Public health interventions in India slowed the spread of COVID-19 epidemic dynamics

Abstract

Background The government of India implemented social distancing interventions to contain the COVID-19 epidemic. However, effects on epidemic dynamics are yet to be understood. Methods Rates of laboratory-confirmed COVID-19 infections per day and effective reproduction number (Rt) were estimated for 4 periods (Pre-lockdown and Lockdown Phases 1 to 3) according to nationally implemented phased interventions. Adoption of these interventions was estimated using Google mobility data. Estimates at the national level and for 12 Indian states most affected by COVID-19 are presented. Findings Daily case rates ranged from 0.03 to 30.05/10 million people across 4 discrete periods in India. From May 4-17, 2020, the National Capital Territory (NCT) of Delhi had the highest case rate (222/10 million people/day), whereas Kerala had the lowest (2.18/10 million/day). Average Rt was 1.99 (95% CI 1.93-2.06) for India; it ranged from 1.38 to 2.78, decreasing over time. Median mobility in India decreased in all contact domains, with the lowest being 21% in retail/recreation (95% CI 13-46%), except home which increased to 129% (95% CI 117-132%) compared to the 100% baseline value. Interpretation The Indian government imposed strict contact mitigation, followed by a phased relaxation, which slowed the spread of COVID-19 epidemic progression in India. The identified daily COVID-19 case rates and Rt will aid national and state governments in formulating ongoing COVID-19 containment plans. Furthermore, these findings may inform COVID-19 public health policy in developing countries with similar settings to India. Funding Non-funded.

Effective public health measures to mitigate the spread of COVID-19: a systematic review

“…The characteristics of the included studies and the main results were summarized Table 1 including the following items: authors, country, study design, objective, methods and main outcomes. For the quality assessment results the quality of 14 (77.77%) included studies [ 14 – 16 , 19 – 21 , 23 – 29 , 31 ] was moderate, the quality of two studies [ 18 , 22 ] was strong and the quality was weak for the two remaining studies [ 17 , 30 ] (Table 2 ). As for the results of the level of evidence and grade of recommendation assessment, six studies had low level of evidence and low grade of recommendation [ 16 , 17 , 19 , 21 , 24 , 30 ].…”

“…For the quality assessment results the quality of 14 (77.77%) included studies [ 14 – 16 , 19 – 21 , 23 – 29 , 31 ] was moderate, the quality of two studies [ 18 , 22 ] was strong and the quality was weak for the two remaining studies [ 17 , 30 ] (Table 2 ). As for the results of the level of evidence and grade of recommendation assessment, six studies had low level of evidence and low grade of recommendation [ 16 , 17 , 19 , 21 , 24 , 30 ]. Ten studies had moderate level of evidence and low grade of recommendation [ 14 , 15 , 20 , 22 , 23 , 25 – 29 ], one study had moderate level of evidence and moderate grade of recommendation [ 18 ] and only one study had high level of evidence and high grade of recommendation [ 31 ] (Table 3 ).…”

“…Three studies [ 16 , 22 , 26 ] have found that travel entry restrictions and bans, borders control measures and quarantine of travellers especially the ones arriving from affected countries along with other interventions was effective in reducing the spread of COVID-19. Seven studies [ 14 , 15 , 23 , 24 , 27 , 30 , 31 ] have shown that city lockdown, stay at home orders, traffic suspension and restrictions of mass gathering are strongly associated with reduced growth rate of COVID-19 confirmed cases and reduction in the epidemic growth. Moreover in their study Salvatore M et al [ 23 ] found that lockdown was partly effective due to state level variations which should be considered in implementing lockdown.…”

“…Individual approaches are needed to containment of an epidemic, with an awareness of their own structure in terms of crowding and socio-economic variables. Singh BB et al [ 30 ] , India (preprint) Longitudinal study Evaluation of the public health interventions using the effective reproduction number (Rt), in key lockdown periods in India. Laboratory-confirmed COVID-19 infections rates per day and effective reproduction number (Rt) were estimated for 4 periods (Pre-lockdown and Lockdown Phases 1 to 3) according to nationally implemented phased interventions.…”

Battling COVID‐19 with dysfunctional federalism: Lessons from India

“…Second, it adds to the literature on Indian federalism, in particular the literature that focuses on the centripetal and dysfunctional policies that are imposed on the states by the central government (Parikh & Weingast, 1997; Rajagopalan, 2017; Tripathi, 1974). And third, it contributes to the literature that makes use of aggregated mobility data in analyzing policy effectiveness (Praharaj & Han, 2020; Singh et al ., 2020).…”