Geographical Variation in COVID-19 Cases, Prevalence, Recovery and Fatality Rate by Phase of National Lockdown in India, March 14-May 29, 2020

BackgroundSince the COVID-19 pandemic hit Indian states at varying speed, it is crucial to investigate the geographical pattern in COVID-19. We analyzed the geographical pattern of COVID-19 prevalence and mortality by the phase of national lockdown in India. MethodUsing publicly available compiled data on COVID-19, we estimated the trends in new cases, period-prevalence rate (PPR), case recovery rate (CRR), and case fatality ratio (CFR) at national, state and district level. FindingsThe age and sex are missing for more than 60 percent of the COVID-19 patients. There is an exponential increase in COVID-19 cases both at national and sub-national levels. The COVID-19 infected has jumped about 235 times (from 567 cases in the pre-lockdown period to 1,33,669 in the fourth lockdown); the average daily new cases have increased from 57 in the first lockdown to 6,482 in the fourth lockdown; the average daily recovered persons from 4 to 3,819; the average daily death from 1 to 163. From first to the third lockdown, PPR (0.04 to 5.94), CRR (7.05 to 30.35) and CFR (1.76 to 1.89) have consistently escalated. At state-level, the maximum number of COVID-19 cases is found in the states of Maharashtra, Tamil Nadu, Delhi, and Gujarat contributing 66.75 percent of total cases. Whereas no cases found in some states, Kerela is the only state flattening the COVID-19 curve. The PPR is found to be highest in Delhi, followed by Maharastra. The highest recovery rate is observed in Kerala, till second lockdown; and in Andhra Pradesh in third lockdown. The highest case fatality ratio in the fourth lockdown is observed in Gujarat and Telangana. A few districts viz. like Mumbai (96.7); Chennai (63.66) and Ahmedabad (62.04) have the highest infection rate per 100 thousand population. Spatial analysis shows that clusters in Konkan coast especially in Maharashtra (Palghar, Mumbai, Thane and Pune); southern part from Tamil Nadu (Chennai, Chengalpattu and Thiruvallur), and the northern part of Jammu & Kashmir (Anantnag, Kulgam) are hot-spots for COVID-19 infection while central, northern and north-eastern regions of India are the cold-spots. ConclusionIndia has been experiencing a rapid increase of COVID-19 cases since the second lockdown phase. There is huge geographical variation in COVID-19 pandemic with a concentration in some major cities and states while disaggregated data at local levels allows understanding geographical disparity of the pandemic, the lack of age-sex information of the COVID-19 patients forbids to investigate the individual pattern of COVID-19 burden. Major highlights of the studyO_LIThe new cases of COVID-19 have increased exponentially since the second lockdown phase in India. There is consistent improvement in the recovery rate (CRR is 7.1 percent in pre-lockdown to 44.0 percent in fourth lockdown period) with a low level of CFR (1.87 percent as of May 29st 2020). C_LIO_LIAt the state level, the most vulnerable states for the COVID-19 crisis are the state of Maharashtra, Tamil Nadu, Delhi, and Gujarat contributing 66.75 percent of total cases. C_LIO_LIThe PPR is found to be highest in Delhi, followed by Maharastra. While the highest recovery rate is observed in Kerala, the highest case fatality ratio in the fourth lockdown is observed in Gujarat and Telangana. The top 10 hotspot districts in India account for 58.3 percent of the new cases. Among them, Mumbai has the highest infection rate of 96.77 per 100 thousand, followed by Chennai with 63.66 per 100 thousand, and Ahmedabad with 62.04 per 100 thousand. C_LIO_LIThe information on age and sex are missing for more than 60 percent of the patients. C_LI