For the assessment of impact of covid-19 induced lockdown on number of OPD patients of Diabetes, Hypertension, Stroke (CVA), Acute Heart Disease, Mental Illness, Epilepsy, Ophthalmic, Dental and oncology in India during the lockdown months (April-May-2020) compared to previous year same timeline and duration, I plotted the monthly numbers of cases-total/public/private/rural/urban against time and compared with previous year. The version 2 of this article will have more periods of comparison and data of 36 states and union territories will be discussed in brief to reduce the length of article. The National Disaster Management Authority (NDMA), Headed and chaired by Hon’ble Prime Minister of India Shri Narendra Modi, in exercise of the powers vested under section 6(2)(i) of the Disaster Management Act, 2005, has passed an Order dated 24.03.2020, directing the Ministries/ Departments of Government of India as well as the State/Union Territory Governments and State/ Union Territory concerned authorities to take proper and effective measures-protocols-guidelines to control the proliferation of COVID-19 in the nation.
Ministries/ Departments of Government of India as well as the State/Union Territory Governments and State/ Union Territory concerned authorities in compliance of the said Order of NDMA as well as order issued by Ministry of Home Affairs (MHA) dated 24.03.2020 under Section 10(2)(l) of the Disaster Management Act, directing the Ministries/ Departments of Government of India, State/Union Territory Governments and State/ Union Territory Authorities to take effective measures for ensuring social distancing so as to prevent the spread of COVID-19 in the country. The Order of lockdown remained in force, in all parts of the country, for a period of 21 days with effect from 25.03.2020 and extended further upto 31st May. This fact is well documented in the newspapers, and international agencies like WHO and Government reports.
Data analysis presented in Table 1, 2,3,4,5,6,7,8,9,10 shows the list of OPD indicators and numbers of OPD used in the study for specific diseases mentioned in the title to know the intervention lockdown impacts of COVID-19 on health service delivery and utilization. Lockdown period is compared to same period of previous year. It’s a well documented fact that population and NCD is increasing by leaps and bounds in India. Hence it is evident from the data analysis that the novel intervention of complete lockdown in India tends to have a detrimental and deleterious impact on health delivery services and utilization.
April-2019 & 2020
Table 1- showing total numbers of specific diseases OPD during April 2019 and 2020 and decrease in OPD during lockdown
Services
|
Total Apr-20(Number of OPD)
|
Total Apr-19(Number of OPD)
|
Total decrease in Apr- 2020(Number of OPD) in comparison to Apr-2019
|
Percent decrease in total OPD in Apr-2020 in comparison to Apr-2019
|
Outpatient - Diabetes
|
1644625
|
2644246
|
-999621
|
37.803631
|
Outpatient - Hypertension
|
2092962
|
3048900
|
-955938
|
31.3535373
|
Outpatient - Stroke (Paralysis)
|
32918
|
64075
|
-31157
|
48.6258291
|
Outpatient - Acute Heart Diseases
|
78852
|
237022
|
-158170
|
66.7322021
|
Outpatient - Mental illness
|
170345
|
486869
|
-316524
|
65.0121491
|
Outpatient - Epilepsy
|
42966
|
91340
|
-48374
|
52.9603679
|
Outpatient - Ophthalmic Related
|
644210
|
2665999
|
-2021789
|
75.836075
|
Outpatient - Dental
|
678914
|
2335144
|
-1656230
|
70.9262469
|
Outpatient - Oncology
|
42566
|
167477
|
-124911
|
74.5839727
|
Table 2- showing total numbers of specific diseases OPD at Public Health facilities in India during April 2019 and 2020 and decrease in OPD during lockdown
Services
|
Public Health Facility Apr-20(Number of OPD)
|
Public Health Facility Apr-19(Number of OPD)
|
Total decrease in Public Health Facility Apr- 2020(Number of OPD) in comparison to Apr-2019
|
Percent decrease in public health facility OPD in Apr-2020 in comparison to Apr-2019
|
Outpatient - Diabetes
|
1605927
|
2546368
|
-940441
|
36.9326429
|
Outpatient - Hypertension
|
2056021
|
2969055
|
-913034
|
30.7516701
|
Outpatient - Stroke (Paralysis)
|
30350
|
59595
|
-29245
|
49.0729088
|
Outpatient - Acute Heart Diseases
|
69002
|
206141
|
-137139
|
66.5267948
|
Outpatient - Mental illness
|
161080
|
449545
|
-288465
|
64.1682145
|
Outpatient - Epilepsy
|
41512
|
86650
|
-45138
|
52.0923254
|
Outpatient - Ophthalmic Related
|
625829
|
2516472
|
-1890643
|
75.1306989
|
Outpatient - Dental
|
667478
|
2285057
|
-1617579
|
70.7894376
|
Outpatient - Oncology
|
33381
|
145540
|
-112159
|
77.0640374
|
Table 3- showing total numbers of specific diseases OPD at Private Health Facilities in India during April 2019 and 2020 and decrease in OPD during lockdown
Services
|
Private Health Facility Apr-20(Number of OPD)
|
Private Health Facility Apr-19(Number of OPD)
|
Total decrease in private Health Facility Apr- 2020(Number of OPD) in comparison to Apr-2019
|
Percent decrease in private health facility OPD in Apr-2020 in comparison to Apr-2019
|
Outpatient - Diabetes
|
38698
|
97878
|
-59180
|
60.463025
|
Outpatient - Hypertension
|
36941
|
79845
|
-42904
|
53.73411
|
Outpatient - Stroke (Paralysis)
|
2568
|
4480
|
-1912
|
42.678571
|
Outpatient - Acute Heart Diseases
|
9850
|
30881
|
-21031
|
68.103365
|
Outpatient - Mental illness
|
9265
|
37324
|
-28059
|
75.17683
|
Outpatient - Epilepsy
|
1454
|
4690
|
-3236
|
68.997868
|
Outpatient - Ophthalmic Related
|
18381
|
149527
|
-131146
|
87.707237
|
Outpatient - Dental
|
11436
|
50087
|
-38651
|
77.167728
|
Outpatient - Oncology
|
9185
|
21937
|
-12752
|
58.1301
|
Table 4- showing total numbers of specific diseases OPD at urban health facilities in India during April 2019 and 2020 and decrease in OPD during lockdown
Services
|
Urban Health Facility Apr-20(Number of OPD)
|
Urban Health Facility Apr-19(Number of OPD)
|
Total decrease in urban Health Facility Apr- 2020(Number of OPD) in comparison to Apr-2019
|
Percent decrease in urban health facility OPD in Apr-2020 in comparison to Apr-2019
|
Outpatient - Diabetes
|
413624
|
703624
|
-290000
|
41.2151945
|
Outpatient - Hypertension
|
505659
|
769481
|
-263822
|
34.2857069
|
Outpatient - Stroke (Paralysis)
|
7921
|
10233
|
-2312
|
22.5935698
|
Outpatient - Acute Heart Diseases
|
13708
|
39127
|
-25419
|
64.9653692
|
Outpatient - Mental illness
|
33083
|
107230
|
-74147
|
69.1476266
|
Outpatient - Epilepsy
|
11913
|
20358
|
-8445
|
41.4824639
|
Outpatient - Ophthalmic Related
|
99196
|
547754
|
-448558
|
81.8904107
|
Outpatient - Dental
|
123720
|
430124
|
-306404
|
71.2362017
|
Outpatient - Oncology
|
8326
|
43244
|
-34918
|
80.7464619
|
Table 5- showing total numbers of specific diseases OPD at rural health facilities of India during April 2019 and 2020 and decrease in OPD during lockdown
Services
|
Rural Health Facility Apr-20(Number of OPD)
|
Rural Health Facility Apr-19(Number of OPD)
|
Total decrease in Rural Health Facility Apr- 2020(Number of OPD) in comparison to Apr-2019
|
Percent decrease in rural opd in Apr-2020 in comparison to Apr-2019
|
Outpatient - Diabetes
|
1231001
|
1940622
|
-709621
|
36.5666781
|
Outpatient - Hypertension
|
1587303
|
2279419
|
-692116
|
30.3637023
|
Outpatient - Stroke (Paralysis)
|
24997
|
53842
|
-28845
|
53.5734185
|
Outpatient - Acute Heart Diseases
|
65144
|
197895
|
-132751
|
67.0815331
|
Outpatient - Mental illness
|
137262
|
379639
|
-242377
|
63.8440729
|
Outpatient - Epilepsy
|
31053
|
70982
|
-39929
|
56.2522893
|
Outpatient - Ophthalmic Related
|
545014
|
2118245
|
-1573231
|
74.2704928
|
Outpatient - Dental
|
555194
|
1905020
|
-1349826
|
70.856264
|
Outpatient - Oncology
|
34240
|
124233
|
-89993
|
72.438885
|
May 2019 & 2020
Table 6- showing total numbers of specific diseases OPD during May 2019 and 2020 and decrease in OPD during lockdown
Services
|
Total May-20(Number of OPD)
|
Total May-19(Number of OPD)
|
Total decrease in May- 2020(Number of OPD) in comparison to May-2019
|
Percent decrease in total OPD in May-2020 in comparison to May-2019
|
Outpatient - Diabetes
|
1703871
|
2795140
|
-1091269
|
39.041658
|
Outpatient - Hypertension
|
2141928
|
3281803
|
-1139875
|
34.7331939
|
Outpatient - Stroke (Paralysis)
|
36011
|
67151
|
-31140
|
46.3730994
|
Outpatient - Acute Heart Diseases
|
97046
|
249823
|
-152777
|
61.1540971
|
Outpatient - Mental illness
|
197833
|
505997
|
-308164
|
60.9023374
|
Outpatient - Epilepsy
|
46798
|
88047
|
-41249
|
46.8488421
|
Outpatient - Ophthalmic Related
|
815141
|
2734647
|
-1919506
|
70.1920943
|
Outpatient - Dental
|
791717
|
2536955
|
-1745238
|
68.7926274
|
Outpatient - Oncology
|
63196
|
169710
|
-106514
|
62.7623593
|
Table 7- showing total numbers of specific diseases OPD at Public Health facilities in India during May 2019 and 2020 and decrease in OPD during lockdown
Services
|
Public Health Facility May-20(Number of OPD)
|
Public Health Facility May-19(Number of OPD)
|
Total decrease in Public Health Facility May- 2020(Number of OPD) in comparison to May-2019
|
Percent decrease in public health facility OPD in May-2020 in comparison to May-2019
|
Outpatient - Diabetes
|
1653763
|
2696173
|
-1042410
|
38.662578
|
Outpatient - Hypertension
|
2093739
|
3200349
|
-1106610
|
34.577791
|
Outpatient - Stroke (Paralysis)
|
32336
|
61844
|
-29508
|
47.713602
|
Outpatient - Acute Heart Diseases
|
81880
|
218110
|
-136230
|
62.45931
|
Outpatient - Mental illness
|
186264
|
468451
|
-282187
|
60.238317
|
Outpatient - Epilepsy
|
45268
|
83440
|
-38172
|
45.747843
|
Outpatient - Ophthalmic Related
|
779471
|
2577502
|
-1798031
|
69.758666
|
Outpatient - Dental
|
773557
|
2433846
|
-1660289
|
68.216683
|
Outpatient - Oncology
|
44506
|
139843
|
-95337
|
68.17431
|
Table 8- showing total numbers of specific diseases OPD at Private Health Facilities in India during May 2019 and 2020 and decrease in OPD during lockdown
Services
|
Private Health Facility May-20(Number of OPD)
|
Private Health Facility May-19(Number of OPD)
|
Total decrease in private Health Facility May- 2020(Number of OPD) in comparison to May-2019
|
Percent decrease in private health facility OPD in May-2020 in comparison to May-2019
|
Outpatient - Diabetes
|
50108
|
98967
|
-48859
|
49.3689816
|
Outpatient - Hypertension
|
48189
|
81454
|
-33265
|
40.8390012
|
Outpatient - Stroke (Paralysis)
|
3675
|
5307
|
-1632
|
30.7518372
|
Outpatient - Acute Heart Diseases
|
15166
|
31713
|
-16547
|
52.1773405
|
Outpatient - Mental illness
|
11569
|
37546
|
-25977
|
69.1871305
|
Outpatient - Epilepsy
|
1530
|
4607
|
-3077
|
66.7896679
|
Outpatient - Ophthalmic Related
|
35670
|
157145
|
-121475
|
77.3012186
|
Outpatient - Dental
|
18160
|
103109
|
-84949
|
82.3875704
|
Outpatient - Oncology
|
18690
|
29867
|
-11177
|
37.4225734
|
Table 9- showing total numbers of specific diseases OPD at urban health facilities in India during May 2019 and 2020 and decrease in OPD during lockdown
Services
|
Urban Health Facility May-20(Number of OPD)
|
Urban Health Facility May-19(Number of OPD)
|
Total decrease in urban Health Facility May- 2020(Number of OPD) in comparison to May-2019
|
Percent decrease in May-2020 in comparison to May-2019
|
Outpatient - Diabetes
|
409952
|
733674
|
-323722
|
44.1234118
|
Outpatient - Hypertension
|
488199
|
796315
|
-308116
|
38.6927284
|
Outpatient - Stroke (Paralysis)
|
8895
|
13029
|
-4134
|
31.7292194
|
Outpatient - Acute Heart Diseases
|
16176
|
41360
|
-25184
|
60.8897485
|
Outpatient - Mental illness
|
48147
|
110314
|
-62167
|
56.3545878
|
Outpatient - Epilepsy
|
12489
|
20025
|
-7536
|
37.6329588
|
Outpatient - Ophthalmic Related
|
128354
|
522125
|
-393771
|
75.4169978
|
Outpatient - Dental
|
142821
|
463955
|
-321134
|
69.2166266
|
Outpatient - Oncology
|
13111
|
33255
|
-20144
|
60.5743497
|
Table 10- showing total numbers of specific diseases OPD at rural health facilities of India during May 2019 and 2020 and decrease in OPD during lockdown
Services
|
Rural Health Facility May-20(Number of OPD)
|
Rural Health Facility May-19(Number of OPD)
|
Total decrease in Rural Health Facility May- 2020(Number of OPD) in comparison to May-2019
|
Percent decrease in May-2020 in comparison to May-2019
|
Outpatient - Diabetes
|
1293919
|
2061466
|
-767547
|
37.23307
|
Outpatient - Hypertension
|
1653729
|
2485488
|
-831759
|
33.46462
|
Outpatient - Stroke (Paralysis)
|
27116
|
54122
|
-27006
|
49.89838
|
Outpatient - Acute Heart Diseases
|
80870
|
208463
|
-127593
|
61.20655
|
Outpatient - Mental illness
|
149686
|
395683
|
-245997
|
62.17022
|
Outpatient - Epilepsy
|
34309
|
68022
|
-33713
|
49.56191
|
Outpatient - Ophthalmic Related
|
686787
|
2212522
|
-1525735
|
68.95909
|
Outpatient - Dental
|
648896
|
2073000
|
-1424104
|
68.69773
|
Outpatient - Oncology
|
50085
|
136455
|
-86370
|
63.29559
|
In version 2 of the article which is under process, the Interrupted time series (ITS) analysis will be done which is a strong quasi-experimental design and utilized to judge the effectiveness of a population-level based intervention such as Lockdown.