key: cord-0985365-nv8kfp7z authors: Ghosh, Kapil; Sengupta, Nairita; Manna, Dipanwita; De, Sunil Kumar title: Inter-state transmission potential and vulnerability of COVID-19 in India date: 2020-06-16 journal: Progress in disaster science DOI: 10.1016/j.pdisas.2020.100114 sha: 0598ab0c8821f999b83660c398aa2c8d9c1680fd doc_id: 985365 cord_uid: nv8kfp7z Abstract Since the first case of COVID-19 traced in India on 30th January 2020, the total no. of confirmed cases is amplified. To assess the inter-state diversity in spreading potentiality of COVID-19, the exposure, readiness and resilience capability have been studied. On the basis of the extracted data, the outbreak scenario, growth rate, testing amenities have been analysed. The study reflects that there is an enormous disparity in growth rate and total COVID-19 cases. The major outbreak clusters associated with major cities of India. COVID-19 cases are very swiftly amplifying with exponential growth in every four to seven days in main affected states during first phase of lockdown. The result shows the vibrant disproportion in the aspect of, hospital bed ratio, coronavirus case-hospital bed ratio, provision of isolation and ventilators, test ratio, distribution of testing laboratories and accessibility of test centres all over India. The study indicates the sharp inequality in transmission potentiality and resilience capacity of different states. Every state and union territory are not well-prepared to contain the spreading of Covid-19. The strict protective measures and uniform resilience system must be implemented in every corner of India to battle against the menace of Covid-19. A new respiratory tract infectious disease COVID-19 caused by coronavirus -2019 has emerged out of the city of Wuhan, China [1] in December 2019, which has already spread worldwide with its deadly effect. Suddenly, it has been transformed into an extraordinary catastrophe towards the world's geopolitical scenario, economic structure and health system [2] . The magnitude of its aftermath is extraordinary [3] . Reuters has released a statement of UN Secretary-General, where he has warned that the world will encounter the most challenging emergency situation since World War II with COVID19. On 30 th January, 2020, World Health Organization (WHO) announced this health disaster as Public Health Emergency of International Concern (PHEIC) and ultimately on 11 th March, 2020, WHO has considered this disease as a pandemic. This emergency situation has an extensive worst impact on the national economy, social and psychological issues as well as on the international affairs of every affected territories [4] . WHO has coined a new term 'infodemic' [5] and information circulated through social media would traumatize people in several times [6] . The prime and initial factor of COVID-19 must be identified as a challenge on the basis of humanitarian ground [7] . WHO In this context, the fact is noteworthy that every state of India is not equally well-equipped with adequate medical infrastructure to provide necessary health care facilities to the COVID-19 patients. Proper medical amenities are highly inaccessible especially to the citizens residing in the remote areas of different states across the country. The inequal service of health sector in various states promote to flourish the rate of contagion countrywide. The low testing rate, deficiency and miserable condition of quarantine centres, rejection of hospitals for admitting patients, scarcity of ventilation systemsare the regular hazardous phenomena of India surging the country's gross no. of positive COVID-19 cases. The fact is evident that the present alarming situation of India is a definite outcome of sharp interstate disparity in the aspect of necessary remedial readiness and resilience capability to combat against COVID-19. Existing gaps in healthcare infractures and socioeconomic vulnerabilities may lead to sharp jump in outbreak of the virus [17] Therefore, the assessment of interstate discrepancy in corona virus outbreak rate and medical accommodations are explicitly imperative to detect the disparity of transmission capability of the states all over India. This study is very crucial not only to focusing the current situation but to also gaining comprehensive idea about the near future scenario and make necessary preparedness to cope with the situation. This paper aims to highlight the interstate variations in transmission potential of COVID-19 and to assess the exposure, preparedness and resilience capacity in different states in India. 2. Materials and methods The present study is based on secondary data sources. State and district wise data regarding the confirmed case of COVID-19 and test records from 30 th January to 31 st May, 2020 have been collected from publicly available portal of covid19india.org. The data is validated by a group of volunteers. Census of India's report has been used to obtain the state wise population of 2020. COVID-19 test centres locational information has been gathered from the Indian Council of Medical Research (ICMR) official bulletin (01 April, 2020). National Health Profile -2019 report has been used to obtain the state wise hospital bed, per capita health expenditure, poverty ratio and aged population (above 60 years). Slum household information has been gathered from Census of India (2011) slum house section. Several newspaper reports have also been used to interpret the problem in different states and union territories in India. State wise available hospital beds (Government hospitals only) and projected population data are used to calculate the availability of hospital bed ratio in different states. To identify states wise potential for hospital shortages, the COVID 19 confirmed cases and hospital bed ratio has also been calculated. Confirmed cases per 1000 persons in different states have been identified on the basis of projected population (2020) and total confirm cases as of 31 st May, 2020. Finally, the ratio of confirmed cases (case per 1000 persons) and hospital bed (bed per 1000 persons) are identified. A scatter diagra m is prepared to show the relationship between slum population and total positive case. The first COVID -19 case in India was identified at Thrissur, Kerala on 30 th January, 2020 and the Ministry of India has confirmed that 63% casualty have been recorded among the age group of above 60 years whereas 30% death is reported within the age group of 40-60 years. According to WHO, the older population is explicitly identified as vulnerable group to the menace of coronavirus infection. The availability of beds for elderly population in India is 5.18 per 1000 old population. To understand the actual scenario of coronavirus and to know whether the current interventions are adequate or falling short, appropriate data of various administrative unit all over the country in temporal basis is required. Test ratio per thousand people in India is very low (3.19) in respect to Italy The study reflects another striking fact of unequal distribution of testing centres all over the country. In India, 56.56% area is falling under 100 km. buffer zone of different testing centres and this 100 km buffer area may be considered as maximum limit of accessibility without considering the geographical factors of regional accessibility (Figure 5) . The map shows that the extension of testing related service is maximum in the Southern part of the country. Moreover, the Western coastal region and the portion of North, North-west India are well-covered with the services of testing labs. But on the other side, the parts of the Eastern, Central, extreme Northern India are mostly uncovered in this context which increase the magnitude of vulnerability of the people residing in these particular regions. Major findings form the above discussions can be summarized in following table- • In India, Recovery rate of COVID-19 patients is increasing and during first phase it was 13.16% and in last phase it reaches to about 50% with great inter-state variation. • Major outbreak clusters are located in Western and Northern India and they are associated with major cities. J o u r n a l P r e -p r o o f Since the first Covid-19 case reported on 20 th January, 2020, spreading pace is not uniform throughout the county. Presently in India, the intensity of severity and casualty are increasing daily in a steady rate and yet to reach at the peak. Community-dependent disaster managing system and preparation [23] is significant to diminish the resultant fatalities and damages [8] . Although, the present study identifies the outbreak hotspot at district, scaling up of hotspot area identification to village or municipality (local administrative unit) may help to better monitoring system. Most emphasis should be given to enhance the testing activities of the suspected people and enforce them to stay isolated. A strategy of community quarantine could be helpful to prevent the people being exposed to the virus [21] . The accurate and updated information of every districts across the country must be circulated to prevent the spreading of coronavirus contagion and to build resilience against this disease. So, the development of proportionate resilience system in every part of India is a mostly crucial issue, which can support to achieve speedy and sustainable retrieval from the menace of COVID-19. 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