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.

Vaccination saves lives: How do patients with chronic diseases and severe COVID-19 fare? Analysis from India’s National Clinical registry for COVID-19 (preprint)

Objectives This study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalised COVID-19 adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC). Methods NCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1 st September 2020 to 26 th October 2021 were examined. Results Analysis of 29,509 hospitalised, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18752 (63.6%)] showed that 15678 (53.1%) had at least one comorbidity. Among 25715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n=3957). Adjusted odds of dying were significantly higher in age-group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy, and tuberculosis, presenting with dyspnea and neurological symptoms. WHO ordinal scale 4 or above at admission carried the highest odds of dying [5.6 (95% CI: 4.6, 7.0)]. Patients receiving one [OR: 0.5 (95% CI: 0.4, 0.7)] or two doses of anti-SARS CoV-2 vaccine [OR: 0.4 (95% CI: 0.3, 0.7)] were protected from in-hospital mortality. Conclusions WHO ordinal scale at admission is the most important independent predictor for in-hospital death in COVID-19 patients. Anti-SARS-CoV2 vaccination provides significant protection against mortality.

Analysis of predictors and outcomes of COVID-19 patients requiring ICU admission from COVID 19 (preprint)

BackgroundSevere Corona virus disease (COVID-19) is associated with high mortality. Although single centre intensive care units (ICU) have reported clinical characteristics and outcomes, no large scale multicentric study from India has been published. The present retrospective, multi-centre study was aimed to describe the predictors and outcomes of COVID-19 patients requiring ICU admission from COVID-19 Registry of Indian council of Medical Research (ICMR), India.MethodsProspectively collected data from multiple participating institutions was entered in the electronic National Clinical Registry of COVID 19. We enrolled patients aged>18 years with COVID-19 pneumonia requiring ICU admission between March 2020 and August 2021. Exclusion criteria were negative RT PCR, death within 24 hours of ICU admission, or patients with incomplete data in the registry Their demographic characteristics, laboratory variables, ICU severity indices, treatment strategies and outcomes were analysed.ResultsA total of 5865 patients, with mean age 56±15 years, with 3840/5865 (65.4%) men, were enrolled in the ICMR registry.. Overall mortality was 2535/5865 (43.5%). Non-survivors were older than survivors (58.2±15.4 years vs 53.6 ±14.7 years; P=0.001). Non-survivors had multiple comorbidities (n=1951, 52.9%) with hypertension (47.2%) and diabetes (45.6%) being the most common, higher creatinine (1.6 ± P=0.001, high D-dimer (1.56 vs 1.37, P=0.001), higher CT severity index (16.8±5.2 vs 13.5 ±5.47 ) compared to  survivors. Non survivors had longer hospital and ICU stay (P=0.001). On multivariate regression analysis, high NLR (HR 1.017, 95% CI 1.005- 1.029, P=0.001), high CRP (HR 1.008, 95% CI 1.006- 1.010, P=0.001), high D dimer ((HR 1.089, 95% CI 1.065- 1.113, P=0.001) were associated with mechanical ventilation while younger age, (HR 0.974, CI 0.965-0.983, p=0.001), high D dimer (HR-1.014, CI 1.001-1.027, P=0.035) and use of prophylactic LMWH (HR 0.647, CI 0.527-0.794, p=0.001) were independently associated with mortality. ConclusionIn this large retrospective study of 5865 critically ill COVID 19 patients admitted to ICU, overall mortality was 2535/5865 (43.5%). Age, high D dimer, CT Severity score and use of prophylactic LMWH were independently associated with mortality. 

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.

COVID-19 vaccine hesitancy among undergraduate medical students: results from a nationwide survey in India (preprint)

COVID-19 vaccine was launched in India on 16 January 2021, prioritizing health care workers which included medical students. We aimed to assess vaccine hesitancy and factors related to it among undergraduate medical students in India. An online questionnaire was filled by 1068 medical students across 22 states and union territories of India from 2 February - 7 March 2021. Vaccine hesitancy was found among 10.6%. Concern regarding vaccine safety and efficacy, hurried testing of vaccines prior to launch and lack of trust in government agencies predicted COVID-19 vaccine hesitancy. Risk perception regarding contracting COVID-19 vaccine reduced COVID-19 vaccine hesitancy as well as hesitation in participating in COVID-19 vaccine trials. Choosing between the two available vaccines (Covishield and Covaxin) was considered important by medical students both for themselves and their future patients. Covishield was preferred to Covaxin by students. Majority of those willing to take the COVID-19 vaccine felt that it was important for them to resume their clinical posting, face-to-face classes and get their personal life back on track. Around three-fourths medical students viewed that COVID-19 vaccine should be made mandatory for both health care workers and international travellers. Prior adult vaccination didnt have an effect upon COVID-19 vaccine hesitancy. Targeted awareness campaigns, regulatory oversight of vaccine trials and public release of safety and efficacy data and trust building activities could further reduce COVID-19 vaccine hesitancy among medical students.

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.