in the prevalence and mortality of COVID-19 cases.