ABSTRACT
India reported over 10 million COVID-19 cases and 149,000 deaths in 2020. To estimate exposure and the potential for further spread, we used a SARS-CoV-2 transmission model fit to seroprevalence data from three serosurveys in Delhi and the time-series of reported deaths to reconstruct the epidemic. The cumulative proportion of the population estimated infected was 48.7% (95% CrI 22.1% - 76.8%) by end-September 2020. Using an age-adjusted overall infection fatality ratio (IFR) based on age-specific estimates from mostly high-income countries (HICs), we estimate that 15.0% (95% CrI 9.3% - 34.0%) of COVID-19 deaths were reported. This indicates either under-reporting of COVID-19 deaths and/or a lower age-specific IFR in India compared with HICs. Despite the high attack rate of SARS-CoV-2, a third wave occurred in late 2020, suggesting that herd immunity was not yet reached. Future dynamics will strongly depend on the duration of immunity and protection against new variants.
Subject(s)
COVID-19 , DeathABSTRACT
The lack of active surveillance for enterovirus D68 (EV-D68) in the US has hampered the ability to assess the relationship with predominantly biennial epidemics of acute flaccid myelitis (AFM), a rare but serious neurological condition. Using novel surveillance data from the BioFire ® Syndromic Trends (Trend) epidemiology network, we characterize the epidemiological dynamics of EV-D68 and demonstrate strong spatiotemporal association with AFM. Although the recent dominant biennial cycles of EV-D68 dynamics may not be stable, we show that a major EV-D68 epidemic, and hence an AFM outbreak, would still be possible in 2020 under normal epidemiological conditions. Significant social distancing due to the ongoing COVID-19 pandemic could reduce the size of an EV-D68 epidemic in 2020, illustrating the potential broader epidemiological impact of the pandemic. NOTE This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.