COVID-19 in India: Are Biological and Environmental Factors Helping to Stem the Incidence and Severity?

Chakrabarti, Sankha Shubhra; Kaur, Upinder; Banerjee, Anindita; Ganguly, Upasana; Banerjee, Tuhina; Saha, Sarama; Parashar, Gaurav; Prasad, Suvarna; Chakrabarti, Suddhachitta; Mittal, Amit; Agrawal, Bimal K; Rawal, Ravindra K.; Zhao, Robert Chunhua; Gambhir, Indrajeet Singh; Khanna, Rahul; Shetty, Ashok K.; Jin, Kunlin; Chakrabarti, Sasanka

doi:10.14336/ad.2020.0402

Cited by 40 publications

(40 citation statements)

References 23 publications

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“…Nearly 85% of COVID-19-related death in Italy have been individuals in the 70+ year-old age group. It is common sense that in a patient with a fatality, in the presence of severe renal or pulmonary or cardiac disease, the mere presence of COVID-19 positivity does not confirm the role of coronavirus in causing death [13]. In our study, patients with diabetes with COVID-19 were older than patients without diabetes.…”

Section: Journal Of Diabetes Researchcontrasting

confidence: 63%

Clinical Characteristics of Diabetic Patients with COVID-19

Deng

Feng

et al. 2020

Journal of Diabetes Research

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Background. Since December 2019, novel coronavirus- (SARS-CoV-2) infected pneumonia (COVID-19) has rapidly spread throughout China. This study is aimed at describing the characteristics of COVID-19 patients in Wuhan. Methods. 199 COVID-19 patients were admitted to Wuhan Red Cross Hospital in China from January 24th to March 15th. The cases were divided into diabetic and nondiabetic groups according to the history of taking antidiabetic drugs or by plasma fasting blood glucose level at admission, and the difference between groups were compared. Results. Among 199 COVID-19 patients, 76 were diabetic and 123 were nondiabetic. Compared with nondiabetics, patients with diabetes had an older age, high levels of fasting plasma glucose (FPG), D-dimer, white blood cell, blood urea nitrogen (BUN) and total bilirubin (TBIL), lower levels of lymphocyte, albumin and oxygen saturation (SaO2), and higher mortality (P<0.05). The two groups showed no difference in clinical symptoms. Diabetes, higher level of D-dimer at admission, and lymphocyte count less than 0.6×109/L at admission were associated with increasing odds of death. Antidiabetic drugs were associated with decreasing odds of death. Treatment with low molecular weight heparin was not related to odds of death. Conclusion. The mortality rate of COVID-19 patients with diabetes was significantly higher than those without diabetes. Diabetes, higher level of D-dimer, and lymphocyte count less than 0.6×109/L at admission were the risk factors associated with in-hospital death.

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Section: Journal Of Diabetes Researchcontrasting

confidence: 63%

Clinical Characteristics of Diabetic Patients with COVID-19

Deng

Feng

et al. 2020

Journal of Diabetes Research

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“…1) (https://ourworldindata.org/coronavirus). This phenomenon clearly points to the presence of biological factors that are attenuating the spread of the COVID-19 outbreak in India, as was predicted in our April 2020 paper [1].…”

Section: Introductionsupporting

confidence: 78%

“…In early April, we hypothesized that COVID-19 mortality would be lower in India by global standards, and the overall impact of COVID-19 in additive mortality may be low [1]. Over the past six months, COVID-19 cases have increased in India.…”

Section: Introductionmentioning

confidence: 99%

Of Cross-immunity, Herd Immunity and Country-specific Plans: Experiences from COVID-19 in India

Chakrabarti¹,

Kaur²,

Singh³

et al. 2020

Aging and disease

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India has witnessed a high number of COVID-19 cases, but mortality has been quite low, and most cases have been asymptomatic or mild. In early April, we had hypothesized a low COVID-19 mortality in India, based on the concept of cross-immunity. The presence of cross-immunity is presumed to lead to a milder course of disease and allow the time necessary for the development of adaptive immunity by the body to eliminate the virus. Evidence supporting our hypothesis has started showing up. Multiple studies have shown the generation of different T cell subsets and B cells responding to epitopes of viral proteins, especially of the spike protein, as a part of adaptive immunity against SARS-CoV-2. Cross-reactive T-cells have been demonstrated in patients who have been previously exposed to endemic coronaviruses. The interplay of cross-immunity and herd immunity is apparent in the COVID-19 scenario in India from the presence of a large number of asymptomatic or mild cases, a low infection-fatality ratio and a generally flat curve of percentage positivity of cases with respect to total testing, both in periods of strict lock-down and step-wise unlocking. It seems that cross-immunity resulted in faster generation of herd immunity. Although the initial restrictive measures such as lockdown prevented the rapid spread of the outbreak, further extension of such measures and overly expensive ones such as enhanced testing in India will result in a huge burden on the health economics as well as the society. Hence, we propose a restructuring of the health services and approach to COVID-19. The restructured health services should move away from indiscriminate testing, isolation and quarantine, and instead, the emphasis should be on improving facilities for testing and management of only critical COVID cases and the replacement of complete lockdowns by the selective isolation and quarantine of susceptible persons such as the aged and those with co-morbidities. In the process of describing India-specific plans, we emphasize why the development of country-specific plans for tackling epidemics is important, instead of adopting a "one policy fits all" approach.

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“…This suggests that COVID-19 fatality might be influenced by a number of other co-factors, like age, co-morbidities, cross-immunities etc. (Chakrabarti et al, 2020). Concentration of air pollutants might have a secondary effect on some of these variables.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

COVID-19 Fatality: Statistical Evidence to Engender the Need for Focal Shift from Air Pollutants to Multi-dimensional Intervention

Patra

Panda

Das

et al. 2021

Aerosol Air Qual. Res.

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Since the outbreak of COVID-19 pandemic, several researchers worldwide have suggested chronic exposure to air pollutants viz. PM2.5, NO2, and O3 as one of the influencing factors for the increased rate of fatality. However, most of these studies lacked a comprehensive international outlook. A strong correlation on a regional scale might require further investigations to evaluate the transboundary validity. Therefore, the current study aims to explore the statistical soundness of association of COVID-19 fatality with PM2.5, NO2, and O3 concentration levels across 463 air quality monitoring stations located in 35 selected cities from USA, India and European Regions (France, Germany and Italy). An aggregated open-source air quality data source was used to download the PM2.5, NO2, and O3 concentration for >900 days in the selected cities. The median of this long-term exposure was tested against the COVID-19 fatality rates. A strength of association parameter, ω 2 , and the coefficient of determination, R 2 , were used to evaluate the transboundary association. ω 2 results indicated that only 24.6%, 0.03% and 15.4% of the variation in COVID-19 fatality rates could be explained using PM2.5, NO2, and O3 concentrations respectively for all the analyzed cities. Further, low values of R 2 between pollutant concentrations and COVID-19 fatality rates corroborated the results (0.27 for PM2.5, 0.00038 for NO2 and 0.18 for O3). These observations strongly suggest a focal shift towards the inclusion of more explanatory variables and an extensive multidisciplinary work is required in order to understand the cause of COVID-19 fatality.

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COVID-19 in India: Are Biological and Environmental Factors Helping to Stem the Incidence and Severity?

Cited by 40 publications

References 23 publications

Clinical Characteristics of Diabetic Patients with COVID-19

Clinical Characteristics of Diabetic Patients with COVID-19

Of Cross-immunity, Herd Immunity and Country-specific Plans: Experiences from COVID-19 in India

COVID-19 Fatality: Statistical Evidence to Engender the Need for Focal Shift from Air Pollutants to Multi-dimensional Intervention

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