Retrospective Analysis of Total COVID-19 Cases and Comparison of Case Fatality and Recovery Rates Among States of India After First and Second Phases of Lockdown

Coronavirus disease 2019 (COVID-19) is the third coronavirus
infection in the last two decades that was first arisen in the city
of Wuhan, Hubei, province of China in December 2019...

Pradesh have emerged as epic centers and are the worst-hit states in India in terms of the total number of Covid-19 cases that have been reported [7]. In response, India has implemented international travel bans and a strict lockdown from March 25, 2020. The first phase of lockdown ended on 14 th April, followed by the second phase ended on 03 rd May, and at present 3 rd phase of lockdown is going on until May 17 th . However, countries like India are at larger risk because of a very large population density, illiteracy, and inadequate healthcare systems to cater to very large demands [8].
In epidemiology, a case fatality rate (CFR), sometimes called case fatality risk is the percentage of cases of a specified condition that is fatal within a definite time. A CFR is conventionally expressed as a percentage and represents a measure of disease severity [9].
CFRs reflect the level of disease severity and CFR is vital for setting priorities for public health in targeted interventions to reduce the severity of the risk. High CFRs reflect limited access to proper health care for the most vulnerable people and insufficiencies in healthcare systems, including the limited capacity of the surveillance system to trigger a timely response [10]. As of the end of the Lockdown 1.0 & 2.0 (i.e. 14 th April & 3 rd May respectively) the CFR of India is at 3.26 & 3.34 respectively for COVID-19 but the CFR's of states of India has not been reported until now, which may be helpful in understanding and estimating the fatality and sternness of this infectious disease in the Indian subcontinent.
The first robust and ideal step in mitigating the outbreak of communicable diseases like COVID-19 is for government health officials to begin early testing. This leads to rapid identification of cases, fast isolation to prevent spread, contact tracing, and swift initiation of treatment. Early testing is the only way to recognize anyone who came into contact with infected people so they can be isolated from the community and may hastily be treated. Testing also is important in the larger public health picture on mitigation efforts, helping investigators to depict the prevalence, spread, and contagiousness of the disease. Due to the limited resources, the testing rate in India is among the lowest in the world, which may underestimate the total number of confirmed cases [3,4]

Source of data and procedure
The data were retrieved from accurate databases including Ministry of Health and family welfare (MoHFW) [11], Centre for Evidence Based Medicine (CEBM) [12]

Parameters used in study
States with total cases ≥ 100 were included in the study and raw data was mapped according to states. Percentage of confirmed cases (PCC), average tests per day CFR and RR were estimated and compared among states.

Measuring the CFR and RR [14]
The formulas below were used to measure PCC, CFR and RR-

Volume 5 -Issue 3
Copyrights @  Figure 2). Average testing per day and % of confirmed cases of COVID 19 among states of India after.      Figure 3).    Cross-state comparisons of CFR and RR as important indicators of disease characteristics are critical for national priority setting and recognizing health system performance [9]. In the initial phases of an epidemic, CFR tends to be on the higher side and this overestimation is due to under testing and a time-lag bias, which is more pronounced at the beginning of an outbreak. Although India is in initial phases of COVID-19, estimating CFR and RR are of vital importance as they denote the current status of the pandemic and helps in planning the additional measures to be adopted to tackle the pandemic effectively. Hence, this study was aimed to measure the CFR and RR of different states having at least >100 confirmed Therefore, strategies must be developed including early detection of COVID-19 followed by access to medical care, which may enhance the chances of recovery rates. Besides, case studies with a detailed and accurate medical history, and scoring CFR alongside RR, should be adopted in hospitals which may be helpful in exactly pointing the hotspots of infection. This will, in turn, help the government authorities in identifying the areas with higher infection rates, so that lockdown can be strictly carried out in that parts of the country and necessary medical resources will be mobilized to that areas.

Comparison of CFR's after 1 st and 2 nd phases of lockdown
Thus, the extended lockdown may provide more time to identify the asymptomatic cases and prevent community transmission at the state level.

Conclusion
Indian states have shown a tremendous improvement concerning testing and mitigation measures to fight against COVID-19 as evidenced by a decrease in % of confirmed cases, CFR, and improvement in RR. Further, employing mass testing and epidemiological studies will strengthen the health care infrastructure and will augment the screening the asymptomatic cases.

Conflicts of Interest
The authors have none to declare.