key: cord-337680-uz6hfixk
authors: Gandhi P, Aravind; Kathirvel, Soundappan
title: Epidemiological studies on COVID-19 pandemic in India: Too little and too late?
date: 2020-05-12
journal: Med J Armed Forces India
DOI: 10.1016/j.mjafi.2020.05.003
sha: 
doc_id: 337680
cord_uid: uz6hfixk

nan

Of the 168374 tests performed in Maharashtra (till 3 rd May 2020) and 5911 SARI cases (till 2 nd April 2020) from 41 sentinel sites, 12296 (7.3%) and 104 (1.8%) patients found positive for COVID-19. 3, 5 Of the cases for whom data was available from Maharashtra (n-12271), New Delhi (n-21) and sentinel sites (n-102), 7476 (60.9%), 14 (66.7%) and 85 (83.3%) were males; and mean/median age was 39.7, 40.3 and 54 years, respectively. [3] [4] [5] The details of clinical presentation at the time of testing was available only with New Delhi study. Of the 21 cases, 9 (42.9%) were asymptomatic, and 6 (28.6%) had comorbidities most commonly hypertension (23.8%) and diabetes mellitus (14.2%). 4 Of the symptomatic patients, fever and cough (42.9%), sore throat (23.8%), headache (13.6%) and breathlessness (4.8%) were the common clinical presentation. 4 A total of 134 (1.2%) and 521 (4.7%) patients were critically ill and deceased (case fatality rate-CFR) respectively in Maharashtra (n-11056) and none in New Delhi. 3, 4 Though higher CFR has been reported among males of Maharashtra (4.8%) compared to females (4.0%), no significant association was found between gender and mortality (p-0.05). The age-specific mortality rate was also high among patients aged 61-70 years (19.2%), 71-80 years (15.8%) and above 80 years (13.9%). 3 No details are available on clinical presentation and mortality other than SARI from sentinel site study.

New Delhi study was able to trace the source of infection to foreign travel history or to close contact with all cases. 4 However, of the 192 cases for whom source investigation was completed in Maharashtra (based on cases reported till 5 th April 2020), 84 (43.8%) had a travel history, and 60 (31.3%) had a contact history with confirmed COVID-19 case. 6 Source of infection was inconclusive among 48 (25.0%) cases. 6 Similarly, of the 102 COVID-19 cases among SARI patients from sentinel sites, source history was not available, and the source could not be traced among 59 (57.8%) and 40 (39.2%) cases, respectively. 5 The considerable proportion of cases for whom the source of infection could not be traced indicates that the community transmission may be happened already in India. 7 The discrepancy in tracing the source between these three studies may be due to the differences in approach, study population and the study period. It was a cluster or community-based approach in Maharashtra and hospital-based approach in New Delhi and sentinel site study. Further, New Delhi study investigated all COVID-19 positive cases, and sentinel site study investigated all SARI cases for COVID-19.

Though the above three literature provides insight into some basic demography of the COVID-19 cases in India, they could not provide representativeness and comprehensiveness, together or alone. They also differ with each other in terms of severity, source of infection and clinical outcomes. It has been more than three months that the disease has emerged into the country. Yet, India lacks basic and comprehensive epidemiological information like socio-demography, risk factors and comorbidities, modes of transmission and its dynamics, clinical presentations, the different testing strategies and its positivity rates, and clinical outcomes.

Though the early, extended nationwide lockdown of the country should be applauded, this alone is not sufficient to defeat the COVID-19. 8 Data is the key in the fight against COVID-19. 9 There are more than a couple of prediction papers published based on this limited epidemiological data with varied assumptions. At times, actions are taken based on these predictions with many limitations, which may affect the country economically and politically in addition to individual-level adverse effects. Though the evidence generated so far in India is indeed too low to comment on the complete epidemiology, it is definitely not late to start, streamline and systematically collect the data and disseminate. In this crisis, the research community can be linked with the people delivering healthcare services at various levels for collecting quality-assured data.

Hence, it is recommended to generate local epidemiological data through robust studies supported with a) timely and adequate funding/resources; b) collaboration with research and development community; c) fast-tracking ethical and administrative procedures and d) prompt dissemination of findings to the stakeholders by fast-tracking the publications for evidence-based decision.

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any institute or government.

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