India’s COVID-19 lockdown bought valuable time. Infection rates are only now starting to increase, and case fatality rates have remained lower than in many other countries. But how the health crisis plays out in the future depends critically on what is done with this borrowed time — and how effectively planning is done for the future.

This is not only in terms of expanding hospital facilities for managing COVID-19 and increasing capacity for testing, but also ensuring that the millions who have not received care during the lockdown do not contribute to a sharp rise in mortality and morbidity from illnesses not related to the coronavirus.

The numbers are frightening. The National Health Mission’s year-on-year comparisons of — mostly — public sector clinics show that vaccinations for measles, mumps, and rubella are down by 69%; outpatient treatment of acute heart conditions is down by 50% and oncology by 70%; inpatient treatment of hepatitis is down by 59% and malaria by 33%; and even the number of lab tests for tuberculosis is down 34%. Other disruptions to TB services have been widely documented as well.

These are probably underestimates. About 70% of primary care and over 50% of hospital care in the country are provided by the private sector, which is massively underrepresented in the data. Many private establishments have shuttered their operations during the lockdown or chosen not to manage patients due to a lack of personal protection equipment or the fear of contracting COVID-19.

If these deficits in care are not addressed soon, we are likely to see a resurgence of vaccine-preventable illnesses, thousands of deaths from chronic illnesses, and a rise in mortality due to infectious diseases such as tuberculosis, which kills over 1,000 Indians every day. Mathematical models suggest that each month of lockdown in India could cause an additional 40,000 TB deaths over the next five years.

As the lockdown lifts, two kinds of challenges will emerge.

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