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COVID-19 in Rajasthan: Status and Effects of Containment Measures

Copyright © 2020 Phcog.Net. This is an openaccess article distributed under the terms of the Creative Commons Attribution 4.0 International license. Cite this article : Sharma RP, Gupta J, Gaur KL, Meena D, Aswal P, Sharma KK, Singh R, Sharma R, Malhotra B, Meena D. COVID-19 in Rajasthan: Status and Effects of Containment Measures. Int J Med Public Health. 2020;10(4):202-6. ABSTRACT Background and Objectives: Presently world is facing Corona virus disease pandemic. This disease was first identified in Wuhan city of China which spread rapidly to more than 200 countries including India. Rajasthan is a state affected badly with this disease. So this present study was conducted to find out the status of COVID-19 in state and to find out the effects of containment measures taken. Materials and Methods: This record base case series type of study was conducted from reports received of confirmed COVID-19 cases and reported to the IDSP, DMHS from March 2nd 2020 to May 25th 2020, from various reporting units of Rajasthan. Desired information’s were collected, compiled and analyzed. Interpretation and Conclusion: There were 7351 laboratory-confirmed case including 4061 recovered cases and 166 deaths. Recovery rate and Case Fatality Rate were found 55.24% and 2.26% respectively. (2.4%) reported. Although patients of all ages were affected with this disease but majority (81.99%) were in 16-60 years of age group. In these positive cases male predominance was also observed with M:F ratio 2.11. Majority of district of Rajasthan were affected with this pandemic having about half of cases in three districts v.i.z. in Jaipur, Jodhpur and Udaipur districts. Average Doubling time has increased from 4 days to 18 days as a result of containment measures undertaken in Rajasthan. So these containment measures like social distancing, masking, washing hand frequently etc. Should be taken care of even after lockdown to prevent the COVID-19 infection.


INTRODUCTION
December 2019, cases of pneumonia of unknown cause were identified in Wuhan, Hubei Province of China. On 31 December 2019, the WHO China Country Office was informed of cases of pneumonia of unknown etiology (unknown cause) detected in Wuhan City, Hubei Province of China. 1 On 07.01.20 causative agent of this disease was identified as severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2). 2 On 13 January 20, first time a COVID-19 case was identified outside China in Thailand. 1 On 30 th January 20 there were 9700 cases worldwide spreading in 21 countries including India. WHO declared it as Public Health Emergency of International concern (PHEIC) on 30 th January 2020. 1 On 11 th March 20, WHO officials declared its a pandemic with 118,000 cases and 4,291 death spread over to 114 countries. 1 First case of COVID-19 was reported in India on 30 th January 20 who was a student came from China 3 and first confirmed cases on 2 nd March 20 in Jaipur a Italian tourist. 4 As of 9 July 2020, there were 767,296 cases and 21,129 deaths in the country being highest number of cases in Asia 5 and third highest number of confirmed cases in the world after United States and Brazil. 5 With the emergence of COVID case in Bundi on 28 th May 20, 33 districts of Rajasthan are affected with this epidemic. 6 As per Ministry of Health and Welfare Government of India declared that on 10 July 2020, there are 22563 cases and 491 deaths in the Rajasthan being tenth in country. Rajasthan government has taken multiple measures to combat to the situation along with following the containment measures suggested by Indian Government. So this record based descriptive study was conducted to find out the status of COVID-19 in state along with to find out the effects of preventive measures taken by the government.

MATERIALS AND METHODS
This record based descriptive analytic study was conducted in Directorate of Medical and Health Services (DMHS) in collaboration of Directorate of Medical Education (DME) in year 2020. For this study all the reports regarding laboratoryconfirmed COVID-19 cases were taken since starting (2 nd March 20) to 25 th May 2020. These reports were retrieved from the department of Integrated Disease Surveillance Programmed (IDSP) of DMHS and from DME. Beside number of cases and information regarding age, sex, residence of positive case, present status of cases was found. Desired information's were collected and compiled in Microsoft Excel 10 workbook sheet. These data were classified presented in the form of tables and charts and analyzed to get inferences.
Steps (main ones) taken by Rajasthan Government to combat the COVID- 19

Monitoring and supervision of containment measures
Thirty three districts of state were divided into 7 zones administratively so for each district and zone respectively nodal officer for COVID-19 was designated who is responsible for monitoring and supervising anti-COVID-19 activities of district. At State and district level War rooms were constituted for prevention, containment and management of COVID -19 through a graded, pre-emptive and proactive approach. These are being regularly reviewed and monitored at the highest level.
To find out the effects of containment measures specially of lockdown, the whole period was divided into:

Statistical Analysis
Qualitative data were expressed in percentage and proportions and quantitative data were expressed in mean and standard deviation. Epidemic curves was constructed with date wise data available. Growth rate, Doubling Time, Case fatality rate etc for COVID-19 were also calculated.

RESULTS
By 25 th May 2020, total 7351 cases were found COVID-19 positive in Rajasthan. Out of these 7351 cases, 4061 were recovered and 166 cases were died due to COVID-19; calculating recovery rate 55.24% and case fatality rate 2.26%. (Figure 1) As per sex wise distribution of cases, majority (67.9%) of cases were male having M:F ratio 2.11 and majority were in age group 16-30 years (38.06%) followed by 31-45 years (27.71%), 46-60 years (16.22%), less than 16 years (10.6%) and more than 60 years age group (7.41%). People who move outside house 16-60 years were 81.99%. (Figure 2 and 3) When district wise distribution of cases were analyzed, it was found that maximum cases were in Jaipur (1807 i.e. 24.58%) followed by Jodhpur (1213 i.e. 16.5%), Udaipur (499 i.e. 6.9%), Nagaur (404 i.e. 5.5%), Kota (387 i.e. 5.26%), Pali (349 i.e. 4.75%) etc. (Figure 4) Epidemic curve was constructed of these 7351 cases, cases were increasing with the time. More than 100 case per day first time came on 11.04.2020, 200 cases crossed on 13.05.2020 and cases crossed over 300 on 24 th May 2020. That shows its faster growth with time, which was better depicted in Table 1 and Figure 5. Status of COVID-19 cases as per status of lockdown were observed to found the effect of lockdowns. It was observed that although the number of cases were regularly increasing with the time but doubling time of cases has increased from 4 days to 18 days in 3 rd lockdown which again become 17 days in 4 th lockdown. Likewise average growth rate also      decreased 24.3% to 4.1% in 3 rd lockdown which again become 4.2% in 4 th lockdown. Although average death rate is increasing with time and ranges from 1.95 to 2.7% but average recovery rate also has significantly increased from baseline (before lockdown); it increases from 0% to 58% till 3 rd lockdown which again start decreasing and become 57%. (Table  1 and 2).  23 Gupta N et al. 19 Gupta M et al. 20 also reported increase in doubling time after lockdown and concluded that it is muchneeded effort to delay the peak flatten the epidemic-curve. Similar observations were from foreign authors. 15