Let us remind ourselves of the death pattern just few decades ago, when most of the deaths were occurring with near and dear ones around, comforted by them, giving a sense of most satisfying death experience. The situation changed. Most of the deaths started happening in hospitals, in front of doctors and nurses, who are supposed to save us, and most probably in ICUs, without being comforted by the near and dear ones. The scene has shifted since March 24. Very difficult to get doctors or nurses, much more difficult to reach hospitals, even more difficult to get admitted. The frightened patients and their near and dear ones with uncertain hopes of getting comfort at the time of death. COVID-19 has changed the scenario. Disposal of the dead body has also acquired frightening aspects.

We must change this scenario. It is possible indeed. However, it will be possible only when the government changes its strategy of dealing with the situation, with more doctors, nurses, and hospital facilities. Fear of death should not be allowed to impair our capacity to deal with it. Actual death rate due to COVID-19 impact will take time to be calculated, though it has been killing people in thousands. With lesser access to health services, death rates, except from injury due to lesser accidents, might have been on the increase.

Population of the country at present is around 1.38 billion, with yearly increase in population of 0.99 per cent. Obviously, statistically speaking, India is on the way of becoming the largest populated country in the world unless something, like disease, violence, or war, reduces the net yearly growth of population by 0.50 per cent. Since, India is one of the most densely populated country of the world, large scale death is possible, especially when we don’t have required level of health facilities on the one hand and the financial capacity of individuals on the other.

The country’s health expenditure was merely 1.28 per cent of the GDP in 2017-18, which the government is trying to increase to 2.5 per cent by 2025. With the country's public expenditure on health that continues to remain the lowest globally, making it seems like an uphill task. Here lies the real concern and the cause of human tragedy we are facing today.

A cursory glance at the death pattern in India gives a chilling sensation when it is thought about in the present scenario of corona outbreak and the little help coming out from the government health mechanism. The economic and financial crisis makes the people even more vulnerable than ever before. They lack financial resources to get treatment for all sorts of diseases apart from the COVID-19.

The distribution of death pattern prepared by the Census of India for the year 2010-2013, that is the latest, shows that people dying above the age of 70 were 38.3 percent and between the age of 55-69 years were 26.1 per cent. That is 64.4 per cent people die after the age of 55 years. People dying between 45-54 are 10.2 per cent and the next largest percentage of death ie 8.7 per cent is of the children between 0-4 per cent. While dealing with the COVID-19, we must generate special facilities for these most vulnerable groups.

Distribution of death by major cause groups shows that highest percentage of people, 49.21 per cent die due to non-communicable diseases, among them males are 51.8 per cent and the females are 45.8 per cent. During the corona outbreak and lockdown, this group of people suffered a lot, because government failed to provide them hospital facilities. It can be presumed that death rate in this group must have risen.

A total of 27.74 per cent of people were dying of communicable, maternal, perinatal, and nutritional conditions, out of which males were 25.7 per cent and females were 30.4 per cent. A sharp rise has been witnessed during the outbreak. Females and children suffered most. Lack of money in the hands of people, and access to food and hospital facilities worsened the conditions of all.

Deaths from injuries were only 10.70 per cent which might have reduced because of lesser number of accidents. Though the rates of death from other forms of injuries, such as crime, and non-traffic accidents has shown a rise during the last six months chiefly due to not being able to receive aids in time due to corona restrictions and lack of access to doctors and hospitals.

A total of 12.35 per cent of people were dying due to symptoms, signs and ill-defined reasons. Here again these deaths might have been on the rise chiefly due to lack of access to hospital facilities.

The death patterns in the rural and urban areas were significantly different. Urban people were dying more of non-communicable diseases about 57 per cent, a 10 per cent higher than the rural folk. It is a matter of great concern that rural deaths are higher than urban areas in all other patterns of death. It is a clear indication that worst is coming to the rural areas where there is lesser medical facilities. They are the really vulnerable people in case of large scale corona disease outbreak, with little transportation facilities and money to avail the medical facilities concentrated in urban areas.

India must now look into the death pattern of various sections of people to avoid an impending large scale human tragedy. The rural areas have to be given top priority now in terms of granting new medical facilities as the existing arrangements are too little to take care of the burgeoning covid infections that have now engulfed the districts. The country needs a revised covid management strategy to take care of the changing pattern of the spread of infection in the last six months. (IPA Service)