Introduction
Coronavirus disease 2019 (COVID-19) is the third coronavirus infection
in the last two decades that was first arisen in the city of Wuhan,
Hubei, province of China in December 2019.[1]The unknown etiology of pneumonia later on confirmed as COVID-19 which
is caused by Severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2). It is a highly infectious viral disease and presented an
unprecedented challenge before the world. COVID-19 has spread globally
very rapidly since its first emergence in china, at present
SARS-CoV-2, enclasps 215 countries world-wide and it’s becoming the
catastrophe of the century. A total of 32,72,202 confirmed cases and
230104 deaths were reported worldwide out of these 39,093 cases and
1306 deaths were accounted from India as of 3rd May
2020.[2] However, the infection rate of COVID19
in India is reported to be 1.7, significantly lower than in the worst
affected countries [3,4]. At present, there is
no specific vaccine available to prevent this viral disease and
epidemiological, clinical shreds of evidence are suggesting several
novel compounds, as well as medicines licensed for other conditions,
that appear to have potential efficacy against
COVID-19.[5] Thus, in a way to combat the spread
of this highly infectious disease, around one-third of the global
population is now under lockdown to halt the spread of this highly
contagious disease.[6]India’s first COVID-19 confirmed case was diagnosed in Kerala, in a
student who has returned from Wuhan, China on January 30, 2020. Since
the outbreak emerged in India, the number of cases has undergone a
steady rise, and currently, several active cases were reported in
different parts of India. While the number of cases has swelled in the
last one month and cases have already been reported from 32 states and
Union Territories, these cases are not evenly spread out across the
country. States like Maharashtra, Gujarat, Delhi, Tamil Nadu,
Rajasthan, Uttar Pradesh, and Madhya Pradesh have emerged as epic
centers and are the worst-hit states in India in terms of the total
number of Covid-19 cases that have been
reported.[7] In response, India has implemented
international travel bans and a strict lockdown from March 25, 2020.
The first phase of lockdown ended on 14th April, followed by the
second phase ended on 03rd May, and at present 3rd phase of lockdown
is going on until May 17th. However, countries like India are at
larger risk because of a very large population density, illiteracy,
and inadequate healthcare systems to cater to very large demands[8].
In epidemiology, a case fatality rate (CFR), sometimes called case
fatality risk is the percentage of cases of a specified condition that
is fatal within a definite time. A CFR is conventionally expressed as
a percentage and represents a measure of disease
severity.[9] CFRs reflect the level of disease
severity and CFR is vital for setting priorities for public health in
targeted interventions to reduce the severity of the risk. High CFRs
reflect limited access to proper health care for the most vulnerable
people and insufficiencies in health-care systems, including the
limited capacity of the surveillance system to trigger a timely
response.[10] As of the end of the Lockdown 1.0
& 2.0 (i.e. 14th April & 3rd May respectively) the CFR of India is
at 3.26 & 3.34 respectively for COVID-19 but the CFR’s of states of
India has not been reported until now, which may be helpful in
understanding and estimating the fatality and sternness of this
infectious disease in the Indian subcontinent.
The first robust and ideal step in mitigating the outbreak of
communicable diseases like COVID-19 is for government health officials
to begin early testing. This leads to rapid identification of cases,
fast isolation to prevent spread, contact tracing, and swift
initiation of treatment. Early testing is the only way to recognize
anyone who came into contact with infected people so they can be
isolated from the community and may hastily be treated. Testing also
is important in the larger public health picture on mitigation
efforts, helping investigators to depict the prevalence, spread, and
contagiousness of the disease. Due to the limited resources, the
testing rate in India is among the lowest in the world, which may
underestimate the total number of confirmed
cases.[3,4] Thus it is essentially required to
estimate the total test rate and percentage of positive cases.
Keeping the above in mind, the present study was aimed to perform a
retrospective analysis of the total number of test performed by
different states, total no. of confirmed cases and % of positivity
rate reported initially in India during the first lockdown (1.0) and
the second phase (2.0) of lockdown. Further, bearing in mind the
prominence of CFR and RR in COVID 19 analysis, measurement and
comparison of the same was done for different states of India at the
end of Lockdown 1.0 & 2.0 using up-to-date state-level data.
Methods:
2.1. Source of data and procedure: The data were retrieved from
accurate databases including Ministry of Health and family welfare
(MoHFW)[11], Centre for Evidence Based Medicine
(CEBM)[12], COVID19 India, and World Health
Organization (WHO)[13]. The analysis of data in
the present study was carried from. 22nd March to 14th of April .i.e.
first phase of lockdown and 15th April to 3rd May,
2020, i.e. second phase of lockdown.
- Parameters used in study: States with total cases ≥ 100 were
included in the study and raw data was mapped according to states.
Percentage of confirmed cases (PCC), average tests per day CFR and RR
were estimated and compared among states.
- Measuring the CFR and RR[14]:
The formulas below were used to measure PCC, CFR and RR-
PCC (%) = (Number of test performed for COVID-19/Number of Confirm
COVID-19 cases) ×100
CFR (%) = (Number of deaths due to COVID-19/ Number of reported cases
of COVID-19) ×100
RR (%) = (Number of cases recovered from COVID-19/ Number of reported
cases of COVID19) ×100
Results:
The geographical spread of coronavirus outbreak in India had extended to
31 states and Union Territories after 1st phase of lockdown with an
addition of one state during 2nd phase of lockdown taking the tally to
total of 32 as of now, with Mizoram being the latest to report Covid-19
cases. Totally 15 & 18 no. of states have crossed 100 cases mark after
completion of 1st& 2nd phases of lockdown respectively. Average testing
per day and % of confirmed cases of COVID- 19 among states of India
after lockdown 1.0 & 2.0