Cohort Profile: Real-Time Insights of COVID-19 in India (RTI COVID-India).

BACKGROUND: The coronavirus disease (COVID) pandemic caused disruption globally and was particularly distressing in low- and middle-income countries such as India. This study aimed to provide population representative estimates of COVID-related outcomes in India over time and characterize how COVID-related changes and impacts differ by key socioeconomic groups across the life course. METHODS: The sample was leveraged from an existing nationally representative study on cognition and dementia in India: Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD). The wave-1 of LASI-DAD enrolled 4096 older adults aged 60 years and older in 3316 households from 18 states and union territories of India. Out of the 3316 LASI-DAD households, 2704 with valid phone numbers were contacted and invited to participate in the Real-Time Insights COVID-19 in India (RTI COVID-India) study. RTI COVID-India was a bi-monthly phone survey that provided insight into the individual's knowledge, attitudes, and behaviour towards COVID-19 and changes in the household's economic and health conditions throughout the pandemic. The survey was started in May 2020 and 9 rounds of data have been collected. FINDINGS TILL DATE: Out of the 2704 LASI-DAD households with valid phone numbers, 1766 households participated in the RTI COVID-India survey at least once. Participants were in the age range of 18-102 years, 49% were female, 66% resided in rural area. Across all rounds, there was a higher report of infection among respondents aged 60-69 years. There was a greater prevalence of COVID-19 diagnosis reported in urban (23.0%) compared to rural areas (9.8%). Respondents with higher education had a greater prevalence of COVID-19 diagnosis compared to those with lower or no formal education. Highest prevalence of COVID-19 diagnosis was reported from high economic status compared to middle and low economic status households. Comparing education gradients in experiencing COVID-19 symptoms and being diagnosed, we observe an opposite pattern: respondents with no formal schooling reported the highest level of experiencing COVID-19 symptoms, whereas the greatest proportion of the respondents with secondary school or higher education reported being diagnosed with COVID-19. FUTURE PLANS: The study group will analyse the data collected showing the real-time changes throughout the pandemic and will make the data widely available for researchers to conduct further studies.

Indian female migrants face greater barriers to post-Covid recovery than males: Evidence from a panel study.

Background: India's abrupt nationwide Covid-19 lockdown internally displaced millions of migrant workers, who returned to distant rural homes. Documenting their labour market reintegration is a critical aspect of understanding the economic costs of the pandemic for India's poor. In a country marked by low and declining female labour force participation, identifying gender gaps in labour market reintegration - as a marker of both women's vulnerability at times of crisis and setbacks in women's agency - is especially important. Yet most studies of pandemic-displaced internal migrants in India are small, rely on highly selected convenience samples, and lack a gender focus. Methods: Beginning in April 2020 we enrolled roughly 4,600 displaced migrants who had, during the lockdown, returned to two of India's poorest states into a cohort observational study which tracked enrolees through July 2021. Survey respondents were randomly selected from the states' official databases of return migrants, with sampling stratified by state and gender. 85% of enrolees (3950) were working prior to the pandemic. Our difference-in-means analysis uses three survey waves conducted in July to August 2020, January to March 2021, and June to July 2021. Our analysis focuses on a balanced panel of 1780 previously working enrolees (the 45% of respondents present in the first wave that also participated in the subsequent two survey rounds). Primary outcomes of interest include labour market re-entry, earnings, and measures of vulnerability by gender. Findings: Before the March 2020 national lockdown, 98% (95% CI [97,99]) of workers were employed in the non-agricultural sector. In July 2020, one month after the end of the lockdown, incomes plummet, with both genders earning roughly 17% of their pre-pandemic incomes. 47% (95% CI [45,49]) were employed in agriculture and 37% (95% CI [35,39]) were unemployed. Remigration is critical to regaining income - by January 2021, male re-migrants report earnings on par with their pre-pandemic incomes, while men remaining in rural areas earn only 23% (95% CI [19,27]) of their pre-pandemic income. Remigration benefits women to a lesser extent - female re-migrants regain no more than 65% (95% CI [57,73]) of their pre-pandemic income at any point. Yet men and women struggle to remigrate throughout - by July 2021, no more than 63% (95% CI [60,66]) of men and 55% (95% CI [51,59]) of women had left their home villages since returning. Gender gaps in income recovery largely reflect higher rates of unemployment among women, both among those remaining in rural areas (9 percentage points (95% CI [6,13]) higher than men across waves) and among those who remigrate (13 percentage points (95% CI [9,17]) higher than men across waves). As a result, we observe gender gaps in well-being: relative to male counterparts, women across waves were 7 percentage points (95% CI [4,10]) more likely to report reduced consumption of essential goods and fared 6 percentage points (95% CI [4,7]) worse on a food insecurity index. Interpretation: Displaced migrants of both genders experienced persistent hardships for over a year after the initial pandemic lockdown. Women fare worse, driven by both lower rates of remigration and lower rates of labour market re-entry both inside and outside home villages. Some women drop out of the labour force entirely, but most unemployed report seeking or being available to work. In short, pandemic-induced labour market displacement has far-reaching, long-term consequences for migrant workers, especially women. Funding: Survey costs were funded by research grants from IZA/FCDO Gender, Growth, and Labour Markets in Low Income Countries Programme, J-PAL Jobs and Opportunity Initiative, and the Evidence-based Measures of Empowerment for Research on Gender Equality (EMERGE) program at University of California San Diego.

Adherence to COVID-19 protective behaviours in India from May to December 2020: evidence from a nationally representative longitudinal survey.

OBJECTIVES: Since the onset of the COVID-19 pandemic, behavioural interventions to reduce disease transmission have been central to public health policy worldwide. Sustaining individual protective behaviour is especially important in low-income and middle-income settings, where health systems have fewer resources and access to vaccination is limited. This study seeks to assess time trends in COVID-19 protective behaviour in India. DESIGN: Nationally representative, panel-based, longitudinal study. SETTING: We conducted a panel survey of Indian households to understand how the adoption of COVID-19 protective behaviours has changed over time. Our data span peaks and valleys of disease transmission over May-December 2020. PARTICIPANTS: Respondents included 3719 adults from 1766 Indian households enrolled in the Harmonised Diagnostic Assessment of Dementia for the Longitudinal Ageing Study in India. ANALYSIS: We used ordinary least squares regression analysis to quantify time trends in protective behaviours. RESULTS: We find a 30.6 percentage point (95% CI (26.7 to 34.5); p<0.01) decline in protective behaviours related to social distancing over the observation period. Mask wearing and handwashing, in contrast, decreased by only 4.3 percentage points (95% CI (0.97 to 7.6); p<0.05) from a high base. Our conclusions are unchanged after adjusting for recorded COVID-19 caseload and nationwide COVID-19 containment policy; we also observe significant declines across socioeconomic strata spanning age, gender, education and urbanicity. CONCLUSION: We argue that these changes reflect, at least in part, 'COVID-19 fatigue,' where adherence to social distancing becomes more difficult over time irrespective of the surrounding disease environment.

Remote Work and the Heterogeneous Impact of COVID-19 on Employment and Health

This paper examines the impact of the COVID-19 pandemic on employment and respiratory health for remote workers (i.e. those who can work from home) and non-remote workers in the United States. Using a large, nationally-representative, high-frequency panel dataset from March through July of 2020, we show that job losses were up to three times as large for non-remote workers. This gap is larger than the differential job losses for women, African Americans, Hispanics, or workers without college degrees. Non-remote workers also experienced relatively worse respiratory health, which likely occurred because it was more difficult for non-remote workers to protect themselves. Grouping workers by pre-pandemic household income shows that job losses and, to a lesser extent, health losses were highest among non-remote workers from low-income households, exacerbating existing disparities. Finally, we show that lifting non-essential business closures did not substantially increase employment.