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Number of non-Covid deaths, emergency cases in India has dropped

It isn’t just fewer accidents. In Covid times, the number of emergency cases rushed to hospitals too has come down drastically and so have the number of deaths. This fall in the number of heart attacks, strokes and emergency procedures is not a trend unique to India.Doctors spoke to TOI put forward several possible explanations for this phenomenon, some obvious — like less stress and reduced pollution — and others not so obvious like fewer medical interventions, including unnecessary procedures. According to the Brihanmumbai Municipal Corpora tion, the number of people who died owing to diabetes, hypertension and heart problems in the month of March was 729 in 2017, 833 in 2018, 937 last year and just 595 this March.A recent Reuters report found a similar trend in many cities across India with fewer burials and cremations during the lockdown period than during the same period last year. Several doctors in their discussion groups and on Twitter have remarked on the sudden reduction in emergency admissions by 50-60% even though the emergency services of most large hospitals have stayed open. They felt that the difficulty in transportation and moving around alone could not ex plain this sufficiently. So what explain it?“Lack of unanticipated exertion in daily life, reduced work-related stress, drop in pollution, not eating out and hence cutting out trans fats, and people getting to spend more relaxed time with families would definitely have helped bring down emergencies, such as acute coronary events or stroke. It can’t be that people are staying back home despite an emergency, as they would definitely rush to a hospital,” said Dr Srinath Reddy of the Public Health Foundation of India “The triggers for heart attacks and strokes related to our lifestyle have disappeared. Plus we have to admit that we were overdoing with our medicine. We are soliciting patients and looking for diseases. If we look hard enough, we will find it too and in treating it are we harming our patients? Concepts such as performance linked payment in many large hospitals could be driving over treatment. The medical profession needs to introspect. In this lockdown period, people are not coming in contact with us and they seem to be doing better,” said Dr OP Yadava of the National Heart Institute in Delhi.Dr Reddy too referred to “iatrogenic complications” or those related to or caused by treatment. “In the US, it was found that medical errors were the third major cause of death leading to 2 lakh deaths per year. Medical errors could be leading to deaths in India too. In this period, those deaths too would come down,” said Dr Reddy, adding that postponing elective surgeries would also bring down deaths.“Any elective procedure or surgery would have some risks or fatality. If the mortality rate is 3% for a surgery (or chance of three deaths out of 100 surgeries), you are postponing those deaths to a period after the lockdown,” he said. “A huge increase in mortality because of smog was recorded in London, about 4,000 more deaths. Conversely, a reduction in pollution would mean that a large number of deaths are averted. With physical distancing, there would be a substantial reduction in pneumonia and associated complications and deaths,” said Dr Vikram Jaggi, director, Asthma Chest Allergy Centre in Delhi.“Though cases of stroke heart attack and some fevers are still coming to the emergency, the numbers have come down, especially of heart attacks. Trauma cases, respiratory disease exacerbations, gastrointestinal bleed and pancreatitis cases triggered by binge drinking too have come down in this period. Infections such as pneumonia flaring up from communicable disease have gone down significantly because of physical distancing and frequent handwashing and cases of complications from surgery which are rushed to emergencies have stopped,” said a senior consultant in a private hospital.According to a New York Times report, cardiologists in the US too felt there was a 4060% reduction in admissions for heart attacks and a decline in other emergencies such as acute appendicitis and acute gall bladder disease.