Further, we aimed to characterize the geospatial spread of the cumulative COVID-19 burden.įull size image Nationwide and Pune regional COVID-19 pandemic management Using public COVID-19 surveillance data collected between February 1st and September 15th, 2020, we aimed to assess the real-world impact of lockdown on incident COVID-19 patients during the first wave in Pune city municipality and its subregions of variable population density. Notably, a rise in new confirmed patients prompted a second, regional lockdown in Pune city, a metropolitan city in western India. However, few assessments report the impact of lockdown in resource-limited settings, including India, which comprises large variations in urban and rural population density 20, 21, 22, 23, 24.Įarly in the COVID-19 pandemic, India instituted a nationwide lockdown for an extended 68-day period, which was followed by staggered phases of relaxation 7. Several European countries have adopted this strategy with relatively high success rates and more recent re-implementation. Among these, lockdowns were most recommended by the World Health Organization 19. Modelling exercises from India and elsewhere support the use of several such interventions to contain the spread of the COVID-19 pandemic, including complete lockdowns, curfews, regional containment strategies, social distancing, and the strict use of barrier protection and adhering to personal sanitary practices (i.e., gowning, use of masks, handwashing, etc.) 1, 2, 3, 4, 5, 6, 13– 18. ![]() However, alternative non-pharmacological strategies remain critical to limit COVID-19 transmission. With mounting morbidity and mortality in resource-rich and resource-limited settings alike 1, 3, 4, 5, 6, 7, scientists across the globe have developed vaccines and are investigating therapeutics and vaccines against COVID-19 8, 9, 10, 11, 12. As of May 1st, 2021, global patients exceeded 163 million with USA reporting the largest caseload and India-the world's second most populous country-recording the second largest cumulative caseload at 24.2 million 1. Worldwide, the trajectory of COVID-19 patients caused by SARS-CoV-2 has continued to rise since first detected in December 2019 in Wuhan, China 1, 2, 3. Both national and regional lockdowns slowed the COVID-19 infection rates in population dense, urban region in India, underscoring its impact on COVID-19 control efforts. Compared to a subsequent unlocking period, incident COVID-19 patients were 43% lower (IRR 0♵7, 95% CI 0♵3–0♶2) during India’s nationwide lockdown and were 22% lower (IRR 0♷8, 95% CI 0.73–0.84) during Pune’s regional lockdown and was uniform across age groups and population densities. Epidemic curves and geospatial mapping showed delayed peak of the patients by approximately 8 weeks during the lockdowns as compared to modelled natural epidemic. The median age of COVID-19 patients was 36 (interquartile range 25–50) years, 36,180 (56%) were male, and 9414 (15%) were children < 18 years. Of 241,629 persons tested for SARS-CoV-2, 64,526 (26%) were positive, contributing to an overall rate of COVID-19 disease of 267♰ (95% CI 265♳–268♸) per 1000 persons. We used geospatial mapping to characterize regional spread. ![]() Effect of lockdown on incident patients was assessed using multilevel Poisson regression. Using anonymized individual-level data captured by Pune’s public health surveillance program between February 1st and September 15th 2020, we assessed weekly incident COVID-19 patients, infection rates, and epidemic curves by lockdown status (overall and by sex, age, and population density) and modelled the natural epidemic using the compartmental model. We examined growth of incident confirmed COVID-19 patients before, during and after lockdowns during the first wave in Pune city that reported the largest COVID-19 burden at the peak of the pandemic. ![]() Assessing the impact of lockdowns on COVID-19 incidence may provide important lessons for management of pandemic in resource-limited settings.
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