Covid-19 Restrictions May Have Led to Rise in Child Deaths in South Asia

The same Covid-19 lockdowns that may have saved lives in South Asia last year may have contributed to a jump in deaths of young children by cutting off essential services, a new report said.

In 2019, South Asia recorded the deaths of 1.4 million children under the age of five, according to a report released Wednesday by Unicef. Last year, such deaths may have climbed by an additional 228,000 as the pandemic made access to medical care and food difficult. Also, an additional 11,000 pregnant women also may have died in India, Nepal, Pakistan, Afghanistan, Sri Lanka and Bangladesh, according to the report, which was supported by the World Health Organization and the United Nations Population Fund.

“The generally restrictive measures taken to mitigate the Covid-19 outbreak has contributed to more deaths,” said Dr. Atnafu Getachew Asfaw, who led development of the report, which pulled national health data comparing people accessing services before and during the pandemic.

The report is the latest example of how the global death toll from the pandemic may have been much higher than official tallies. A Wall Street Journal analysis of excess deaths in 2020 suggests that the death count from Covid-19 may be far worse than official figures.

In close to 60 countries that have figures for deaths last year, the number of deaths was more than 10% above average. Less than two-thirds of the increase in deaths has been attributed directly to Covid-19. Public-health experts believe that many, if not most, of the additional deaths were directly linked to the disease.

In South Asia, disruptions—much of it caused by lockdowns and other pandemic restrictions—were a shock to healthcare systems. Overrun hospitals, fears among healthcare workers and measures that delayed people from seeking help were among many factors contributing to the increase in deaths.

The Unicef report estimated the deaths related to Covid restrictions by using survey data from each country to determine a baseline level of medical and children’s services in 2019. The models also took into account the level of disruption to those services by country.

Official figures could take years to be released. For example, the latest publicly available official mortality numbers in India are from 2018 and the national mortality numbers for 2020 aren’t likely to be published this year.

In South Asia, where 10% of its 1.8 billion people live below the international poverty line of $1.90 a day, malnutrition was another major childhood killer.

In western Nepal, at least a dozen patients a day would typically come to a government-run clinic in the Kailali district to seek treatment for childhood malnutrition, said facility manager Gita Bista. But starting last March, only one or two patients a day trickled in. Lockdown restrictions meant many families simply couldn’t find a ride to the clinic, Ms. Bista said.

“They were also scared,” she said, “that their children will be exposed to Covid-19 infection at the hospital.”

These declines were repeated throughout Bangladesh and Nepal, where the number of children who received treatment for severe acute malnutrition plunged by over 80% after the pandemic hit, the report said.

Healthcare access for pregnant women was a recurring problem during the pandemic. Nearly 60% of the potential additional deaths of children last year likely occurred shortly after birth. In the second quarter of 2020, when the most severe lockdowns were in effect, most medical services for women and children plunged by more than 50% across South Asia compared with 2019.

As highly transmissible coronavirus variants sweep across the world, scientists are racing to understand why these new versions of the virus are spreading faster, and what this could mean for vaccine efforts. New research says the key may be the spike protein, which gives the coronavirus its unmistakable shape. Illustration: Nick Collingwood/WSJ

Aruna Uprety, a doctor and president of Nepal Public Health Foundation, a Kathmandu-based health advocacy group, said she traveled throughout Nepal last year where she encountered at least four or five women who died in childbirth who could have been saved if they had been able to get to a hospital. Ambulances were either not available or too expensive for most families to afford, she said.

“More children and mothers have died,” she said “It’s especially the case in rural Nepal where poverty is high and access to health facilities is already severely limited.”

The report estimated that essential services may improve 10% in the first quarter and 20% in the second quarter of 2021, compared with the last three months of 2020. In the first half of this year, Nepal and Sri Lanka are expected to see a decline in child deaths, while Bangladesh will see fewer maternal deaths.

Countries need to take into account the health impacts of lockdowns and other restrictions as they continue to battle Covid-19, the report said.

Dr. Asfaw of Unicef said that countries should find a way to enforce coronavirus-safety measures, such as hand washing and social distancing, that don’t cause a massive disruption in essential services.

“That doesn’t mean mitigation measures weren’t necessary or were wrong,” he said. “But if you just focus on that one and stop everything else, you will lose more people from other issues.”

Write to Shan Li at and Krishna Pokharel at

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