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Year : 2020  |  Volume : 13  |  Issue : 5  |  Page : 573-574  

Lessons from COVID-19 in India: Extended lockdowns – At what cost? A counterview

Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India

Date of Submission14-Jun-2020
Date of Decision25-Jun-2020
Date of Acceptance03-Jul-2020
Date of Web Publication7-Sep-2020

Correspondence Address:
Sachin Ramchandra Atre
Dr. DY Patil Medical College, Hospital and Research Centre, Pune, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_338_20

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How to cite this article:
Atre SR. Lessons from COVID-19 in India: Extended lockdowns – At what cost? A counterview. Med J DY Patil Vidyapeeth 2020;13:573-4

How to cite this URL:
Atre SR. Lessons from COVID-19 in India: Extended lockdowns – At what cost? A counterview. Med J DY Patil Vidyapeeth [serial online] 2020 [cited 2020 Oct 25];13:573-4. Available from: https://www.mjdrdypv.org/text.asp?2020/13/5/573/294365

I thank (author/s) for providing an alternative view to my editorial. The author states that the suspension of tuberculosis (TB) diagnosis and management activities is not restricted to regions or countries which have implemented lockdowns but is a global phenomenon in high TB burden countries as the entire focus globally is on the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic. Also that the global TB community already has a roadmap to tackle the consequences arising out of this.[1] I have a strong disagreement on this point for following reasons. Even in the absence of COVID-19, India carries a forth of global burden of TB which is the highest in the world. Due to priority for COVID-19, a major portion of the existing limited infrastructure and human resources[2] from the National TB Elimination Program has been diverted to COVID-19 over the last 3 months.[3] As a result, the TB diagnosis and treatment management were substantially affected. The number of new TB cases detected in April 2020 (accurate up to April 27) in government-run health-care centers was 34,342, as compared to 1.56 lakh cases in the same month in the previous year with 78% decrease, and the number of new cases detected in private health facilities in this month was 6967, compared to 65,735 in April 2019 indicating 89% decrease.[4] Given this ground reality and known meager 1.2% of GDP investment for public health, just having a paper-based roadmap is like a vehicle without fuel, which can hardly be expected to handle the consequences arising from this policy measure. With the lockdown and disruption of TB services, there is a likelihood that a significant number of people with undiagnosed TB, especially resided in crowded slums in Mumbai and other metropolitan cities, will fuel transmission of both drug susceptible and drug resistant TB bacilli.

The author further describes the mode of transmission and R0 for SARS-Cov-2, which is based on early data. It is important to note that R0 is not fixed and can differ with settings depending on a variety of factors such as population behavior, infectivity or virulence, and population density etc. Disease control policies and their enforcement can also substantially influence it. Further, I disagree with the author that the financial investment or infrastructure for COVID-19 is weak because till date major resources have been diverted to this single disease. Probably, no other disease condition in India has received that kind of attention so far in recent years. Although the proportion of cases tested positive has increased from 5.7% in May to 8.1% (308993 of 3.78 million as of June 13, 2020), the case fatality has actually decreased from 3.3% to 2.87% nearly after 1 month when lockdowns were partially lifted.[5],[6]

Finally, the population density in India has a considerable variation in each geographical area, so it is inappropriate to make an average for the entire country, especially in the context of such epidemics. There is a need to identify hotspots (or high-risk zones) and conduct their careful monitoring. Hospitalization should be done only in case of emergencies to avoid unnecessary overburdening of the health system and also to avoid nosocomial transmissions. While the accuracy of the tests used for diagnosing COVID-19 is still debatable,[7] the relatively stable and now reducing case fatality rate over 3–4 months irrespective of lockdown or unlocking with around 50% of cases already cured/discharged should serve as important indicators from public health point of view. Without any doubt, I agree with the author that COVID-19 requires attention, but certainly, it must be noted that the cost of each human life is the same irrespective of the health condition, which can no way recovered by any means. Moreover, the resulted economic disruption is unaffordable for a country like India as it is now leading to several collateral damages in addition to human lives. Hence, prioritizing a single disease over everything else is not a justified strategy.

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Conflicts of interest

There are no conflicts of interest.

  References Top

The Potential Impact of the COVID-19 Response on Tuberculosis in High Burden Countries: A Modelling Analysis. Developed by Stop TB Partnership in Collaboration with Imperial College, Avenir Health, Johns Hopkins University and USAID. Available from: http://www.stoptb.org/assets/documents/news/Modeling%20Report_1%20May%202020_FINAL.pdf. [Last accessed on 2020 Jun 14].  Back to cited text no. 1
Atre SR, Murray MB. Management and control of multidrug-resistant tuberculosis (MDR-TB): Addressing policy needs for India. J Public Health Policy 2016;37:277-99.  Back to cited text no. 2
The Stop TB Partnership. The TB Response is Heavily Impacted by the COVID-19 Pandemic. Available from: http://stoptb.org/news/stories/2020/ns20_014.html. [Last accessed on 2020 Jun 12].  Back to cited text no. 3
TB Patients Badly hit by Lockdown — 80% Drop in Diagnosis, Huge Struggle for Medicines. Available from: https://theprint.in/health/tb-patients- badly-hit-by-lockdown-80-drop-in-diagnosis- huge-struggle-for-medicines/411399/. [Last accessed on 2020 Jun 13].  Back to cited text no. 4
Total COVID-19 Tests. Available from: https://ourworldindata.org/grapher/full-list-total-tests-for-covid-19. [Last accessed on 2020 Jun 13].  Back to cited text no. 5
Ministry of Health and Family Welfare, Government of India. Available from: https://www.mohfw.gov.in/. [Last accessed on 2020 Jun 13].  Back to cited text no. 6
Woloshin S, Patel N, Kesselheim AS. False negative tests for SARS-CoV-2 infection –challenges and implications. N Engl J Med 2020;10.1056/NEJMp2015897. doi:10.1056/NEJMp2015897.  Back to cited text no. 7


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