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 - Wave 14 17th Aug 2020 - Times Now
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 - Wave 14 17th Aug 2020 - Times Now
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 - Wave 14 17th Aug 2020 - Times Now
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 - Wave 14 17th Aug 2020 - Times Now
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 - Wave 14 17th Aug 2020 - Times Now
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 - Wave 14 17th Aug 2020 - Times Now
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.
OVERVIEW OF COVID-19
                                                                                          AN INDIA PERSPECTIVE
                                                                                            17th AUGUST, 2020

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