OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE - Wave 14 17th Aug 2020 - Times Now
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OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE Wave 14 17th Aug 2020
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 EXECUTIVE SUMMARY This document presents a study performed by Protiviti and Times Network as of 17th August 2020, to estimate the extent to which COVID19 is expected to influence India as a country using aggregated statistical measures computed based on 3 types of forecasting models: % Based Models, Time Series model & SEIR Model. We analyzed India as a whole, top 10 Indian states and 26 cities/hot-spots along with the entire country for a period of close to 50 days to project the evolution of the COVID19 pandemic using the ‘Number of daily new cases’ along with the total ‘active’ patients count. The projected evolution of infected cases initially assumed an inherited effect of countrywide lockdown applied from 24 March 2020 for 45 days or so. The projections provided in the study are primarily based on time series modeling and therefore, we understand that this complex and dynamic nature of the influence of COVID19 shall evolve on a daily basis and is a continuous work in progress. The models that are used suggest that the peak ranges from around 780,354 cases on an optimistic side to around 938,306 on a higher side and expected to happen around early September. Additionally, based on SEIR model, primarily designed to analyze the time based influence of such pandemics both in smaller and larger cohorts, on an average run down suggests that the closing date at an India level may fall somewhere towards the end week of November, 2020. Some states have already started to peak out and some might come out of it during later part of August to early September while some highly infected ones may take a month longer. The lockdown plays a key role on the exit. In case of a longer period of lockdown, we can expect the curve to be flattened but can expect a later exit date (i.e. a flat curve will stretch the pandemic). For the lockdown to eradicate the pandemic, a robust lockdown and containment is required for a substantial period of time. Also, when a lockdown is lifted we expect the cases to rise if proper measures are not taken. The mode in which lockdown is lifted will impact the outcome / # of cases.
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 SETTING THE CONTEXT This document presents a study performed by Protiviti and Times Network as of 17th August 2020, to estimate the extent to which COVID19 is expected to influence India as a country using aggregated statistical measures computed based on 3 types of forecasting models: % Based Models, Time Series model & SEIR Model. We analyzed top 10 Indian states and 26 cities/districs along with the entire country for a period of close to 50 days to project the evolution of the COVID19 pandemic using the ‘Number of daily new cases’ along with the total ‘active’ patients count. The projected evolution of infected cases assumes an inherited effect of countrywide lockdown applied from 24 March 2020 and the numbers proposed for the future also consider that this period of lockdown continues for the next 45 days or so. The projections provided in the study are primarily based on time series modeling and therefore, we understand that this complex and dynamic nature of the influence of COVID19 shall evolve on a daily basis and is a continuous work in progress.
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 SETTING THE CONTEXT Point to be noted: The outputs of the modelling are not to be consumed directly for publication by any other source. The models presented in the study are based on the fundamental assumptions of time series modeling well stated in the published academic sources. The models which are developed using existing standard epidemiological modeling techniques like SIR and SEIR are with the limitations of limited data, dynamic environmental factors and external government based interventions. The proposed SEIR model does not take into account the asymptomatic transmission explicitly, however, it cannot also be fully discarded in the actual scenario. Additionally, we have not considered stratified cohorts of population for studying this transmission based COVID19 pandemic. A later version of the model might include age based or other stratifying features that may account for differing demographics in India. We have taken utmost care while collecting, preparing and processing the required infected count data, however, the overall quality of data will have a material impact on the quality and reliability of outputs. Although the modeling period included both the lockdown and pre-lockdown phases in India, but there is no specific designed parameter available in the proposed model that may help analyze Government intervention in retarding the growth of this pandemic in India. Therefore, an effect of an external policy level change might only reflect in our modelling output after a lag of 3-4 days. This work is completely a scenario based modeling framework wherein Protiviti along with the Times Network group have analyzed this pandemic situation and have come up with a robust statistical way to model it under a number of key assumptions. Therefore, the outputs of the study are not an indication of the future but rather probable situations for consideration and further deliberation. This study does not take into account COVID-19 testing data in India and all the states, timing of testing, external factors like immunity, BCG vaccination, and international travel history data for a specific time period, specific cluster density, demographics etc. This predictive modeling considers the learning of progression rate from other countries like US, Italy, China, Malaysia, South Korea and incorporate in the models to create scenarios with certain assumptions. The study depends on a number of assumptions which may vary at a granular level. Lastly, the modeling here is regulated assuming that the cases listed on reliable government sourced websites are an average over time. We completely understand the public health care system in India and can reasonably assume that the number of cases considered in our study are on a lower side as many cases are not getting reported and the testing rate of India is towards the lower side when compared globally.
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 INDIA’s FIGHT AGAINST COVID-19 India's response to COVID-19 has been pre-emptive, pro-active and graded with high-level political commitment and a ‘whole government’ approach to respond to the COVID-19 pandemic. Ministry of Health and Family Welfare is working to strengthen surveillance, build capacity of health system and optimize ‘window of opportunity’ created by mandatory physical distancing in India. 2,766,511 1.2 to 1.6 16 Weeks 30,041,400 Total Cases on 17th R0 –reproduction rate Of mandatory social Tests completed, Aug 2020, 3 month of the virus, with Distancing, has helped this has increased ago, total active cases most estimates contain virus within by 8.4 times in 1 were at 26 averaging at 1.36 404 districts month Major Affected States The most affected states / union territories are Maharashtra, Tamil Nadu and Delhi. Out of 736 districts, 411 districts have reported Delhi confirmed numbers. The silver lining is that 10.46% the poorest of districts have the least number of cases. Additionally, many of the remaining 325 districts, are also the least capable of handling an exponential increase in cases. Fewer cases also mean, quarantine and track Maharashtra & trace procedures are easier to apply, and 29% form an effective first line of defense. 3% - 6% of total for these states & districts to continue social >6% - 15% of total distancing until appropriate improvements in Tamil Nadu medical care, and access to medical facility 6.7% >15% - 20% of total has improved in these districts.
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 GLOBAL SCENARIO OF COVID-19 EPIDEMIC The World Health Organization (WHO) declared the 2019–20 coronavirus outbreak a Public Health Emergency of International Concern (PHEIC) on 30 January 2020, and since then, 21,845,024* new cases have been registered, of which approx. 93% recovered, and 7% were fatal. A total of 215 countries have since reported an outbreak in a period of 4 months. * - as of 16th August 2020, 11.59 PM GMT. This is an ever evolving situation, and is also growing exponentially. % Change of Total Cases over the last 1 month 90% Italy 80% USA Spain 70% Iran 60% SK India 50% 40% INDIA 30% 11.3% 20% 10% 0% MUCH OF THE BATTLE IS AHEAD OF US! The total number of cases confirmed is a function of total tests performed, and seems exaggerated for countries with smaller infected case count. While this is the case for India, the worrying trend line for rate of change of cases in India is indicating an upward linear trend , currently at around 21%. Just like countries battling Covid-19 at least a month prior to India, early indicators depict a movement of this rate of change up to 30% - 40% range before it will start to drop by around 3rd or 4th week of April. Nevertheless, this indicates one thing, as countries improve the rate of testing, and turnaround time for results from each test, the rate of change increases proportionally, indicating a still persistent exponential growth rate across the world, and an greater exponent driving the Indian scenario. Recovered / Total Death / Total cases Total Cases Total Deaths cases with outcome with outcome WORLD 21,845,024 772,900 93.1% 9.5% INDIA 2,766,511 53,026 50% 3%
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 COUNTRIES NEARING THEIR PEAK Understanding if a country is nearing its peak of cases is difficult to estimate, especially while the pandemic is unraveling its full potential. But, fundamentally, the total number of log-log chart of no. of tests per million vs. no. of cases per million, provides a clear picture of those countries which are starting to turn the curve. Spain US Number of Cases per Million (log scale) UK Italy 1,000 100 South Korea 10 INDIA 1 1 10 100 1,000 10,000 100,000 1,000,000 Number of Individuals tested per Million (log scale) South Korea is a success story, but from the graph it is clear that Italy has turned the curve, and will start recording fewer cases going forward. It is also worth noting that when the number of tests reach around 10,000 individuals per million, South Korea was able to successfully curb the spread. This was due to quick action, and effective social distancing, and quarantine policies. India could take this road if the current containment policies are effective and peak by the time we reach 10,000 individuals tested per million. Without proper containment policy, or delayed implementation of the same, will result in a steeper rise, and subsequently steep fall in cases. This scenario analysis will help us assess the model that we can use to estimate the current state of the pandemic, especially in relation to THIN CURVE India. The goal of the country is to hit a flat curve that will sufficiently spread the cases encountered to meet the medical supply FLAT CURVE constraints. Our best case scenario therefore is to aim for the flat curve.
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 WHERE ARE WE & WHAT TO EXPECT What will be the impact of the novel coronavirus (COVID-19) in India? Answering this question requires an accurate forecast of the spread of confirmed cases as well as analysis of the number of deaths and recoveries. Forecasting, however, requires ample historical data, often times, the correct data useful in forecasting is not available. At the same time, no prediction is certain as the future rarely repeats itself in the same way as the past. The below graph is an aggregation of 3 types of forecasting model: % Based Models, Time Series model & SEIR Model. Total Number of Active Forecasted Cases 1,000,000 10^6 100,000 10^5 10,000 10^4 10^3 1,000 10^2 100 20/03 03/04 17/04 01/05 15/05 29/05 12/06 26/06 10/07 24/07 07/08 21/08 04/09 18/09 02/10 16/10 30/10 Best Case Worst Case Most Likely For each of these model categories, multiple models were built to simulate the situation in progress in India. These Models are % Based Model Time Series Model SEIR Model The model assumes that the The model assumes that past A mathematical prediction Indian COVID-19 situation events and observations model that divides the closely approximates one of predict the future situation population into Susceptible the following countries: accurately. population (S), Exposed 1) Approximation of Italy 1) Hybrid (China & South Population (E), Infected (I) and (Italy) Korea) Recovered (R) population. It 2) Approximation of US (US) 2) Poly Regression (2nd predicts future values by Degree) assuming or predicting values for 3) Poly Regression (3rd coefficients for the mathematical Degree) equations.
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 METHODOLOGY Based on the nuances and the complexity associated with limited pandemic data, we adopted a methodology of forecasting using aggregated measures computed using 3 types of forecasting models: % Based Models, Time Series model & SEIR Model. Percentage Based Model Apply the growth progression rate of the infected cases for USA and Italy on India data and project the cases using the same trends over time to get the forecasted figures and no mathematical/statistical model has been applied Considering the infected cases as a function of total population and use the percentage of Hubei to project the trend in India based on early data points available for India Hybrid Model Segregate the data on two major segments – before lockdown and after lockdown and 2 distinct models have been built for two segments considering the trends only and no other external factors have been taken into account Within lockdown there are 3 stages- Progression rate, Flattening rate and Decay Rate : 3 different time series models has been fit separately based on the learning from China, Malaysia and South Korea All the coefficients are based on Ordinary Least Square methodology and adjusted R-Square is the primary metric considered for accuracy; R-Square is more than 90% for all the models Polynomial Regression Models To overcome the problem of Bias-Variance tradeoff while selecting an appropriate and effective statistical model, we made use of Polynomial Regression models to model the COVID19 infected Indians data. Polynomial Regression model assumes that the relationship between the dependent (Daily Count of Infected Patients) and independent variable (Time - Days) is curvilinear (specifically Polynomial) The coefficients of the proposed models are estimated using Ordinary Least Square (OLS) method while the model accuracy and performance is assessed using adjusted R-square values along with observing the Mean Squared Error (MSE) values Polynomial Regression of degree 2 and 3 provided for relatively a better fit along with an average forecasting accuracy of over 94% & 98% respectively Susceptible Exposed Infected Recovered (SEIR) Model The basic Reproduction Number (R0) is the most common measure of estimating the strength of an epidemic. In simple words, R0 is the secondary cases generated by one primary case in a susceptible population. In order to estimate the extent of the Covid19 pandemic in India, we made use of the SEIR model proposed by Betten Court and Ribeiro1 & Gani et al.2, Estimation of basic reproduction number (R0) is performed through initial intrinsic growth rate method using standard deterministic SEIR model. This standard deterministic SEIR epidemic model classifies each individual into susceptible S(t), latent/exposed E(t), infective I(t) and recovered R(t) individual. Our estimate of reproduction number for India is 1.55 with 95% CI [1.52 , 1.61 ], whereas for different states the effective reproduction number varies in between 1.16 to 1.52 Model assumes that the infectious period, latent period, transmission probability and infection rate per person per unit time is dynamic and varies based on individuals and their respective location The pandemic spread curve presents a transmission rate/infection rate and its evolution over a period of time 1. Bettencourt, L. M. A. and Ribeiro, R. M., Real time Bayesian estimation of the epidemic potential of emerging infectious diseases. PLoS One, 2008, 3(5), e2185. 2. S. R. Gani, Sk. Taslim Ali and A. S. Kadi, The transmission dynamics of pandemic influenza A/H1N1 2009–2010 in India, CURRENT SCIENCE, 101(8) 25 Oct. 2011
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 PROPENSITY TO MANAGE CASES TOTAL BEDS India is undermanned, underprepared, and is facing the crisis, with an uphill battle of improving the health infrastructure and increasing capacity to meet the demands 1,872,971 of COVID-19 patients. Worryingly, the total ICU beds with working Ventilators, which is crucial for severely affected COVID-19 patients, is in the range of few Total non ICU Beds available across India thousands. Total susceptible cases requiring intensive care from a population standpoint is approximately 322 Million Indian citizens. 164,886 ICU beds, or 6.4% of Total Number of Active Forecasted Cases total hospital beds 10^6 40% - 45% 10^5 Average % of beds currently occupied, and is un-usable. 10^4 10^3 126 Will have ICU Beds for 10^2 every million susceptible 20/03 03/04 17/04 01/05 15/05 29/05 12/06 26/06 10/07 24/07 07/08 21/08 04/09 18/09 population, (i.e. all of the 1Million may need intensive care) Best Case Worst Case Most Likely At its probable worst, COVID-19 might reach a peak of 7.87 lakh patients. We expect that in the best case scenario, India will reach around 7.80 lakh cases, around 7.87 lakh cases in a most likely scenario and 9.38 lakh cases in the worst case scenario. In the most likely scenario we expect that the India will be 95% free around 1st week of September. The problem of community spread is greatly concerning, and the country is scrambling to add new beds, increase capacity of intensive care units, to mitigate the situation of 100,000 patients not having access to life saving facilities. Additionally complicated is the scenario where the distribution of beds are not in proportion to the affected. The cites are disproportionately affected, and therefore will be the first to run out of beds, even though they are the ones with better facilities. The % of cases that are fatal in rural regions may be higher due to this reason. The government is undertaking medical colleges and railway coaches into isolation wards, stadiums into quarantine facilities, and readying part of hospitals under defense, central police forces and railways for Covid-19 patients.
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 STATEWISE ANALYSIS This section represents how some of the states has been doing in the last one month. We can see from the graphs below that some of the states have started showing of decline while some of the states show growth. # of Active Cases by Staes over time and Average 100000 Average The first graphs talks about the Growth Rate ( 7 Days Average) growth rate growth of the number of active 90000 (Last 7 Days) cases and 7 day moving average. MH : 2% 80000 TN : 1% The second graph talks about the UP : 4% Doubling Rate or the number of 70000 KA : 6% days it took to double. 60000 KL : 5% RJ : 5% If we look at these information we 50000 TG :-1% can clearly see that there are 3 GJ : 2% buckets of states 40000 AP : 9% WB : 3% 1. Where the growth has gone 30000 DL : -4% done considerably MP : 3% 20000 HR : 1% 2. Where the growth has OD : 7% stabilized and 10000 3. Where there are still very high 0 rate of growth. 15/05 11/08 20/03 24/03 28/03 01/04 05/04 09/04 13/04 17/04 21/04 25/04 29/04 03/05 07/05 11/05 19/05 23/05 27/05 31/05 04/06 08/06 12/06 16/06 20/06 24/06 28/06 02/07 06/07 10/07 14/07 18/07 22/07 26/07 30/07 03/08 07/08 15/08 We can categorize Tamil Nadu MH TN UP KA KL RJ TG (TN), Telangana (TL), Delhi (DL) AP GJ WB DL MP HR OD and Haryana (HR) in the first bucket. Doubling Time for Each State (500+) Maharashtra (MH), Kerala (KL), Uttar Pradesh (UP), Karnataka 40 (KA), Madhya Pradesh (MP), 35 Rajasthan (RJ), West Bengal (WB) No of Days to Double (500+) and Gujarat (GJ) falls under the 30 second bucket with a 7 day moving 25 average ranging between 2%- 6% 20 and a Doubling Rate of 8-15 Days. 15 Finally, there are the high growth 10 states Andhra Pradesh (AP) and Odisha (OD) where the growth 5 rate is in 7% - 10% and the 0 Doubling rate hovering around 6/7 1K+ 2K+ 4K+ 8K+ 16K+ 32K+ 64K+ 128k+ 256K+ 512K+ days. No of Cases These states are further analyzed in details in the following sections MH TN DL TG KL UP RJ AP MP KA GJ JK HR WB OR 11
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 STATEWISE PROJECTIONS The above model is broken down into below numbers for each of the top 10 affected states. The values identify the peaks in worst case scenarios Maharashtra Tamil Nadu 10^5 10^4 10^4 10^3 10^2 2,46,936 57,968 10^1 10^1 Earliest End Date: Mid November Earliest End Date: Late October Worst Case : Mid December Worst Case : Early November Uttar Pradesh Karnataka 10^4 10^6 10^3 10^5 10^2 73,243 97,163 10^1 10^1 Earliest End Date: Late October Earliest End Date: Early November Worst Case : Mid November Worst Case : Early November Kerala Rajasthan 10^4 10^4 10^3 10^3 10^2 10^2 26,386 14,762 10^1 10^1 Earliest End Date: Mid October Earliest End Date: End October Worst Case : Early November Worst Case : Mid December
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 STATEWISE PROJECTIONS The above model is broken down into below numbers for each of the top 10 affected states. The values identify the peaks in worst case scenarios Telangana Andhra Pradesh 10^4 10^5 10^4 10^3 10^3 10^2 10^2 29,966 99,827 10^1 10^1 Earliest End Date: End October Earliest End Date: End October Worst Case : Mid December Worst Case : Mid December Gujarat West Bengal 10^5 10^5 10^4 10^4 10^3 10^3 10^2 10^2 15,331 33,820 10^1 10^1 Earliest End Date: Mid October Earliest End Date: Mid october Worst Case : Early November Worst Case : Early November
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 MAHARASHTRA’S FIGHT AGAINST COVID-19 As of 17th August, total 145,802 active COVID-19 cases and 20,686 deaths have been reported in Maharashtra, the financial capital of India, Mumbai, being the worst affected. COVID-19 cases reported from Asia’s largest slum, Dharavi has aggravated the situation Maharashtra government officials and health care workers are working assiduously to contain the spread. Confirmed Cases 0 - 10000 10000 - 20000 20000 - 30000 30000 - 40000 40000 - 50000 60,4358 20,686 4,37,870 50000+ Total Cases Total Deaths Total Recovered Projections 32,08,735 # of tests done Oct 12 End of Infection 30.66 Days Doubling Rate 0.05 Death to Recovery Ratio 1.30 SEIR Model Reproduction Rate (R0) 14
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 ANDHRA PRADESH’S FIGHT AGAINST COVID-19 As of 17th July, the total active cases of COVID-19 in Andhra Pradesh is 75,478, of which the maximum cases are in Kurnool, Guntur and Krishna districts. %age of deaths is at 2.8% in comparison to the total number of cases. Confirmed Cases 0 - 1000 1000 - 2000 2000 - 3000 3000 - 4000 4000 - 5000 2,96,609 2,820 2,18,311 5000+ Total Cases Total Deaths Total Recovered Projections 29,05,521 # of tests done Oct 15 End of Infection 17.26 Days Doubling Rate 0.o1 Death to Recovery Ratio 1.29 SEIR Model Reproduction Rate (R0) 15
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 GUJARAT’S FIGHT AGAINST COVID-19 As of 17th August, the total active cases of COVID-19 in Gujrat is 13,184, of which the maximum cases are in Ahmedabad, Surat, Vadodara, Rajkot districts. % of deaths is at 4.6% in comparison to the total number of cases. Confirmed Cases 0 - 3000 3000 - 6000 6000 - 9000 9000 - 12000 12000 - 15000 79,816 2,821 63,811 15000+ Total Cases Total Deaths Total Recovered Projections 13,58,364 # of tests done Sep 30 End of Infection 39.39 Days Doubling Rate 0.04 Death to Recovery Ratio 1.19 SEIR Model Reproduction Rate (R0) 16
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 KARNATAKA’S FIGHT AGAINST COVID-19 As of 17th August, the total active cases of COVID-19 in Karnataka is 72,125, of which the maximum cases are in Bengaluru, Mysuru and Belagavi districts. % of deaths is at 3.8% in comparison to the total number of cases. Confirmed Cases 0 - 1000 1000 - 2000 2000 - 3000 3000 - 4000 4000 - 5000 5000+ 2,33,283 4,208 1,56,950 Total Cases Total Deaths Total Recovered Projections 20,75,086 # of tests done Oct 20 End of Infection 19.48 Days Doubling Rate 0.03 Death to Recovery Ratio 1.52 SEIR Model Reproduction Rate (R0) 17
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 KERALA’S FIGHT AGAINST COVID-19 As of 17th August, the total active cases of COVID-19 in Kerala is 14,575, of which the maximum cases are in Kasaragod, Kannur Kozhikode districts. %age of deaths is at 0.6% in comparison to the total number of cases. Confirmed Cases 0 -1000 1000 - 2000 2000+ 46,140 176 31,389 Total Cases Total Deaths Total Recovered Projections 12,05,759 # of tests done Sep 30 End of Infection 18.71 Days Doubling Rate 0.01 Death to Recovery Ratio 1.26 SEIR Model Reproduction Rate (R0) 18
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 RAJASTHAN’S FIGHT AGAINST COVID-19 Rajasthan recorded its first COVID-19 case on 3rd March 2020 and by the mid of March, Bhilwara, a district in Rajasthan, seemed on the cusp of a large-scale outbreak. However, since March 30, Bhilwara has witnessed a huge turnaround and there has been only a few reported cases. A 'ruthless containment' strategy, timely action, comprehensive screening and strict enforcement of curfew and lockdown restrictions has helped Confirmed Cases Bhilwara immensely. 0 - 1500 1500 - 3000 3000 - 4500 4500 - 6000 6000 - 7500 62,630 898 48,960 7500+ Total Cases Total Deaths Total Recovered Projections 19,30,842 # of tests done Oct 20 End of Infection 28.06 Days Doubling Rate 0.02 Death to Recovery Ratio 1.19 SEIR Model Reproduction Rate (R0) 19
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 TAMIL NADU’S FIGHT AGAINST COVID-19 Tamil Nadu has the second highest number of COVID-19 patients in India with 48,151 active cases on 17th Aug. It has witnessed a massive rise in positive cases since the beginning of April and has identified the majority of cases to a single source i.e. a religious congregation that took place in Delhi in March. In light of recent events, the state has allocated ₹9,000 crore to fight against the coronavirus pandemic. Confirmed Cases 0 - 8000 8000 - 16000 16000 - 24000 24000 - 32000 32000 - 40000 3,43,945 6,007 289,787 40000+ Total Cases Total Deaths Total Recovered Projections 37,78,778 # of tests done Oct 10 End of Infection 31.90 Days Doubling Rate 0.02 Death to Recovery Ratio 1.41 SEIR Model Reproduction Rate (R0) 20
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 TELANGANA’S FIGHT AGAINST COVID-19 The first confirmed COVID-19 case in the Indian state of Telangana was on 2nd March 2020. Less than 100 cases were reported in month of March, however there has been a sharp increase in the number of cases since the start of April. The rapid increase in Covid-19 cases in districts has forced the state health department to declare nearly 100 villages and areas in various districts as ‘hotspots’ and impose more restrictions on Confirmed Cases the movement of people. 0 - 200 200 - 400 400 - 600 600 - 800 800 - 1000 1000+ 92,255 711 72,202 Total Cases Total Deaths Total Recovered Projections 7,53,349 # of tests done Oct 01 End of Infection 29.14 Days Doubling Rate 0.01 Death to Recovery Ratio 1.29 SEIR Model Reproduction Rate (R0) 21
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 WEST BENGAL’S FIGHT AGAINST COVID-19 Confirmed Cases 0 - 2000 As of 17th August, the total active cases of COVID-19 in West Bengal is 24,361, of which the maximum cases are 2000 - 4000 in Kolkata, Howrah and North 24 Parganas districts. 4000 - 6000 %age of deaths is at 2.9% in comparison to the total 6000 - 8000 number of cases. 8000 - 10000 10000+ 1,19,578 2,528 92,689 Total Cases Total Deaths Total Recovered Projections 13,47,091 # of tests done Oct 03 End of Infection 13.05 Days Doubling Rate 0.03 Death to Recovery Ratio 1.22 SEIR Model Reproduction Rate (R0) 22
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 UTTAR PRADESH’S FIGHT AGAINST COVID-19 The coronavirus pandemic was first confirmed in the Indian state of Uttar Pradesh on 5th March 2020, in Ghaziabad. On 17 March, the Uttar Pradesh government extended the closure of all educational institutions, cinemas, shopping malls, swimming pool, gyms, multiplexes and tourists places in the state till June 30th. Confirmed Cases 0 - 2000 2000 - 4000 4000 - 6000 1,58,216 2,585 1,09,607 6000+ Total Cases Total Deaths Total Recovered Projections 38,72,640 # of tests done Oct 05 End of Infection 20.09 Days Doubling Rate 0.02 Death to Recovery Ratio 1.24 SEIR Model Reproduction Rate (R0) 23
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 APPENDIX : INFORMATION SOURCES PERCENTAGE OF DISTRIBUTION OF INFECTION FOR BELOW AND OVER 60 YEARS: For India: We have taken an 80-20 consideration based on initial trends. The most recent number given out by the MHA was 83% and 17% respectively, but these numbers may keep changing. For South Korea: https://www.cdc.go.kr/board/board.es?mid=a30402000000&bid=0030 For Italy: https://www.statista.com/statistics/1105061/coronavirus-deaths-by-region-in-italy/ For United States: https://www.businessinsider.in/slideshows/miscellaneous/nearly-30-of-us-coronavirus-cases-have-been- among-people-20-44-years-old-the-cdc-says-showing-that-young-people-are-getting-sick-too/29-of-confirmed-us- coronavirus-cases-have-been-in-people-between-the-ages-of-20-and-44-/slideshow/74720295.cms PERCENTAGE OF MILD, SEVERE AND CRITICAL CASES WORLD FIGURES - https://www.worldometers.info/coronavirus/#countries (AS OF MARCH 29) CHINA FIGURES - https://www.worldometers.info/coronavirus/country/china/ (AS OF MARCH 29) (These are critical and non-critical cases) For An Overall Estimate Of The Number Of Mild, Severe And Critical Cases Around The World, We Have Taken A Study Conducted Involving More Than 44,000 Patients In China Who Tested Positive For Covid-19, With Respect To Their Different Levels Of Severity. 80.9% Of The Cases (36160) Were Categorised As Mild, 13.8% (6168) Were Categorised As Severe And 4.7% (2087) Were Categorised As Critical. 0.6% (257) Were Categorised As Missing. This Roughly Meets The Global Trend Of Critical And Non- Critical Cases Of 95% And 5%, But We Have Gone With This Three-Way Break-Up Of Cases And Mapped It To The World And India Figures. AGE GROUP DIVISION FOR CASES We have an average for India based on the cases currently – and that works out to an 80% below 60 and 20% above 60 estimate for the total number of infections. We have three models for the age group division of cases: The World Model of 95% non- critical cases and 5% critical cases. For below 60, we have applied the same numbers to extrapolate a figure However, for above 60, we have factored in a small difference in margin: made it 90% non-critical cases and 10% critical cases – keeping in mind the fact the possibility of criticality increasing for the older people. We have applied the China Model of 72% non-critical cases and 28% critical cases – that's the current number among the ACTIVE cases in China. This gives a possible worst case-scenario. For this, we have applied 72% and 28% for the India data, and made it 70% non critical and 30% critical for the above 60 category. We have a third model, which is the Mild, Severe and Critical Model based on a study of 42000 infections in China conducted in February. We have applied 81% (mild), 14% (severe) and 5% (critical) for the below 60 category, and slightly different numbers for the above 60 category which is 70% mild, 20% severe and 10% critical.
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 APPENDIX : INFORMATION SOURCES OTHER ASUUMPTIONS: India data as per date of hospitalisation to recovery or continued hospitalisation: https://www.covid19india.org/ The Mild, Severe and Critical Model http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51 Factoring in China data of hospitalisation in ICU and hospital in WUHAN based on LANCET study: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext Factoring in China reports of hospitalisation inside and outside Wuhan (though no specific reference here to ICU data): http://www.xinhuanet.com/english/2020-02/04/c_138755345.htm Factoring in US studies of potential hospital and ICU days for Covid-19 http://www.healthdata.org/sites/default/files/files/research_articles/2020/covid_paper_MEDRXIV-2020-043752v1-Murray.pdf Note that we have not applied the standard ICU and ward duration of stay because the averages for the US and China and our numbers too from data available for CORONA is significantly higher.
OVERVIEW OF COVID-19 AN INDIA PERSPECTIVE 17th AUGUST, 2020 COVID-19 DISCLAIMER The pandemic novel coronavirus 2019, is rapidly evolving, with new findings and insights being discovered daily. This document is a series of observations that represents Protiviti and Times Network viewpoint, at a certain point in time. This document does not constitute or claims to serve as an advisory for any medical, safety or regulatory action.
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