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COVID-19 in India reveals interesting trends

 COVID-19 Outcomes in a Low Income Country: India

    Many cases of COVID-19 have been traced back to low and middle-income countries (LMICs) where many individuals are at higher risk for the virus and limited access to health care services. However, many coronavirus studies have been conducted in wealthier countries including the U.S. and European countries. Although there have been some studies modeling potential COVID-19 outcomes in LMICs, very few studies have traced real-life COVID-19 cases to validate the outcomes of the models. A recent investigation  conducted by a professor at UC Berkeley and published in Science, analyzes these real-life COVID-19 cases from two states in South India. The results from this study answer the question of how COVID-19 outcomes in LMICs compare to that of wealthier countries, such as the United States.


Background Information

    As of October 2020, India has had 7.8 million COVID-19 infections, making up 18.4% of cases worldwide. Data was taken and analyzed from two states South India: Andhra Pradesh and Tamil Nadu. The collective residents of these two states make up approximately 10% of India's population. While Andhra Pradesh and Tamil Nadu are not particularly wealthy, they have the largest healthcare workforce and highest public health spendings per person. According to the Science study, "Both states initiated rigorous disease surveillance and contact tracing early in response to the pandemic." (Contact tracing is the process of identifying people who may have been in contact with an infected individual.)   Researchers then analyzed the contact tracing data and the effectiveness of the surveillance plan from the two states. While some results from the South India study confirm COVID-19 trends seen in past research, other findings from this study are inconsistent with and contrast common trends seen in the U.S. and other parts of the world. 

Results

    In the states of Andhra Pradesh and Tamil Nadu, a total 85,000 people tested positive COVID-19, along with 600,000 close contacts. The overall death rate was about 2%, with a higher death rate in men and older individuals, a common trend that has been observed globally. An inconsistent trend seen in India as compared to the U.S. is the number of cases and deaths in older age groups. In the two Indian states, incidence of COVID-19 cases decline with age at 40 years. Conversely, in the United States, COVID-19 incidence increases with age at 65 years. Additionally, death rate due to COVID-19 was lower for those aged 75 and older in South India compared to the United States. Whereas the two Indian states have a mortality rate of 17.9% for those aged greater than 75 years, the U.S. has a much higher mortality rate of 58.1% for the same age group. Researchers believe this may be attributed to the notion that those who live to old age tend to be wealthier than those who die young.



    Furthermore, researchers found that half of the deaths in Andhra Pradesh and Tamil Nadu occurred within 6 days of detecting the virus. According to the World Health Organization, time-to-death from hospital admission was 13 days in the U.S. and 2-8 weeks in China. The 6 day time span of time-to-death from hospital admission in India indicates that many patients are diagnosed during a late stage in their disease course. This late diagnosis is a significant contributing factor to the amount of deaths in the region. Additionally, in the two states, at least one underlying condition was noted among 62.5% of deaths, a substantially higher percentage compared to 22% of deaths in the United States.

Contact Tracing: Results and Significance

    Contact tracing results found that infected individuals were more likely to spread the virus to others in their age group. This pattern was strongest among children ages 0-14. These results are significant as they indicate children are a contributing factor to the spread of the disease. It's important, especially for children and adolescents, to limit social contact when feeling sick and to wear a mask and social distance around others.

Sources

1. Laxminarayan, Ramanan, et al. “Epidemiology and Transmission Dynamics of COVID-19 in Two Indian States.” Science, American Association for the Advancement of Science, 30 Sept. 2020, science.sciencemag.org/content/early/2020/09/29/science.abd7672.




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