Playing defense? Health care in the era of Covid.

Health workers have to balance their own welfare vs. that of their patients particularly when patients have a readily transmissible disease. These risks become more consequential during an outbreak, and especially so when the chance of severe illness or mortality is non-negligible. One way to reduce risk is by reducing contact with patients. Such changes could be along the intensive or extensive margins. Using data on primary care outpatient encounters during the early months of the Covid-19 pandemic, I document important changes in the intensity of provider-patient interactions. Significantly, I find that adherence to clinical guidelines, the probability that routine procedures such as physical examinations were completed, and even the quality of information given by health providers, all declined sharply. I present evidence that these effects likely reflect risk mitigation behavior by health providers.

In Nigeria, Stillbirths And Newborn Deaths Increased During The COVID-19 Pandemic.

The COVID-19 pandemic has put severe pressure on health care systems worldwide. Although attention has been focused on COVID-19 hospitalizations and deaths, some experts have warned about potentially devastating secondary health effects. These effects may be most severe in low- and middle-income countries with already weak health care systems. This study examines the effect of the COVID-19 pandemic on early infant deaths, a question that is currently unsettled. We present new evidence from Nigeria showing that early infant deaths have significantly increased during the pandemic. Using data on the birth outcomes of a large and diverse cohort of pregnant women enrolled in a prospective study and a quasi-experimental difference-in-differences design, we found a 1.1-percentage-point (22 percent) increase and a 0.72-percentage-point (23 percent) increase, respectively, in stillbirths and newborn deaths. Our findings show that the health effects of the pandemic extend beyond counted COVID-19 deaths. If these findings generalize to other low- and middle-income countries, they may indicate that the hard-won gains in child survival made during the past two decades are at risk of being reversed amid the ongoing pandemic. Policies addressing disruptions to health services delivery and providing support to vulnerable groups-specifically to households with pregnant women-will be critical as the pandemic continues.