Key words: COVID-19, CFR, RR, SARS-CoV-2, Pandemic, India, States
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.
  1. 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.
  2. 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