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ObjectivesTo describe the public health strategies and their effect in controlling the COVID-19 pandemic from March to October 2020 in Chennai, India. SettingChennai, a densely populated metropolitan city in Southern India, was one of the five cities which contributed to more than half of the COVID-19 cases in India. ParticipantsWe collected the de-identified line list of all the 192,450 COVID-19 case-patients reported from 17 March to 31 October 2020 in Chennai and their contacts for the analysis. We defined a COVID-19 case-patient based on the RT-PCR positive test in one of the Government approved labs. Outcome measuresThe primary outcomes of interest were incidence of COVID-19 per million population, case fatality ratio, deaths per million and the effective reproduction number (Rt). We also analysed the indicators for surveillance, testing, contact tracing and isolation. ResultsOf the 192,450 RT-PCR confirmed COVID-19 case-patients reported in Chennai from 17 March-31 October 2020, 114,889 (60%) were males. The highest incidence was 41,064 per million population among the 61-80 years. The incidence peaked during June 2020 at 5239 per million and declined to 3,627 per million in October 2020. The city reported 3,543 deaths, with a case fatality ratio (CFR) of 1.8% and the crude death rate was 431 per million. When lockdown began, Rt was high (4.2) in March and fluctuated from April to June 2020. The Rt dropped below one by the first week of July and remained so until October 2020, even with the relaxation of restrictions ConclusionThe combination of public health strategies controlled the COVID-19 epidemic in a large, densely populated city in India. We recommend continuing the interventions to prevent resurgence, even as vaccination is being rolled out. StrengthsO_LIWe did a comprehensive analysis of COVID-19 strategies and outcome in a large, densely populated metropolitan city in India. C_LIO_LIWe documented that the community-centric public health strategies were feasible and effective in controlling the COVID-19 outbreak even in a large, thickly populated city C_LIO_LIThe lessons learnt are relevant to similar settings in low-and middle-income countries. Given the ongoing multiple waves of COVID-19 and the difficulty in controlling the transmission, our experience and lessons learnt will be valuable for policymakers and scientific advisors globally C_LI LimitationsO_LIWe analysed the data available from the GCC database and not from the hospitals where patients with moderate to severe illness were admitted. Hence, we could not report the severity of illness among admitted patients. C_LIO_LISecond, the COVID-19 incidence might have been underestimated while testing was low during the early phase of the epidemic C_LI
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BACKGROUND: India reported first laboratory-confirmed case of coronavirus disease 2019 (COVID-19) on 30 January from Kerala. Media surveillance is useful to capture unstructured information about outbreaks. We established media surveillance and described the characteristics of the COVID-19 cases, clusters, deaths by time, place, and person during January-March 2020 in India. METHODS: The media surveillance team of ICMR-National Institute of Epidemiology abstracted data from public domains of India's Central and State health ministries, online news and social media platforms for the period of January 31 to March 26, 2020. We collected data on person (socio-demographics, circumstances of travel/contact, clinical and laboratory), time (date/period of reported exposures; laboratory confirmation and death) and place (location). We drew epidemic curve, described frequencies of cases by age and gender. We described available details for identified clusters. RESULTS: As of March 26, 2020, India reported 694 (Foreigners = 45, 6%) confirmed COVID-19 cases (Attack rate = 0.5 per million population) and 17 deaths (Fatality = 2.5%) from 21 States and 6 Union Territories. The cases were higher among 20-59 years of age (60 of 85) and male gender (65 of 107). Median age at death was 68 years (Range: 38-85 years). We identified 13 clusters with a total of 63 cases and four deaths among the first 200 cases. CONCLUSION: Surveillance of media sources was useful in characterizing the epidemic in the early phase. Hence, media surveillance should be integrated in the routine surveillance systems to map the events specially in context of new disease outbreaks.
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Outbreaks of an unexplained acute neurologic illness affecting young children and associated with high case-fatality rates have been reported in the Muzaffarpur district of Bihar state in India since 1995. The outbreaks generally peak in June and decline weeks later with the onset of monsoon rains. There have been multiple epidemiologic and laboratory investigations of this syndrome, leading to a wide spectrum of proposed causes for the illness, including infectious encephalitis and exposure to pesticides. An association between illness and litchi fruit has been postulated because Muzaffarpur is a litchi fruit-producing region. To better characterize clinical and epidemiologic features of the illness that might suggest its cause and how it can be prevented, the Indian National Centre for Disease Control (NCDC) and CDC investigated outbreaks in 2013 and 2014. Clinical and laboratory findings in 2013 suggested a noninflammatory encephalopathy, possibly caused by a toxin. A common laboratory finding was low blood glucose (<70 mg/dL) on admission, a finding associated with a poorer outcome; 44% of all cases were fatal. An ongoing 2014 investigation has found no evidence of any infectious etiology and supports the possibility that exposure to a toxin might be the cause. The outbreak period coincides with the month-long litchi harvesting season in Muzaffarpur. Although a specific etiology has not yet been determined, the 2014 investigation has identified the illness as a hypoglycemic encephalopathy and confirmed the importance of ongoing laboratory evaluation of environmental toxins to identify a potential causative agent, including markers for methylenecyclopropylglycine (MCPG), a compound found in litchi seeds known to cause hypoglycemia in animal studies. Current public health recommendations are focused on reducing mortality by urging affected families to seek prompt medical care, and ensuring rapid assessment and correction of hypoglycemia in ill children.
