The Lockdown Paradox

Businesses seem to be following a 20:80 rule in the lockdown. It takes a lockdown to realise that my business of education has always been a non-essential service!! Businesses that are essential report a 80% drop in business. The funny thing is that medical services, though declared essential, are not as essential as you thought them to be. Most doctors are enjoying their vacations along with you The government has given doctors curfew passes to visit – and also allowed patients a similar facility. You would assume that this is a time where some of you would have in your own hypochondriac ways found new diseases lurking inside you. But across doctors, across hospitals – patient flow has collapsed. Large private hospitals, the ones that continue functioning, have seen the 20:80 rule apply. Patient inflows have dropped 80%. The only patients who come in are the dialysis and the onco ones. One possible reason is that patients are referred to the larger hospitals mostly by General Practitioners for a cut. And with GPs not wanting to venture out – the cut inspired flow has dried up. The scene in government hospitals seems to be no different. And nobody seems to be complaining. Good health in the times of Covid seems paradoxical. 

Everyone is eating home food – healthy. And not only are they eating home food – they are making it – healthier. All the obesity epidemics that were forecasted have fallen flat. How many of you are making desserts every day? Too painful, Sire, when you have to make the gooey stuff yourself. 

Reduced pollution is a significant reason for reduced doctor trips. Less traffic on the road also means fewer accidents and falls. So much less business for ortho. Homicide rates are down – as criminals also are on enforced WFH. How much crime can these guys indulge in with their own family? 

Incidentally, there is a divergence of opinion on Domestic Violence. Somebody reported to me that DV rates are up. But my guess is that since it is not fueled by alcohol, the intensity of DV would have reduced. The forced abstinence has most folks suspecting a Gujarat angle to it. For once, most Chief Ministers are siding with the non-teetotallers!

Another statistic that I am sure is down is suicide rates. If we were to believe WhatsApp university, there can’t be more depressing times to live in. Yet depression is relative. Like one of my friends said – in school if you were the only kid who flunked an exam, it was depressing. But if everyone flunked then it was cause for joy. Company is the antidote for suicide. And whatever our relations be with our immediate family members, it’s their company which keeps us away from negativity – and therefore suicide.  

In the midst of the lockdown, I visited the Aundh crematorium, as I was returning back after accompanying my wife to her daily visit to her pathology lab in Pimpri. Found two rickshaws standing – I was a bit sad to have interrupted a funeral. But the rickshaws were there only for washing. Managed to find the PMC employee who mans the crematorium. He was more than happy to chat about death rates. He mentioned that in pre lockdown days, there was an average of 1 cremation per day. If I assume Aundh’s population to be around 2 lakh, and the same average mortality rate as the rest of India – 0.7 per thousand, then we can expect about 140 deaths a year – or one every other day. Kind of matches. 

Our crematorium friend reported that it is now up to 2 per day. Most of the dead are senior citizens. No Covid positive cases so far. He offered to show me the register, I declined – but in hindsight, could have got some interesting data from there. He went on to tell me that his mother works at the main Vaikunth crematorium in Navi Peth, and death rates are up over there too. PMC has stopped wood pyres, and surprisingly, also electrical crematorium use. All cremations are done using gas post lockdown. Must be because the temperatures are higher – and risks of contamination lower. One very interesting quip he made as I was leaving was about more alcoholics dying nowadays than usual. Lockdown has been associated with dry days, so I wondered why. Well, he said, they die because they are missing their daru. Hmm.. Didn’t know that alcohol withdrawal symptoms could include death 🙁

Hmm. The guy in the field was reporting stuff differently than what I had thought. I had spoken with friends like  Mahesh Dabi, who is extremely active in all kinds of social circles. He informed me that in his community WhatsApp group there used to be an average of 5 deaths reported every month. Post lockdown, the death rate dropped to just 1 per month. I wondered if the situation was different for the lower income groups – who don’t have to worry so much for your middle class lifestyle diseases like diabetes and hypertension. They are still stuck in stuff like TB and malaria, which I assume has not seen a decline. 

If you try Googling for death in these times, the only death stats available are Covid deaths. I tried getting primary data from the Pune Municipal Corporation website. They do have meticulous records of each death and birth.. Alas, the data is dated. Figures are available from 2011 to 2018 only. Then I got lucky – Times of India had managed to get some specific Mumbai data. I quote:

Deaths in cases harbouring chronic conditions such as diabetes, hypertension and heart problems registered a dip of almost 36% this March compared to the same month in previous years. Diabetes, hypertension and heart problems can be life-threatening when the patient contracts another disease like Covid-19.In March 2017, there were 729 deaths owing to some of these co-morbidities, in March 2018 the number was 883 deaths, and in March 2019 it was 937. This March, the number of deaths dipped to 595.

And here is a report from Reuters.

Central Mumbai, home to some 12 million people, saw the number of deaths fall by about 21% in March compared with the same month of 2019, according to municipal data. Overall deaths plummeted 67% in Ahmedabad, the biggest city in Prime Minister Narendra Modi’s home state of Gujarat, over the same period.

I was chatting with Dr Kokane, a senior physician working at Naidu Hospital, the nodal hospital for Pune’s covid cases. He feels that the morbidity rates in drug resistant TB are much more scary than Covid. And unlike the US, in India TB is a much bigger killer than Covid. He has a clear suggestion to make – it is the co morbidities that you should be more worried about. Vijay Chheda tells me that 70% of the Covid deaths in the US are of people who are obese. So instead of getting worked out about imperfect sanitisation measures – it’s better to get worked up about getting our weight in control. Continue to eat right. And ensure that you start moving out of your house soon to get that exercise. 

 

References:

https://www.reuters.com/article/us-health-coronavirus-india-casualties/mortality-rates-drop-sharply-in-parts-of-india-bucking-coronavirus-trend-idUSKCN2260WM

https://timesofindia.indiatimes.com/city/mumbai/despite-covid-city-march-toll-down-from-earlier-yrs/articleshow/75384716.cms

http://opendata.punecorporation.org/Citizen/CitizenDatasets/Index

 

My friend Harihar Narayanswamy’s comment 

Honestly I think this is a rose tinted view of things. Obesity epidemic being down – every market I go lays Maggi cheese thums up and such other stuff is amongst the first things to disappear of shelves. And kids can’t be getting healthier with no exercise for 40 days and same is true for many people who have not walked even 10 minutes a day in the lockdown. 

As for hospitals many private hospitals have shut completely – people are scared to go lest they be hounded for corona and many hospitals are not accepting patients if they don’t have corona free certificate. 

As for death rates being down I have not read any such statistic and some guy who uses whatsapp groups to base his conclusion is rather dubious at the least. And if that is the criteria I know at least five friends who have had a relative die in the last 40 days which is more than what I heard in the 40 days before lockdown – it proves nothing. 

As for domestic violence that’s the most dangerous thing you have written in saying it may not be as bad because of lack of alcohol. The UN has warned this could be a big uptick and also in India I am imagining many kids are feeling the brunt of the mental stress parents are going through.

Lastly mental health which you have not addressed is to my mind the biggest problem. Spouses parents people have never spent so much time together. And it is stressful because Indian houses are small and not designed for 4 people to be cooped up 24 hours together without respite from each other for so long. Same work for home means my boss finishes shouting and then the kids are probably cranky and there’s house work to be done so longer is the house a sanctuary – ditto for kids whose houses their safe haven has been turned into a workspace. 

Now imagine 80% of India lives in really tiny two room houses and such to tell them that this is a blessing is rather rich from affluent people like us. 

 

Comments by Anant Chaudhari

– The paradox you have noted was also seen in US during the Great Depression in 1930-36 when unemployment rate was 50% and yet overall health situation improved, which was paradoxical.

– In India lockdown was imposed forcibly. So many hospitals and people don’t have any option but to temporarily close and stay home. 

– In economic downturn people tend to invest time in education and skills improvement by enrolling in schools or other programs. So, substitution effect occurs between job/leisure and education. In normal time education plays a complementary role for salaried people. Probably, you might see more enrollment in your online training classes. Economic downturn is the best time to invest time in educating ourselves.

– DV varies by income groups .. lower income families more likely to have DV.

– It’s time to reinvent.. I run about 5 miles every day and reduced my wants .. focusing on simple life, food .. cleaning body and mind inside out .