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ORIGINAL ARTICLE
Year : 2021  |  Volume : 34  |  Issue : 1  |  Page : 328-332

COVID-19 – a descriptive study of demographic trends in Rajasthan, listed in top five affected states of India


1 Department of Medicine, S.M.S. Medical College and Attached Hospitals, Jaipur, Rajasthan, India
2 Department of Physiology, Government Medical College, Barmer, Rajasthan, India
3 Department of Physiology, S.M.S. Medical College and Attached Hospitals, Jaipur, Rajasthan, India
4 Department of Pharmacology, S.M.S. Medical College and Attached Hospitals, Jaipur, Rajasthan, India

Date of Submission13-Jun-2020
Date of Decision07-Jul-2020
Date of Acceptance12-Jul-2020
Date of Web Publication27-Mar-2021

Correspondence Address:
Bhoopendra Patel
Teaching Faculty Quarters, Government Medical College, Barmer, Rajasthan 344001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_183_20

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  Abstract 


Objective
The aim was to investigate the epidemiological profile and disease trend of nCOVID-19 in Rajasthan, listed among the top five COVID-19-affected states in India.
Background
The pandemic of coronavirus disease (COVID-19) has created a huge burden on health care system, and every nation, including India, has been struggling to contain the spread of this virus through various measures, including nationwide lockdowns.
Methods
The present observational descriptive study was performed on available epidemiological data of the state of nCOVID-19, from March 2, 2020, to April 22, 2020, and highlights epidemiological profile and disease trend of nCOVID-19 in the state of Rajasthan.
Results
Rajasthan in India reported 1918 nCOVID-19 cases with 25 deaths as of April 22, 2020. The nCOVID-19 exhibited a sex bias with a preponderance for male patients (62.7%), with a male: female ratio of 1.68. Individuals in the age group of 16–30 years represented the highest percentage (34.7%) of nCOVID-19 cases. The recovery rate and death rate were 31.8 and 1.5%, respectively. Higher proportion of cases in Rajasthan belonged to districts located in eastern plains and arid western zones.
Conclusion
Implementation of lockdown, along with mandatory advisory on practices like social distancing, wearing of facial mask, and frequent hand washing in India, remains a crucial step in containment of this pandemic. Moreover, timely and adequate changes of guidelines as issued by Indian Council of Medical Research, India, have led to flattening of the epidemiological curve.

Keywords: age, COVID-19, distribution, epidemiological, sex


How to cite this article:
Bhandari S, Shaktawat AS, Sharma R, Mehta S, Patel B, Gupta K, Singhal SK, Gupta J, Kakkar S, Yadav K, Tak A, Dube A. COVID-19 – a descriptive study of demographic trends in Rajasthan, listed in top five affected states of India. Menoufia Med J 2021;34:328-32

How to cite this URL:
Bhandari S, Shaktawat AS, Sharma R, Mehta S, Patel B, Gupta K, Singhal SK, Gupta J, Kakkar S, Yadav K, Tak A, Dube A. COVID-19 – a descriptive study of demographic trends in Rajasthan, listed in top five affected states of India. Menoufia Med J [serial online] 2021 [cited 2021 Aug 4];34:328-32. Available from: http://www.mmj.eg.net/text.asp?2021/34/1/328/312011




  Introduction Top


The start of 2020 has witnessed one of the worst pandemics in the history of humans caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with secondary attack rate of 0.45% among all contacts, and 10.5% among household members [1]. The clinical presentation of novel coronavirus disease is varied, ranging from mild to moderate symptoms of cough, sore throat, headache, rhinorrhea, vomiting and diarrhea, fever, and shortness of breath, to signs and symptoms complex of severe pneumonia, acute respiratory distress syndrome, septic shock, and/or multiple organ failure [2].

SARS-CoV-2 has spread to 213 countries with 2 774 135 confirmed cases and 190 871 confirmed deaths worldwide as of April 26, 2020 [3]. Spread of this enormous pandemic began from Wuhan, a city of Hubei province of China [4]. In India, even after implementation of total lockdown as a preventive measure to contain the spread of virus, the number of active cases of nCOVID-19 reported was 19 868, with 5803 cases either cured or discharged and 824 deaths. The worst hit states in India were Maharashtra, followed by Gujrat, Delhi, Madhya Pradesh, Rajasthan, Tamil Nadu, and Uttar Pradesh [5],[6]. The aim of this study was to understand the epidemiological profile and disease trend of nCOVID-19 in the state of Rajasthan to appreciate its disease dynamic that could substantially help in containing the spread of SARS-CoV-2 infection along the precincts of the nation and across the globe.


  Methods Top


The present study was conducted at S.M.S. Medical College and attached hospitals, Jaipur, a premier tertiary care teaching hospital of Rajasthan and sharing the highest load of nCOVID-19 cases in Rajasthan. This observational descriptive study used epidemiological data of 1918 patients with nCOVID-19 for statistical analysis admitted in various health care facilities of Rajasthan between March 2 and April 22, 2020. The present study comes under the exemption from review by ethical committee, as the proposal has less than minimal risk with no link identifier, that is, the study was conducted on data available on public domain for systemic review and research. Individuals who met the criterion of suspected case, defined as 'symptomatic patient with travel history to countries with COVID-19 infection over the previous last 14 days, or who had exposed themselves to COVID-19-positive patients in the community', were admitted in the hospital. All the included patients were reverse-transcriptase polymerase chain reaction (RT-PCR) positive for SARS-CoV-2, tested at 26 RT-PCR facilities available at various government and private medical colleges of Rajasthan. The nasopharyngeal and oropharyngeal swabs were used as the RT-PCR sample.

Positive cases were described as total positive cases till date (cumulative) and new positive cases detected on the said date. Total admitted cases were those who were still hospitalized. Net positive cases (active) were calculated as total cases (total recovered + total deaths). The discrepancy between total admitted cases and net positive cases arose due to the fact that all positive cases on a date were not admitted on the same date. The recovery rate was calculated as 'Total recovered cases × 100/total hospital-admitted cases till date', and death rate was calculated as 'Total deaths due to nCOVID-19 × 100/total hospital-admitted cases till date'. Positivity rate of samples was calculated as 'positive samples/total samples tested × 100'.


  Results Top


The total number of nCOVID-19 cases reported in Rajasthan as of April 22, 2020, was 1918, inclusive of 1350 active cases and 25 deaths. The total number of hospital-admitted cases was 1708, of which 1140 patients were still hospitalized and 543 patients had recovered. The recovery rate achieved was 31.8% with a death rate of 1.5%. Sex-wise distribution of nCOVID-19 cases indicated a male preponderance of nCOVID-19 with 62.7% affected cases being males and 37.3% females (male/female ratio = 1.68). Age-wise distribution of nCOVID-19 cases in the Rajasthan exhibited an affliction toward age group of 16–30 years (34.7%) followed by 31–45 years (25.8%). Elderly population above 60 years of ages was the least affected (10%). Among the patients admitted (n = 1140) till the said date, two of them (0.2%) required ventilatory support out of four (0.4%) kept under ICU care. Rest of the patients (99.6%) had minimal symptoms, hence were being managed in general wards [Table 1] and [Table 2].
Table 1: Distribution of nCOVID-19 cases on basis of sex, age, and admission status

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Table 2: Date-wise trend of nCOVID-19 cases in Rajasthan as of April 22, 2020

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Appearance of new cases (n = 1918) exhibited a fluctuating trend with a rise overall, especially after April 9, 2020. The number of admitted and active nCOVID-19 cases also increased steadily throughout the month of April 2020. There was a steady rise throughout in recovery of patients with nCOVID-19 (543 cases) and also, achieving a recovery rate of 31.8% as of April, 22, 2020. The recovery rate declined between April 3 and April 7, 2020, followed by a steady rise. Although the number of deaths was rising (25 deaths reported as of April 22, 2020), a decline in death rate was noted at the end of April 2020, which became 1.5%. [Table 2] and [Figure 1].
Figure 1: Date-wise trend of nCOVID-19 cases in Rajasthan as of April 22, 2020.

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Positivity rate of nCOVID-19 samples exhibited a fluctuating trend with an overall positivity rate of 3.06%. The average COVID-19 tests reported positive per day were 62.04, with 2372.29 tests reported negative per day, and average sample tested per day was 2471.86. A total of 1918 patients were reported positive, with 60 711 negative cases, of 62629 total samples tested as of April 22, 2020. Trend of doubling time of nCOVID-19 cases with time assuming the base number '1' on February 29, 2020, revealed a peak in doubling time (12 days) around mid of March (March 14, 2020) with decreased doubling time around a month later (April 18, 2020) [Table 3] and [Figure 2].
Table 3: Date-wise positivity rate in Rajasthan as of April 22, 2020

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Figure 2: Date-wise positivity rate of nCOVID-19 in Rajasthan as of April 22, 2020.

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Overall, 7% of the total cases belonged to other states, with highest cases from Maharshtra (n = 30) and lowest belonging to Gujrat and Madhya Pradesh (n = 1). Three cases were non-Indians including two from Italy and one from Bangladesh. Within the state of Rajasthan, the highest number of cases were reported from the district of Jaipur (n = 701) followed by Jodhpur (n = 290). Among the total nCOVID-19 cases in Jaipur, a patient load of 32.9% alone was shared by the S.M.S. Medical College, a tertiary care center in Jaipur.


  Discussion Top


Patients with nCOVID-19 exhibited a sex bias, with a preponderance for male patients, who made up 62.7% (n = 1203) of the patient population, as compared with the 37.3% (n = 715) females, with male: female ratio of 1.68, a finding that is similar to a study in Wuhan, China, by Chen et al. [7], and such predominance was also observed in patients with nCOVID-19-related mortalities [8]. This could be attributed to an active lifestyle and frequent traveling by male individuals, predisposing them to transmission of infections. It could be perceived that patients in the age range of 16–30 years, comprising 34.7% of sample patient population, were maximally afflicted. The infection of SARS-CoV-2 seemed to have spared the pediatric (11.6%) and the elderly age group (10%). This observation of an affliction of SARS-CoV-2 for young individuals, as compared with the findings of Wuhan, China, COVID-19 outbreak, needs further age standardization, as Hasan et al. [9] in 2020 too had documented the propensity of SARS-CoV-2 to affect adult population as compared with that observed for pediatric cases (11.6%). Indians constitute one of the largest proportions of population in the younger age groups in the world [10]. This might be the reason of higher proportion of nCOVID-19 cases belonging to younger age group in this study.

A total of 187 new COVID-19-positive cases were reported as of April 21, 2020. A rapid increase in recovery of cases was observed beginning from April 8 and continued to rise thereafter. However, the recovery rate declined between April 3 and April 7, 2020, followed by a steady rise. The decline could be attributable to the increase in the total number of cases in comparison with the recoveries, owing to better detection rates as per the revised Indian Council of Medical Research (ICMR) guidelines issued on March 20, 2020, wherein hospitalized cases of severe acute respiratory illness for nCOVID-19 diagnosis were also included in the criteria. A surge in new cases with recovery of the patients requiring a specified time could explain the transient decline in recovery [11],[12]. Recovery also depends upon the number of cases admitted previously. This led to increase in absolute number of recovered patients after April 7, 2020, in line with the addition of new patients, resulting in rise in recovery rate. The recovery rate was just 1.8% on the day one of April that had risen to 31.8% on April 22. A decline in death rates was noted at 1.5% from an initial figure of 1.8% observed at beginning of April 2020. Although the number of deaths was rising (25 deaths), a decline in death rate observed might be owing to better management strategy of the COVID-19 both medically and epidemiologically.

Positivity rate of nCOVID-19 samples exhibited a fluctuating trend with an overall positivity rate of 3.06%. An increase during the second week of April could be attributed to a better testing strategy with better detection of cases in hotspots and later on declined during third week possibly owing to better disease control. An important epidemiological parameter that can be used to describe the spread of nCOVID-19 in community is doubling time. Trend of doubling time of nCOVID-19 cases with time assuming the base number '1' on February 29, 2020, revealed a peak in doubling time (12 days) around mid of March (March 14, 2020), with decreased doubling time around a month later (April 18, 2020). The total number of patients who were admitted on April 22 was 66.7% (n = 1140) of the total admitted patients, with 31.8% patients (n = 543) discharged from hospitals. The number of admitted and active nCOVID-19 cases also increased steadily throughout the month of April 2020. This might be owing to another revision in ICMR guidelines for testing strategy, involving cluster sampling in areas of hotspots that led to a higher detection of COVID-19 cases [13].

Among the patients admitted (n = 1140) till the said date, two of them (0.2%) required ventilatory support out of four (0.4%) kept under ICU care. Rest of the patients (99.6%) had minimal symptoms, hence were being managed in general wards. This could be owing to a milder form of illness prevailing in majority of cases with few requiring ventilatory supports.

Within the state of Rajasthan, the highest number of cases were reported from the district of Jaipur (n = 701) followed by Jodhpur (n = 290). The nCOVID-19 cases in Rajasthan have been reported in higher number from the districts around eastern plains (semi arid, flood prone, and south estern zones) and arid western zone. Three cases were non-Indians including two from Italy and one from Bangladesh, supporting the premise of SARS-CoV-2 being a virus of foreign origin with a supposedly high infectivity, an observation that had been supported by Remuzzi and Remuzzi [14] who had observed that after China, the supposed epicenter and esoteric reality of COVID-19 pandemic, Italy is particularly the most affected country.


  Conclusion Top


Despite rigorous efforts even by developed countries, the pandemic of nCOVID-19 has cost many lives with simultaneous hit at the economy. This forces us to think of measures beyond the medical management directed at containment of spread of nCOVID-19 virus. Implementation of lockdown in India has saved many precious lives that makes the practices like social distancing, advisory to wear mask, and frequent hand washing crucial steps in containment of this pandemic. Moreover, timely change of the ICMR guideline has led to the flattening of curve. The higher number of cases being younger and male could be owing to higher proportion of young population in India, which have an active lifestyle predisposing them to transmission. This pandemic makes us realize of a refreshing aspect, that mankind is fighting in solidarity for survival of mankind and the nation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Burke RM, Claire MM, Dratch A, Fenstersheib M, Haupt T, Holshue M, et al. Active monitoring of persons exposed to patients with confirmed COVID-19-United States, January-February 2020. MMWR Morb Mortal Wkly Rep 2020; 69:245–6.  Back to cited text no. 1
    
2.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395:497–506.  Back to cited text no. 2
    
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WHO. Coronavirus disease (COVID-19) outbreak situation. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019. [Last accessed on 2020 Apr 26].  Back to cited text no. 3
    
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WHO. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Available from: https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second -meeting-of-theinternational-health-regulations-(2005)-emergency- committee-regarding-the-outbreak-ofnovel-coronavirus-(2019 -ncov). [Last accessed on 2020 Apr 25].  Back to cited text no. 4
    
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Ministry of Health and Family Welfare, Government of India. COVID-19 India. Available from: https://www.mohfw.gov.in/. [Last accessed on 2020 Apr 26].  Back to cited text no. 5
    
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Bhandari S, Shaktawat AS, Tak A, Patel B, Gupta K, Gupta J, et al. A multistate ecological study comparing evolution of cumulative cases (trends) in top eight COVID-19 hit Indian states with regression modeling. Int J Acad Med 2020; 6:91–95.  Back to cited text no. 6
    
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Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395:505–513.  Back to cited text no. 7
    
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Bhandari S, Sharma R, Singh Shaktawat A, Banerjee S, Patel B, Tak A, et al. COVID-19 related mortality profile at a tertiary care centre: a descriptive study. Scripta Med 2020; 51:69–73.  Back to cited text no. 8
    
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Hasan A, Mehmood N, Fergie J. Coronavirus disease (COVID-19) and pediatric patients: a review of epidemiology, symptomatology, laboratory and imaging results to guide the development of a management algorithm. Cureus 2020; 12: e7485.  Back to cited text no. 9
    
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Census data of India. Age Structure and Marital Status. Available from: https://censusindia.gov.in/Census_And_You/age_structure_and_marital_status.aspx. [Last accessed on 2020 Apr 26].  Back to cited text no. 10
    
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Indian Council of Medical Research, Department of Health Research. Strategy of COVID19 testing in India, March 17, 2020.  Back to cited text no. 11
    
12.
Indian Council of Medical Research, Department of Health research. Revised Strategy of COVID19 testing in India version 3, March 20, 2020  Back to cited text no. 12
    
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Indian Council of Medical Research, Department of Health Research. Strategy for COVID testing in India, version 4, April 9, 2020.  Back to cited text no. 13
    
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Remuzzi A, Remuzzi G. COVID-19 and Italy: what next?. Lancet 2020; 395:1225–28.  Back to cited text no. 14
    


    Figures

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