The trend of COVID-19 pandemic in India: a methodical comparison with Italy, UK, and the US

Introduction: To statistically compare the trends of epidemiological indicators of COVID-19 in India with Italy, the UK, and the US. Methodology: In this descriptive analysis, epidemiological indicators were calculated and their trends were plotted and compared statistically. Regression analysis was done to predict the fatalities. Results: The trends of total and active cases per million populations are rising in India and US, while Italy has achieved the plateau in the total cases per million populations, and active cases have been sharply declining with time. The UK is about to achieve the same. India has remained far behind the other three countries in the number of tests per million populations (p < 0.05). In the initial phase, the test positivity rate of India was quite lower but has overtaken Italy and UK. India has always reported a higher recovery rate than US and lower than Italy. CFRs have achieved a plateau in Italy and UK, in US it is declining, while it remained almost constant in India throughout the pandemic. Testing was a significant covariate in predicting the fatalities. Conclusions: India was able to manage the initial phase of this pandemic due to early and strict government interventions and strong public health responses.

Cost analysis of Telemedicine use in Pediatric Nephrology -The LMIC perspective (preprint)

Background The overall cost of managing chronic diseases is a significant barrier to accessing complete and timely healthcare, especially in rural and geographically isolated areas. This cost disparity becomes more pronounced in the case of children and more so in under-resourced regions of the world. In the era of COVID-19, as the need for physical distancing increased, there was a transition in approach to healthcare provision to Telemedicine consultations. The cost saving using teleconsultations is evaluated in this study in a pediatric nephrology clinic. Methodology This prospective cohort study was conducted at a tertiary care center in western Rajasthan from March 2021 to October 2022. All consecutive pediatric (29 days -18 years) patients attending telemedicine services for renal-related illness were enrolled. Basic demographic details were collected. The cost analysis was done after six months, in terms of perceived cost savings by a telemedicine consultation compared to an in-person visit during six months starting from enrolment. Results One hundred twelve patients were enrolled. Two hundred sixty-six teleconsultations attended. The 109 patients who could be followed up saved INR 4,57,900 during six months of follow-up. ( 3 lost to follow-up). The average cost saving was INR -1577/patient/visit. The patients saved 4.99 % of the family income [Median of 2.16 %( IQR: 0.66-5.5 %)]. The Highest expenditure per visit was incurred for food and transport. The median distance from the residence to the clinic was 122.5 km (IQR: 30-250). Over the six-month study period, our patients have saved a travel distance of 83274 km. (743 km per patient). Conclusion The use of telemedicine as a follow-up method helps save significant costs and distances travelled by patients.

Adverse events reported from the COVID-19 vaccines: a descriptive study based on the WHO database (VigiBaseR)

The emergency approval of a few COVID-19 vaccines provided a ray of hope to fight the deadly pandemic. However, their approval was solely based on limited data from the clinical trials in a short period, thereby imposing a demand for post-marketing surveillance studies to monitor beneficial and adverse events (AEs). This study focuses on observing the serious adverse events (SAEs) data reported in the World Health Organization database. The data from VigiBaseR was analyzed. The duplicates in the data were removed and analyzed based on age, gender, and SAEs at the system organ classification level and the individual preferred term level. A total of 103,954 AEs were reported. The majority of them were seen as females (80%), from Europe (83%), and were between 18 and 64 years (80.74%) of age. The most-reported AEs were of the nervous system (19.1%), musculoskeletal (11.2%), and elderly (>65 years) people. The reported SAEs from the COVID-19 vaccines were in line with the data published in the clinical trial reports. These SAEs to vaccines will need causality analysis and review of individual reports.

Efficacy and Safety of Ayurveda Intervention AYUSH 64 as add-on therapy for patients with COVID 19 infections: An open labelled, Parallel Group, Randomized controlled clinical trial (preprint)

The authors have withdrawn this manuscript because they found a serious issue in data-analysis which leads to wrong interpretation of the results. Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.

Clinical Profile of Bloodstream Infections in Covid-19 Patients: A Retrospective Cohort Study (preprint)

Background: Bloodstream infections (BSIs) are emerging cause of significant morbidity and mortality in severe Corona virus disease (Covid-19). We aimed to assess the prevalence, clinical profile and outcome of BSIs in critically ill Covid-19 disease. Material and Methods: This was a single-centre retrospective study conducted at a tertiary care hospital in Western India. All the patients (age >18 years) with reverse-transcription polymerase chain reaction (RT-PCR) confirmed Covid-19 pneumonia admitted in Covid intensive care unit (ICU) between September 2020 to February 2021 were included. Hospital electronic records were searched for demographic data, time of bloodstream infection since admission, clinical profile, antimicrobial resistance pattern and clinical outcome of all patients who developed BSIs.Results: Out of 750 patients admitted in Covid ICU, 8.5% developed secondary BSIs. All severe Covid-19 pneumonia patients developed BSIs succumbed to illness. The major proportion of BSIs were gram-negative pathogens (53/64, 82.8%). Acinetobacter baumannii was the commonest isolate followed by Klebsiella pneumoniae (32.8% and 21.9% respectively). Multidrug-resistance microorganisms (MDRO) were found in 57.8% of the cases. The majority of MDRO belonged to K. pneumoniae and Enterococcus groups. The proportion of gram-negative bacteria resistant to carbapenems was 47.2% (25/53). Conclusion: BSIs in severe Covid-19 patients carries a substantial mortality, which is a cause for concern. Timely initiation of empirical antibiotics and prompt de-escalation are vital to improve the outcome. At the same time, strict compliance of infection control practices should be accomplished to reduce the occurrence of MDRO.

Barriers and Facilitators to COVID-19 screening at Jaipur International Airport, India. (preprint)

Background:Airports pose a possible threat in facilitating global disease transmission within the community which may be prevented by rigorous systematic entry-exit screening. With the aim to capture the perception of stakeholders associated with COVID-19 on barriers and facilitators of airport screening at Jaipur International Airport. Also, to assess key outcomes viz. total passengers screened, suspected cases, & confirmed cases.Methods:An inductive-deductive mix-method thematic analysis was conducted to capture qualitative data of key stakeholders. Additionally, quantitative data was obtained from the Rajasthan Medical & Health Department team deployed for COVID-19 airport screening.Results:Jaipur International Airport screened 4565 passengers (Males=4073 and Females=492) with 23 suspected cases during an outlined period of declaration of Pandemic to Lockdown in India (11th to 24th March 2020). Total 65 passengers had travel history from China (3 from Wuhan). The mean average age of passengers was 40.95 ± 7.8 years. The average screening time per passenger was 2-3 minutes with a load of 25-90 passengers per team per flight. Fishbone analysis of screening challenges revealed poor cooperation of passengers, masking symptoms, apprehension, and stigma related to quarantine. Moreover, inadequate human resources and changing guidelines overburdened healthcare providers. But, perception of risk, and social responsibility of travelers together with supportive organization behavior act as facilitators. Overall, groundwork on airport screening was insightful to propose key action areas for screening.Conclusions:Globally, COVID-19 has an impact on health infrastructure and international travel. International coordination with streamlined screening will go a LONG way in virus containment. 

Serial interval, basic reproduction number and prediction of COVID-19 epidemic size in Jodhpur, India (preprint)

Background: Understanding the epidemiology of COVID19 is important for design of effective control measures at local level. We aimed to estimate the serial interval and basic reproduction number for Jodhpur, India and to use it for prediction of epidemic size for next one month. Methods: Contact tracing of SARSCoV2 infected individuals was done to obtain the serial intervals. Aggregate and instantaneous R0 values were derived and epidemic projection was done using R software v4.0.0. Results: From among 79 infector infectee pairs, the estimated median and 95 percentile values of serial interval were 5.98 days (95% CI 5.39 to 6.65) and 13.17 days (95% CI 11.27 to 15.57), respectively. The overall R0 value in the first 30 days of outbreak was 1.64 (95% CI 1.12 to 2.25) which subsequently decreased to 1.07 (95% CI 1.06 to 1.09). The instantaneous R0 value over 14 days window ranged from a peak of 3.71 (95% CI 1.85 -2.08) to 0.88 (95% CI 0.81 to 0.96) as on 24 June 2020. The projected COVID-19 case-load over next one month was 1881 individuals. Reduction of R0 from 1.17 to 1.085 could result in 23% reduction in projected epidemic size over the next one month. Conclusion: Aggressive testing, contact-tracing and isolation of infected individuals in Jodhpur district resulted in reduction of R0. Further strengthening of control measures could lead to substantial reduction of COVID19 epidemic size. A data-driven strategy was found useful in surge capacity planning and guiding the public health strategy at local level.

Dynamics of SARS-CoV-2 transmission among evacuees quarantined at Jaisalmer, India (preprint)

Background During COVID-19 pandemic, Indian nationals were evacuated from foreign countries to various quarantine facilities in India. Individuals arriving from Iran on 14 March 2020 were quarantined at Jaisalmer, Rajasthan. All individuals were tested for SARS-CoV-2 infection after completing 14 days of quarantine. Those testing positive were isolated at AIIMS Jodhpur, India. We attempt to describe the transmission dynamics of SARS-CoV2 in this cohort.Methods Basic SEIR compartmental model was developed using daily stepwise approach in Microsoft Excel. Advanced model using standard differential equations in Python software version 3.6 was used to estimate R0 based on model fit to actual data.Results Forty-eight SARS-CoV-2 infections were found among the 474 evacuees. Out of them 44 (92%) were asymptomatic. R0 for the overall duration was found to be 2.29 (95% CI 1.84–2.78). Male gender and age greater than 60 years were associated with SARS-CoV-2 infection (RR = 4.33, 95% CI 2.07–9.05 and 5.32, 95% CI 3.13–9.04, respectively). Isolation of infected individuals and stricter quarantine of remaining individuals reduced the R0 from 2.41 initially to 1.17 subsequently.Conclusion R0 value was found comparable to the earlier studies indicating similar transmission dynamics among quarantined individuals in India. Further, universal testing and prompt isolation of infected individuals was found effecting in interrupting the transmission of SARS-CoV-2. Role of asymptomatic individuals in transmission appears to be strong in the context of quarantine of evacuees.