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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 34  |  Issue : 1  |  Page : 28-33

The epidemiological and trending pattern of nCOVID-19 in the state of Rajasthan, India


Department of General Medicine, SMS Medical College and Attached Group of Hospital, Jaipur, Rajasthan, India

Date of Submission29-Apr-2020
Date of Acceptance11-Jun-2020
Date of Web Publication6-Jul-2020

Correspondence Address:
Dr. Govind Rankawat
Department of General Medicine, SMS Medical College and Attached Group of Hospital, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijaai.ijaai_17_20

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  Abstract 

PURPOSE: The present study was undertaken to investigate the behavioral distribution pattern and progression of coronavirus disease 2019 (COVID-19) across age and gender in the state of Rajasthan, India, inherently distinctive and native to localized part of the globe giving requisite information and paraphernalia to designate advisory board of the state to design and frame customized policy for demands of the state as per the trending pattern relative to age and sex distribution, profile of new infected cases, recovery rate, and case fatality rate.
METHODS: The present ongoing study assessed patients admitted till April 22, 2020, across the state of Rajasthan, India, with reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 test. Analyses of the patients included characteristic age and gender distribution through the geographic identities of state along with the time trending pattern of newly infected patients, recovered patients, and case fatality rate.
RESULTS: A total of 1888 sample patient population of RT-PCR-confirmed COVID-19 was evaluated, with the majority of sample patient population being in young adult age group with a mean age of 34.42 years. Nearly 11.65% of the patients were below 15 years of age, 34.79% were in the age range of 16–30 years, 25.90% were in the age group of 31–45 years, and 17.69% were in the age group of 46–60 years, with only 9.95% of the patient population being in the age group of above 60 years. Interestingly, 11.65% of patients with COVID-19 were in the pediatric age group. The percent of affected females (37.35%) was much less than that compared to males (62.65%), with an average sex ratio of 0.59. Across the sample patient population of 1888, 543 patients recovered fully, 25 patients died, and 1320 cases were active in the said time frame, with an average recovery rate of 28.76% and a case fatality rate of 1.32%, and the remaining 69.91% of the patient population made up the active case group. The timeline and the trending pattern of COVID-19 in the state of Rajasthan was suggestive of an increasing rise of number of new cases with antecedent mortality, though a reassuring concomitant rise in the recovery rate of patients could also be appreciated. The infective COVID-19 dictum of spread through contact could very well be appreciated in select geographic hotspots and/or zones, and 108 sample patient population was from out of Rajasthan.
CONCLUSION: It was interesting to observe that majority of the resident population of the state of Rajasthan that was COVID-19 positive was in the young adult age group of 30–50 years inclusive of pediatric patients, an observation that is different from reports as documented from across the world. Male population seemed to be more prone to infection. The time frame in which the evaluation was done is suggestive of an increasing trend in the number of new cases with antecedent case fatality, though recovery was also on the rise indicative of a potential decreasing load. The geographic mapping of COVID-19 patients could be established through contact tracing.

Keywords: Coronavirus disease 2019, epidemiology, mortality, recovery, time trend distribution


How to cite this article:
Bhandari S, Singh A, Banerjee S, Sharma R, Rankawat G, Gupta V, Keswani P, Mathur A, Agarwal A, Sharma S, Meena P D. The epidemiological and trending pattern of nCOVID-19 in the state of Rajasthan, India. Indian J Allergy Asthma Immunol 2020;34:28-33

How to cite this URL:
Bhandari S, Singh A, Banerjee S, Sharma R, Rankawat G, Gupta V, Keswani P, Mathur A, Agarwal A, Sharma S, Meena P D. The epidemiological and trending pattern of nCOVID-19 in the state of Rajasthan, India. Indian J Allergy Asthma Immunol [serial online] 2020 [cited 2020 Oct 25];34:28-33. Available from: https://www.ijaai.in/text.asp?2020/34/1/28/289060


  Introduction Top


Coronavirus disease 2019 (COVID-19) is a pandemic infectious disease caused by a novel coronavirus, known as severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). SARS-CoV-2 genome is similar to that of severe acute respiratory syndrome and Middle East respiratory syndrome.[1] Infection by COVID-19 can result in a range of clinical outcomes, from asymptomatic to severe life-threatening course or death. Characterization of the trending pattern of COVID-19 along the axes of age, gender, and geography is an essential component of any infectious disease that has ominous pandemic designs and forms an essential input for designing, framing, and development of effective control/containment strategies and their effective implementation thereof. The principles of quality evaluation of closely pursuing and tracking forms the basic stratagem for a novel infective agent causing pandemicity in order to characterize its transmission and natural history with subsequent features of effective screening. The careful monitoring of cases and probability of an infection in the community enables inferences, critical to modeling the course of the outbreak. The initial monitoring and screening lays the ground work for effective extrapolative predictions that are data and time dependent. The results of a descriptive, exploratory analysis of early introduction of reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 cases (till April 22, 2020, in Rajasthan, India) have the potential in giving an insight into the disease's natural history[2] and transmission characteristics[3] and the unseen burden of infection.[4]


  Methods Top


Study design

This study was a descriptive, exploratory analysis of all cases of COVID-19 diagnosed state wise in Rajasthan, India, as on April 22, 2020. As COVID-19 has been declared as a public health pandemic emergency, formal screening and diagnostic investigation began all over the subcontinent of India. The data were handled as a de-identified set to protect patient privacy and confidentiality.

Data source

COVID 19 categorized as notifiable disease, so all cases reported and recorded at controlling body of infectious disease information system especially Indian council of medical research (ICMR). Entry of each case into the system was performed by local epidemiologists and public health workers who investigated and collected information on possible exposures. All case records contain national identification numbers, and therefore, all cases have records in the system and no records were duplicated. All data stored in COVID 19 case records in the Infectious Disease Information System through the end of April 22, 2020, were extracted from the system as a single dataset and were then stripped of all personal identifying information. No sampling was done to achieve a predetermined study size and no eligibility criteria were used; all cases were included.

Variables

Patient characteristics were collected at baseline, and confirmed cases were diagnosed based on positive viral nucleic acid test (RT-PCR) result on throat swab samples. Number of variables were used including age distribution, gender distribution, time trend of new patients, recovered patients, mortality status, and their geographical distribution. These variables were then categorized for analysis along with necessary preventive and curative action. Age distribution graphs were constructed using patient age at baseline for confirmed cases diagnosed in Rajasthan, India. Sex ratio (i.e., male:female [M:F] ratio) was also calculated. The average recovery rate was calculated by the total number of recovered cases (numerator) divided by the total number of positive cases (denominator), and the case fatality rate was calculated as the total number of deaths (numerator) divided by the total number of cases (denominator), expressed as a percent. For geographical analysis, the state-level distribution of all districts at the time of diagnosis was used to build a geographical graph. The epidemiological curve for all cases was constructed by plotting the number of cases (y-axis) versus time duration of calendar in a group of 4 days (x-axis).


  Results Top


Patients

A total of 1888 unique records were extracted, and data from all records were included in the analysis [Table 1]. Thus, all the 1888 individuals diagnosed with COVID-19 as of April 22, 2020, were included in the analysis. The variables of age and sex were analyzed according to their frequency of distribution, and the data were also analyzed with respect to time trend to calculate new positive cases, total positive cases, new recovered cases, total recovered cases, new deaths, total deaths, and active cases in a fixed slot of progressive time interval.
Table 1: Time trend status of coronavirus disease 2019 (n =1888)

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Age distribution and sex ratio

The age distribution of cases in Rajasthan, India, is presented in [Graph 1]a and [Graph 1]b. A majority of patients were young adults and their mean age was 34.42 years with a male preponderance. Nearly 11.65% of the participants were below 15 years of age, 34.79% were in the age group of 16–30 years, 25.90% in the age group of 31–45 years, 17.69% in the age group of 46–60 years, and 9.95% above 60 years of age group. Interestingly, 11.65% of the patients with COVID-19 were in the pediatric age group and only 10% patient of sample population was above 60 years of age. Nearly 46.44% of the affected patients were below 30 years of age. Only 37.35% of the females were afflicted as compared to 62.65% of males who were RT-PCR-confirmed COVID-19 patients with an average sex ratio being 0.59 [Graph 1]c.



Recovery, deaths, and case fatality rate

A total of 1888 patients were infected with COVID-19 in Rajasthan, India, till April 22, 2020 [Table 1]. At the onset of this epidemic, disease transmission was very slow that gradually accelerated, with maximum newly diagnosed COVID-19-positive patients found in the last time zone of graphic presentation [Graph 2]a. Among the newly diagnosed patients, a big acceleration was also noted in the third time zone of month April (April 4, 2020–April 13, 2020). The number of cumulative positive patients also raised continuously despite adequate preventive measures [Graph 2]b. A total of 543 patients were recovered and 25 patients had died till April 22, 2020. With an increase in the number of new positive cases, an increase in recovery could also be appreciated, a fact that could be seconded by effective medical treatment, peculiarities of geographic locale (endemic for malaria with Bacillus Calmette–Guérin vaccination), and/or a different SARS-CoV-2 strain. Coincidently a dip was noted in recovery graph with time zone distribution in the fourth time zone of April month [Graph 2]c. In this time zone, new cases were raised but the number of recovered patients slowed down. The number of total recovered patients also increased progressively, with an average of 23 patients recovering per day and an overall average recovery rate with respect to total positive patients being 28.76% in the month of April, 2020 [Graph 2]d. In the present study, the recovery rate never proceeded to the new positivity rate. The data also exhibited that cumulatively 25 patients had died due to COVID-19, with mortality increasing with time reaching a maxima in categorized fifth time zone (April 17, 2020–April 20, 2020) [Graph 2]e. An average death rate per day was calculated for given time duration which was equivalent to 1 death per day with an overall case fatality rate in terms of total positive patients being 1.32%.



Geo-temporal findings

As COVID-19 infection spread through the community, it covered 28 districts out of the total 33 of the state of Rajasthan [Graph 3]. A total of 108 patients were from out of Rajasthan, while 1780 patients were residents of Rajasthan. In Rajasthan, majority of the cases (52.48%) were limited to Jaipur and Jodhpur districts, with highest cases (37.13%) being in Jaipur district.




  Discussion Top


The dread and spectre of COVID-19 made its first appearance in Wuhan, China, in the month of December, 2019, and it has spread like a wildfire out and across the precincts of China, afflicting humankind the world over. Confirmed cases of COVID-19 were being reported from all corners of the globe and subsequently the World Health Organization officially declared COVID-19 a pandemic on March 11, 2020.[5]

The present study was undertaken to investigate behavioral distribution pattern and progression of COVID-19 across age and gender in the state of Rajasthan, India, inherently distinctive and native to localized part of the globe, giving requisite information and paraphernalia to designate advisory board of the state to design and frame customized policy for demands of the state as per the trending pattern relative to age and sex distribution, profile of new infected cases, recovery rate, and case fatality rate. The data are suggestive of the fact that COVID-19 afflicted the young adult resident population inclusive of the pediatric age group of Rajasthan more as compared to the not so young age group. Infectivity rate was low in old-age population with an average age of 34.42 years in Rajasthan state of India as compared to other countries where the average age of distribution was higher.[6] The disease trend afflicting the pediatric and young adult population mandates laying of such specific medical infrastructure subservient to relevant age group. The preponderance of COVID-19 in males as compared to that observed in females could be due to customary and cultural characteristic features of the region. Sex ratio for COVID-19 infection in Rajasthan state was much lower than that of other countries.[7] In the eventuality of high infectivity rate of COVID-19, the number of newly diagnosed positive patients was observed to be on rise in the month of April, 2020, suggestive of an ascending upstroke phase of the disease spread. The recovery rate of the disease also increased within the said time duration due to effective strategical protocol so evolved for the management of COVID-19, leading to low case fatality rate of COVID-19 spread across the locales of the state of Rajasthan. Another intriguing feature of COVID-19 had been found to spread in selected clustering area. Which leads to evolution of hotspots areas, required special attention for social distancing to prevent disease spread, a fact that could be appreciated in the districts of Jaipur and Jodhpur. However, due to differential population features and dynamics with strict adherence to containment measures, there were five districts of the state of Rajasthan that registered absolutely nil cases of COVID-19. The spread with restricted mushrooming of menace of COVID-19 could be achieved with an interactive involvement of all sections of the society, with stray dissensions being natural and normal features of diverse heterogeneous society, bringing in people together in an act of solidarity and camaraderie for the very cause and survival of humankind.

Acknowledgments

I would like to thank the Infectious Disease Information System of the Hospital Administration System and Medical Directorate, Rajasthan, for providing valuable data.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Tarentino AL, Maley F. A comparison of the substrate specificities of endo-beta-N-acetylglucosaminidases from Streptomyces griseus and Diplococcus Pneumoniae. Biochem Biophys Res Commun 1975;67:455-62.  Back to cited text no. 1
    
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Lessler J, Reich NG, Cummings DA, New York City Department of Health and Mental Hygiene Swine Influenza Investigation Team; Nair HP, Jordan HT, et al. Outbreak of 2009 pandemic influenza A (H1N1) at a New York City school. N Engl J Med 2009;361:2628-36.  Back to cited text no. 2
    
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Lipsitch M, Cohen T, Cooper B, Robins JM, Ma S, James L, et al. Transmission dynamics and control of severe acute respiratory syndrome. Science 2003;300:1966-70.  Back to cited text no. 3
    
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Lessler J, Salje H, Van Kerkhove MD, Ferguson NM, Cauchemez S, Rodriquez-Barraquer I, et al. Estimating the severity and subclinical burden of Middle East respiratory syndrome coronavirus infection in the Kingdom of Saudi Arabia. Am J Epidemiol 2016;183:657-63.  Back to cited text no. 4
    
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Coronavirus (COVID-19) Events as they Happen (n.d.). Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen. [Last accessed on 2020 Mar 20].  Back to cited text no. 5
    
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Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med 2020;382:1199-207. doi:10.1056/NEJMoa2001316.  Back to cited text no. 6
    
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Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (Covid 19) outbreak in China: Summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA 2020;323:1239-42. doi:10.1001/jama.2020.2648.  Back to cited text no. 7
    



 
 
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