COVID-19 – The Initial Response
A novel strain of coronavirus — SARS-CoV-2 —reported in December 2019 in Wuhan, China, spread to more than 200 countries worldwide and was declared a Global Pandemic by the World Health Organization (WHO). Drastic actions were taken by governments and authorities globally. As a result, lockdowns, social distancing, work from home, restrictions on social gatherings, isolation of those with symptoms, and diversion of most funds and health workforce to the COVID response became the norm the world over. Primary healthcare services were almost immediately slashed, with many services like Family Planning (FP), Maternal, Newborn & Child Health (MNCH) care, and immunization put on hold as Outpatient Departments (OPDs) were closed.
COVID-19 & Health Services
The health service delivery for elective cases halted, and preventive services decreased. Given the huge influx of COVID patients, health workers, supplies and medical equipment were channeled exclusively toward COVID response. This disrupted and compromised essential and regular health services within an already strained health system, and put at risk people with health problems that are not linked to the pandemic, such as those requiring family planning, maternal, neonatal, and child health and nutrition (RMNCH-N) services.
COVID-19 & RMNCH Services
Although the mortality rate for COVID-19 is lower in children and women of reproductive age, these groups are adversely impacted by disruption of RMNCH-N services and indirect effects of COVID and subsequent lockdowns, particularly in low-and middle-income countries. The pandemic and pandemic response has impacted both the provision and use of basic RMNCH-N services. Interventions by programs (e.g. Immunization, Family Planning, Nutrition, HIV/Aids) have either been halted or reduced. The role of community health workers has been undermined because of social distancing while women’s visits to health centers have decreased due to imposed lockdowns, closure of OPDs, travel restrictions, delays in transportation, and the fear of getting infected.
COVID-19 & Maternal & Child Mortality
COVID-19 has undermined nearly a decade of progress toward the Elimination of Preventable Child and Maternal Mortality. According to UNICEF, under scenarios that mirror prior pandemics such as Ebola, where health services like family planning, antenatal and postnatal care, vaccination, child delivery and preventive and curative support are decreased by around 45%, under-five child deaths can increase by as much as 44.7% and maternal deaths by 38.6% per month. Hence the projections indicate that if routine health care is disrupted and food access is reduced, the rise in infant and maternal deaths due to COVID’s indirect impact alone will be devastating.
This number is backed by analysis of UNICEF data by Johns Hopkins Bloomberg School of Public Health, which estimates that around 1.2 million under-five deaths will occur in just six months due to decreased routine healthcare and an increase in the proportion of children who are wasted. This analysis also suggests that Pakistan is already projected to have the greatest additional number of child deaths and is among the 10 countries that are most likely to witness the highest excess in child mortality rates under the worst-case scenario during COVID.
COVID-19 & Immunization
The Johns Hopkins Bloomberg School of Public Health analysis further reported that, as of April 14, more than 117 million children in 37 countries may skip their measles vaccine, as the pandemic has halted immunization drives to avoid the possibility of virus spreading. Due to the global spread of ongoing pandemic, routine immunization programs are interrupted due to both COVID-19 related pressure on the healthcare system and reduced demand for vaccination due to physical distance or community reluctance requirements.
Interruption of immunization programs, even for short periods, can lead to an increased number of vulnerable people and raise the risk of outbreak-prone Vaccine-Preventable Diseases (VPDs) such as measles, polio, diphtheria, and yellow fever. These outbreaks of VPD that result in increased morbidity and mortality particularly in young infants and other vulnerable groups will lead to a greater burden on health systems that is already stressed by the response to COVID-19.
All direct mortality from the pandemic and indirect mortality from vaccine-preventable and treatable diseases will rise significantly when health systems are overloaded, especially in low and middle-income countries.
COVID-19 & Medical Supply Chains
COVID-19 is causing disruptions in the pharmaceuticals and medical supply chains in countries with already weak healthcare systems. The low purchasing power of low-and middle-income countries and their lack of resources for domestic production are detrimental to ensuring a steady supply chain of medicines. Consequently, what we are seeing now is a tendency towards deprioritizing these procurements thereby leading to serious disruptions in the supply chains. A situation further compounded by the absence of any available alternative measures. This is resulting in unmet demand and risks for the already vulnerable citizens with limited access to medicines and supplies.
COVID-19 – How to Ensure the Safety of Mothers & Children?
For preventing significant loss of maternal & neonatal deaths; for ensuring that vulnerable women and girls do not lose access to contraceptives and other FP services; and for avoiding discontinuation of reproductive, maternal and family planning services; it is essential that sexual and reproductive health are prioritized as the essential services that they are, so that COVID-19 does not claim lives and livelihoods indirectly. For this purpose, following basic measures during pandemic can ensure that our negligence does not exacerbate the already devastating impact of COVID-19 on our health system and communities:
- No funds and healthcare providers should be diverted from RMNCH to COVID-19 response;
- Health and safety of mothers and children must be prioritized at the policy & planning level;
- Primary health systems need to be strengthened through integration of care networks;
- Uninterrupted supply of contraceptive, vaccines, maternal and newborn care drugs must be ensured;
- Essential nutrition support must be provided to vulnerable children and families;
- Continued availability of services to mothers and children, while keeping them safe, through trained and well-equipped healthcare workers needs to be ensured; and
- Investment should be made in Mobile Clinics for delivering immunization and health services where most needed, especially in rural and marginalized communities.
Countries across the globe will need to make tough decisions to meet the demands of direct response to COVID-19. At the same time, they will need to participate in strategic planning and concerted action to ensure that the critical provision of health services, especially RMNCH, are not compromised in these challenging times.
Photo courtesy: UNICEF Pakistan