All Shorenstein APARC News Commentary October 1, 2020

Locked Out of Critical Care

COVID-19 Lockdown and Non-COVID Mortality
Close up on technician's gloved hands handling a dialysis machine
Wisconsin Technical Colleges via Flickr

This commentary was first published by the economics and policy portal Ideas for India.


India’s 10-week long national lockdown to contain the spread of Covid-19 was among the most severe in the world. This article investigates the effects of the lockdown restrictions on healthcare access and health outcomes for patients needing life-saving chronic care. It finds that access to health services was severely disrupted; mortality increased by 64% between March and May 2020; and there was 25% total excess mortality in the four months after the imposition of the lockdown.

On 24 March 2020, India announced a nationwide lockdown that barred people from leaving their homes, required non-essential commercial establishments and transport services to close, and was enforced strictly with penalty of arrest. Google Mobility data show that mobility decreased by 60-80% within days of the announcement. Although critical health services were officially exempt from the lockdown, widespread disruptions to routine and emergency non-Covid services have been documented (Smith et al. 2020Prasad et al. 2020IndiaSpend, 2020). However, quantifying the impact of these disruptions on health outcomes has remained difficult due to the unavailability of reliable and high-frequency data on morbidity and mortality. In the absence of administrative data, evaluating the effect of the Covid-19 lockdown on non-elective health services requires the identification of patients in need of such care and the collection of primary data.

In a new research study (Jain and Dupas 2020), we use insurance claims filed under a large-scale government health insurance program in Rajasthan, to identify all patients requiring critical, chronic non-Covid healthcare. We focus on dialysis, a form of life-sustaining long-term hospital care that is typically required 2-4 times each week for the duration of the patient’s life. Missing dialysis visits or shortening their duration is associated with large increases in hospitalization and mortality (Saran et al. 2003). We conducted a series of rapid phone surveys with the households of the identified patients between May and August 2020 to measure the effects of the lockdown on healthcare, morbidity, and mortality in the four months following its imposition.

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