Figure no: 01 The comparison of case fatality rate (CFR) and recovery rate (RR) between different states of India on 14th April, 2020 (n = 15).
Discussion:
udy supports the fact that the current CFR of the COVID-19 pandemic in India (3.26) seems to be less than SARS (10%), and MERS (36%)14. Also except five states, all the other states in India were found to have CFR less than the CFR of India but many factors may confuse the current estimation for CFR of COVID-19 in Indian states, namely, low case testing, asymptomatic cases, undetected cases or delayed case reporting, which can significantly affect the 2 indicators which are linked with a degree of preparedness and mitigation of both the general public and government. Moreover, enhancing the testing capacity in larger states like Uttar Pradesh, Madhya Pradesh, Rajasthan and West Bengal may give the more positive cases and it may change the CFR scenario also. Study also shows that RR of COVID 19 in some states is on high end compared to India (10.99%) hinting the strength of clinicians 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 in containing this disease. Apart from this, certain factors like vastly densely populated slums, illiteracy, poverty and poor sanitization etc., may promote the spread of the disease in India. Thus, the Indian government has adopted the strategy of country wide lockdown starting from March 25th 2020 up to 14th April, 2020 and extended now up to 03rd May, 2020. This decision may have been taken in view of the, absence of a safe and effective vaccine or medicine, reducing viral transmission in the current stage. Further lockdown may provide more time to identify the asymptomatic cases and prevent the community transmission in state level.  Along with lockdown strategy, promotion of public awareness, avoidance of public transport, self-quarantine, and use of preventive appliances i.e. face mask, hand hygiene etc. can effectively mitigate the spread of this highly infectious viral disease in India.
Conclusion:   Initial findings from reports of China CDC on COVID 19 pandemic conclude that the COVID-19 severity and death is associated with age and comorbidities. oups, such as old age, children and people underlying diseases such as diabetes and cancer, receive adequate protection from COVID-19. 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. 
Conflicts of interest
The authors have none to declare.
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