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Laxminarayan R, Wahl B, Dudala SR, Gopal K, Mohan B C, Neelima S, Jawahar Reddy KS, Radhakrishnan J, Lewnard JA. Epidemiology and transmission dynamics of COVID-19 in two Indian states. Science 2020; 370:691-697. [PMID: 33154136 PMCID: PMC7857399 DOI: 10.1126/science.abd7672] [Citation(s) in RCA: 267] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/23/2020] [Indexed: 01/08/2023]
Abstract
Although most cases of coronavirus disease 2019 (COVID-19) have occurred in low-resource countries, little is known about the epidemiology of the disease in such contexts. Data from the Indian states of Tamil Nadu and Andhra Pradesh provide a detailed view into severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission pathways and mortality in a high-incidence setting. Reported cases and deaths have been concentrated in younger cohorts than would be expected from observations in higher-income countries, even after accounting for demographic differences across settings. Among 575,071 individuals exposed to 84,965 confirmed cases, infection probabilities ranged from 4.7 to 10.7% for low-risk and high-risk contact types, respectively. Same-age contacts were associated with the greatest infection risk. Case fatality ratios spanned 0.05% at ages of 5 to 17 years to 16.6% at ages of 85 years or more. Primary data from low-resource countries are urgently needed to guide control measures.
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Affiliation(s)
- Ramanan Laxminarayan
- Center for Disease Dynamics, Economics and Policy, New Delhi, India
- Princeton Environmental Institute, Princeton University, Princeton, NJ, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brian Wahl
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shankar Reddy Dudala
- Department of Community Medicine, Government Medical College, Kadapa, Andhra Pradesh, India
| | - K Gopal
- Animal Husbandry, Dairying and Fisheries Department, Government of Tamil Nadu, Chennai, Tamil Nadu, India
| | - Chandra Mohan B
- Backward Classes, Most Backward Classes, and Minorities Welfare Department, Government of Tamil Nadu, Chennai, Tamil Nadu, India
| | - S Neelima
- Department of Community Medicine, Guntur Medical College, Guntur, Andhra Pradesh, India
| | - K S Jawahar Reddy
- Department of Health, Family Welfare, and Medical Education, Government of Andhra Pradesh, Amaravati, Andhra Pradesh, India
| | - J Radhakrishnan
- Health and Family Welfare Department, Government of Tamil Nadu, Chennai, Tamil Nadu, India
| | - Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA.
- Center for Computational Biology, College of Engineering, University of California, Berkeley, CA, USA
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