4. Discussion:
India’s testing rate was on lower-end matched to other countries in a
fight against COVID- 19 until 03rd May 2020 but on the other hand % of
confirmed cases after testing was lower (3.57%) when compared with
Italy (23%), Austria (16.7 %), US (13.5 %) and UK (10 %).[15].
This may indicate that the COVID 19 is still under the Phase 2 stage in
India and also highpoint the efforts of the Indian government.
Interstate analysis of lockdown 1.0 and 2.0 shows that some states
especially West Bengal, Jammu & Kashmir, Punjab and, Haryana have very
smaller no. of testing rates, while Tamil Nadu, Maharashtra, Andhra
Pradesh, Uttar Pradesh, Rajasthan, Gujarat, and Karnataka have
accelerated the testing and data showed a high shift in testing rate in
these states during the second phase of lockdown. Impact of social
distancing and lockdown can be observed clearly in this study where the
total no of cases and % of confirmed cases have declined in states
after lockdown 2.0 except Maharashtra. However, the analysis of both the
phases 1.0 and 2.0 is quite encouraging, showing positive impact
supporting the lockdown initiative of Govt. of India at pan India level.
Despite this, the results of the study is a wakeup call for a few states
where the testing rate is very less, and % of confirmed cases are high.
The testing rate should be accelerated in these states to stop the
asymptomatic transmission. Low testing rates may create a panic
situation in the future, and undiagnosed cases may lead to community
transmission that can create a dangerous situation for populations. Thus
it is essentially required, states and central govt. may unite together
to build the testing facility and accelerate the testing.
Currently, the mitigation measures adopted by the Indian government had
effectively reduced the spread and flattened the now ubiquitous curve to
allow health care providers to provide effective care to those in
critical need as evidenced by the decrease in % of confirmed cases. But
the critical question remains what the future holds because lockdown
can’t remain all time, thus during the lockdown, it is essential to test
the maximum population in high positive percentage areas so that the
symptomatic and asymptomatic cases can be traced and separated. Based on
the results obtained in our study, we attempt to answer these questions
in a rigorous evidence-based manner. At a fundamental level, epidemics
spread over a network where carriers spread diseases with whom they are
connected to some degree. These networks or ’links’ can be via person to
person interaction, local transport or travel, or via shared spaces/
surfaces. The geographic location of the networks is relevant because
there may be different modes of spread that can exist within any region.
The mitigation procedures cannot completely break this human to human
’link’ to disconnect the communities, and hence we recommend
policymakers and govt. to employ epidemiological studies and serological
test cards to screen the asymptomatic cases. Classical epidemiological
models are based on serological testing and utilized in past to estimate
a reproduction number or R0 (pronounced as R-naught) to describe the
intensity of the outbreak and is defined as the average number of
infectious. For large scale serological testing, private labs should
also be roped in, which will be helpful to accelerate the testing and
can screen the COVID-19 asymptomatic cases at a fast track level.
Cross-state comparisons of CFR and RR as important indicators of disease
characteristics are critical for national priority setting and
recognizing health system performance.[9] In the initial phases of
an epidemic, CFR tends to be on the higher side and this overestimation
is due to under testing and a time-lag bias, which is more pronounced at
the beginning of an outbreak. Although India is in initial phases of
COVID-19, estimating CFR and RR are of vital importance as they denote
the current status of the pandemic and helps in planning the additional
measures to be adopted to tackle the pandemic effectively. Hence, this
study was aimed to measure the CFR and RR of different states having at
least >100 confirmed cases in India during the ongoing
COVID-19 pandemic using recent state-level data after the 1st& 2nd
phases of lockdown i.e. 14th April & 03rd May 2020.
Globally, India was in no.32 position in CFR after 1st phase of lockdown
and no. 44 position after 2nd phase of lockdown. The improvement in CFR
may be attributed to the mitigation measures adopted by the government
like complete lockdown, strict social distancing, closure of intra &
interstate transport, improvement of testing facilities, awareness
programs, self-quarantine and mandatory use of preventive appliances
i.e. face mask, hand hygiene, etc., during this period. CFR of eight
states has decreased after the completion of the 2nd phase of lockdown
compared to 1st phase, indicating the success of mitigation measures
adopted by the general public and government. Still, India needs to
tackle the menace of low case testing, asymptomatic cases, undetected
cases, or delayed case reporting to decrease the CFR on a pan India
basis. The study also shows that RR of COVID- 19 has improved in all the
analyzed states except West Bengal hinting the strength of clinicians,
paramedical staff, and health care workers in the management of this
disease with the available medications advised by Indian Council of
Medical Research (ICMR). However, limited infrastructure and health care
facilities available in India for the 1.3 billion populations (approx.)
pose a challenge for the government authorities and policymakers in
containing this disease further. Therefore, strategies must be developed
including early detection of COVID-19 followed by access to medical
care, which may enhance the chances of recovery rates. Besides, case
studies with a detailed and accurate medical history, and scoring CFR
alongside RR, should be adopted in hospitals which may be helpful in
exactly pointing the hotspots of infection. This will, in turn, help the
government authorities in identifying the areas with higher infection
rates, so that lockdown can be strictly carried out in that parts of the
country and necessary medical resources will be mobilized to that areas.
Thus, the extended lockdown may provide more time to identify the
asymptomatic cases and prevent community transmission at the state
level.
5. Conclusion : Indian states have shown a tremendous
improvement concerning testing and mitigation measures to fight against
COVID- 19 as evidenced by a decrease in % of confirmed cases, CFR, and
improvement in RR. Further, employing mass testing and epidemiological
studies will strengthen the health care infrastructure and will augment
the screening the asymptomatic cases.