COVID-19 pandemic: a health challenge for commoners during the first unlock phase in India.

AIM: COVID-19, the disease caused by the novel coronavirus, is now a worldwide pandemic. This disease has become a reason for disturbance and concern. India, as a densely populated country, took initiative after the pandemic was declared. The objective of this study was to determine the mortality and recovery rates at 30 days from the first unlock phase after five phases of lockdown. The the number of infected people has continually increased, and currently, this pandemic continues to present challenges to public health. SUBJECT AND METHODS: Statistical analysis was used to calculate the mortality rate, ratio between active and death cases, active cases and recovered cases, recovered and death cases in India during the first 30 days of the unlock phase.
RESULTS: The relationship between the new cases, deaths and recovered cases, shows that the new and recovered cases increased progressively. From the scatter plot of daily deaths and new cases, the R2 value is 0.0047. That means the death ratio is low against the new cases. Also, if we look at another scatter plot, the ratio between new cases and recovery rate shows the R2 value is 0.8015. That means the recovery rate was very high during the study period in India. The R2 value of daily recovery and death is 0.0072. India faced a huge number of new coronavirus cases and increased death rate every day during the first unlock phase.
CONCLUSION: There was not the same condition as in the preliminary stage. The affected graphs progressively increased, and the government is fighting to control this deadly infection. Central and state governments are working together to combat this pandemic.

Introduction

Pandemics lead to serious health-related concerns for people, and the current pandemic is harming the socio-economic condition of every infected country and adversely affecting public health. As implied in the name COVID-19, ‘CO’ stands for ‘corona’, ‘VI’ stands for ‘virus’, ‘D’ means ‘disease’ and ‘19’ represents the year of its first occurrence (Chakraborty and Maity 2020). In June 2020, worldwide 9,129,146 confirmed cases and 473,797 deaths were registered by the World Health Organisation (WHO, 24th June 2020 on 4:44 pm CEST). After the COVID-19 outbreak in Wuhan, China, it created a massive loss of life in other countries, including Italy, Iran, France and Spain. There is currently no medicine or treatment to use in defence against this virus; all the affected countries have attempted national lockdown, rapid testing and quarantines (Hamzelou 2020). The epicentre is currently situated in the United States of America (USA). Over 2,295,272 confirmed cases and 120,171 deaths were registered by 24 June 2020 (WHO report, 2020).

In between 2002 and 2003, SARS infected approximately 8000 people and 774 people died. In 2012, WHO registered 2494 people infected and 858 killed by another coronavirus called MERS-CoV (Middle East Respiratory Syndrome-Coronavirus), which spread to approximately 27 countries (WHO report 2003, 2013). Coronaviruses are a group of related RNA viruses, and this disease is created in mammals and birds. In the case of the human body, COVID-19 symptoms are sometimes similar to the common cold, chest pain and many more. Scientists have divided the virus into four groups, including alpha, beta, gamma and delta. The four common are 229E (alpha), NL63 (Alpha), OC 43 (Beta) and HKU1 (Beta) (Strains of Coronavirus Webmd 2020). However, the SARS-like bat CoV was transmitted to the human body after having evolved in the Himalayan palm-civet (Song et al. 2005). In the past decades, the world has faced five types of pandemics: H1N1 in 2009, Polio in 2014, Ebola (West Africa) in 2014, Zika in 2016 and Ebola (Democratic Republic Congo) in 2019. WHO registered the sixth worldwide pandemic on 30 January 2020 named COVID-19. The worldwide rates of fatalities and infections have contributed to a huge amount of economic losses recently (Allocati et al. 2016; Fan et al. 2019). This deadly disease has affected the world economically, hampering people’s lifestyles. After a few months, there was not yet a vaccine for this virus. Many countries tried to improve the methodology to control the disease and sought a vaccine for the coronavirus but, as of June 2020, were not yet successful. (However, now, several vaccines have been developed in various countries and are being distriubuted, albeit sometimes slowly.) Rapid testing, quarantine and social distancing are used to slow down the social and viral movement, sometimes with unfortunate economic consequences.

Subsequently, this pandemic has affected the world public health and challenged health facilities worldwide. The term novel coronavirus indicates a ‘new pathogen of a previous know type’ of the virus. The acute disease originated in Wuhan, China, in December 2019. After that, the virus spread throughout China. Then the disease began to affect the other countries of the world, including India. On 30 January, India reported its first case of COVID-19 or novel coronavirus. By 3 February 2020, three cases were registered; all were students who had just come from Wuhan. On 4 March 2020, 22 new cases came to light, where Italian tourists were included (14 infected). The first death due to COVID-19 occurred on 12 March 2020. A 76-year-old man died in Karnataka, State of India. The following day, a 60-year-old woman died in Delhi. Two days later, two more cases were confirmed and both of them had returned from abroad. On the other side, the active cases were increasing gradually. By 17 February, the case number increased by three and by 20 Feb, five confirmed death cases were registered all over India. The Government of India decided to protect people from this viral disease and took actions such as implementing the ‘Janta Curfew’ on 22 March from 7 A.M to 9 P.M and declared the 1st phase of Lockdown from 23 March to 14 April 2020. During lockdown, the main focus of the Government was not only to recover the infected persons but also to control the spread of COVID-19. The Government of India wanted to control the virus in the 1st stage, before it reached the stage of community spreading. In a highly populated country, it is not possible to control the spread of disease when people do not understand the current problem. The lockdown phase was increased gradually but the infected number also increased side by side. In the fourth stage, every day almost 5000 cases were registered and the deaths amounted to approximately 120 per day.

In India, during the fifth phase of lockdown, the coronavirus spread was somewhat limited. However, after 31 May 2020, the government announced that some COVID free areas (Green Zone) are concession for goods, malls, religious places, some industry and many more. In every 1 lakh (100,000) population, on world average every 77.6 person was infected. Although, in the USA, 542 persons and, in Germany, 217 people in 1 lakh were infected. In India, only 12.6 people were infected with COVID 19. The recovery frequency was 7.10% in the month of March that improved to 42.6% in May, while India’s mortality was 2.8% and the world’s mortality rate was 6.15%. The per lakh mortality in India was 0.3%, while the global average was at 4.7%, the USA was at 31.6% and Germany at 10.2% (Republicworld.com 31 May 2020). However, the situation of the COVID-19 pandemic in India was very difficult after 1 June 2020. On 25 May, India was situated in 10th position of the worldwide cases, but after one month (24 June 2020), India increased the rank and was situated in 4th position for coronavirus cases (Worldometer 2020).

Methods

In this study, the World Health Organization (WHO), Worldometer website data were used to measure the coronavirus situation in India. That website and also the WHO provided the current COVID-19 data on the country-wise situations to help the global community and health organizations to take better sustainable decisions on the current pandemic. The 30 days data were retrieved from the WHO website and used to investigate the effect of COVID-19 during the ‘Unlock Phase’ in India,

This study included information regarding the situation of India during the first 30 days of the unlock phase, namely the total cases, active cases, deaths and recovered cases of COVID-19 in India. The statistical data was analysed to understand the unlock phase condition of coronavirus in India. The relation between daily death and daily recovery, daily recovery and new cases, daily death and daily new case shows the actual condition during the first unlock phase in India.

Result and discussion

India—one of the most densely populated countries in the world—is also trying to protect people from this disaster and save the coronavirus affected patients. According to the details, the death ratio was higher than the last three phases of lockdown. Per day more than 100 people were losing their life; 476,565 patients had recovered from COVID-19 infection; more than 55% of patients beat acute disease cases. Also, the trend line presents this same scenario. The coronavirus was first discovered or reported in India on 30 January 2020. In the first few days, the active cases were not too high. From this trend line, it is very clear to find that the active cases increased gradually. Also, the recovery ratio is increased, with more than 55% of patients having already recovered. However, in last 30 days, the new cases and death were very high during unlock phase 1, but the recovered cases were also high during that time.

Coronavirus status in the last one month for most infected ten countries

The first case of COVID-19 was registered in China, but soon after, the virus spread worldwide, gradually infecting other countries and becoming a pandemic (Worldometer 2020). The USA is the most affected country and the total cases were 2,462,708 and overall 124,282 persons were killed by this virus as of 26 May 2020 (Fig. 1). During the coronavirus pandemic, the world health condition deteriorated (Table 1). In India, a huge number of people were infected with COVID-19. On 26 May, 146,376 cases and 1426 deaths were registered (Worldometer 2020). However, one month later in June, the situation was very bad in India; 474,272 persons were affected by this virus and approximately 14,914 persons had died (Fig. 2). Worldwide, a huge number of people were affected due to this pandemic, including in the USA, Brazil, Russia, India, Spain, UK, Peru, Chile, Italy and Iran (Table 2).

Fig. 1

Maximum coronavirus infected countries on 26 May 2020. India is situated in the tenth position of the world’s most affected countries

Table 1

Maximum coronavirus infected countries on 26 May 2020

Country name	Total cases	Total deaths	Total recovered	Actives cases
USA	1,706,277	99,807	464,727	1,141,743
Brazil	376,669	23,522	153,833	199,314
Russia	362,342	3807	131,129	227,406
Spain	282,480	26,837	196,958	58,685
UK	261,184	36,914	0	0
Italy	230,158	32,877	141,981	55,300
France	182,942	28,432	65,199	89,311
Germany	180,808	8432	162,000	10,376
Turkey	157,814	4369	120,015	33,430
India	146,376	4187	61,151	81,038

Data Source: Worldometer, 26 May 2020

Fig. 2

Maximum coronavirus infected countries on 24 June 2020. India is situated in the fourth position of the world’s most affected countries

Table 2

Maximum coronavirus infected countries on 24 June 2020

Country name	Total cases	Total death	Total recovered	Active cases
USA	2,462,708	124,282	1,040,608	1,297,818
Brazil	1,192,474	53,874	649,908	488,692
Russia	613,994	8605	375,164	230,225
India	474,272	14,914	271,934	187,424
UK	306,862	43,081	0	0
Spain	294,166	28,327	0	0
Peru	264,689	8586	151,589	104,514
Chile	254,416	4731	215,093	34,592
Italy	239,410	34,644	186,111	18,655
Iran	212,501	9996	172,096	30,409

Data Source: Worldometer, 24 June 2020

COVID-19 situation during first 30 days of the unlock phase in India

In India, the spread of the novel coronavirus was divided into phases. From 30 January 2020 until 31 May 2020, the lockdown is divided into 5 phases. From 30 January 2020 to 22 March 2020 is considered as the before lockdown phase. On 30 January 2020, a case in Karnataka was registered, then the second case was registered on 2 February 2020 in Delhi, the third on 3 February 2020 and the fourth one was registered almost a month later, on 2 March 2020. Also, the first death case came out on 13 March 2020 from Karnataka and the second death was reported from Delhi on 14 March 2020. On 17 March, the third case was registered. There were only a total of 5 death cases before the lockdown phase, and there were 341 confirmed cases. After ‘Janta Curfew’ was implemented on 22 March as of 14 h, the Govt. of India decided to lockdown the country from 23 March (5:00 pm) to 14 April, which isconsidered as the lockdown phase. In the first five days, the average of confirmed cases was approximately 76.6 people, whereas in the last five days of phase 1 lockdown, it was 899.6 people. Also, the average number of deaths for the first five days was 2.4 people, and in the last five days, it increased to 34.

After the lockdown was over, the government initiated an unlock phase 1 for handling this pandemic. Some restrictions were applied by the government, but private offices, some parts of government offices, small industries, religious places, shopping malls, restaurants and food markets were open for public use. However, social distancing remains the main way to stay healthy. As a densely populated country, India faces many challenges during this pandemic, and in some places, people are not maintaining their social distancing from other people. The Government has taken some valuable steps for controlling the virus. However, in a developing country, it is a big challenge for common people to earn their daily food.

In India, during the first unlock phase, a total of 384,697 new cases were registered within 30 days, and within 122 days, a total of 200,547 cases were registered. Overall, 65.73% new cases were registered within 30 days. The new cases gradually increased in India. Side by side, death and recovered cases also increased; 62.43% death rate and 66.07% recovery rate were shown in the worldometer data. During the unlock phase of 1 June to 30 June, the lowest number of new cases was 8171 and the highest number of cases was 19,906 people infected (Table 3).

Table 3

Infected condition during unlock phase 1 in India

Date	New cases	New case increases	Death	New death increases	Recovery
01-06-2020	8392	0	230	0	3902
02-06-2020	8171	−221	204	−26	4531
03-06-2020	8909	738	217	13	3786
04-06-2020	9304	395	260	43	4379
05-06-2020	9851	547	273	13	4783
06-06-2020	9887	36	294	21	5762
07-06-2020	9971	84	287	−7	5153
08-06-2020	9983	12	206	−81	5247
09-06 − 2020	9987	4	331	125	5070
10-06-2020	9985	-2	279	−52	6814
11-06-2020	9996	11	357	78	5993
12-06-2020	10,956	960	396	39	7259
13-06-2020	11,458	512	386	−10	8095
14-06-2020	11,929	471	311	−75	7363
15-06-2020	11,502	−427	325	14	10,631
16-06-2020	10,667	−835	380	55	7232
17-06-2020	10,974	307	2003	1623	6886
18-06-2020	12,881	1907	334	−1669	10,744
19-06-2020	13,586	705	336	2	9024
20-06-2020	14,516	930	375	39	13,975
21-06-2020	15,413	897	306	−69	9071
22-06-2020	14,821	−592	445	139	10,885
23-06-2020	14,933	112	312	−133	10,437
24-06-2020	15,968	1035	465	153	13,114
25-06-2020	16,922	954	418	−47	13,983
26-06-2020	17,296	374	407	−11	10,246
27-06-2020	18,552	1256	384	−23	14,229
28-06-2020	19,906	1354	410	26	11,628
29-06-2020	19,459	−447	380	−30	13,497
30-06-2020	18,522	−937	418	38	12,565
Total	384,697		11,729		256,284

Data Source: World Health Organization (WHO), 24 June 2020

In the relationship between the new cases, deaths and recovered cases, shows that the new cases and the recovered cases increased gradually (Fig. 3). In the scatter plot of daily death and daily new cases, the R2 value is 0.0047 (Fig. 4). Also, if we look at another scatter plot, the ratio between new cases and recovery rate shows an R2 value of 0.8015 (Fig. 5). That means the recovery rate was very high during that time in India. In addition, the daily recovery and daily death’s R2 value is 0.0072 (Fig. 6). That means the death ratio is low against the new cases.

Fig. 3

Relationship between daily new cases, death and recovery in India during the unlock phase

Fig. 4

Scatter plot shows the relationship between new cases and death

Fig. 5

Scatter plot shows the relationship between new cases and recovery

Fig. 6

Scatter plot shows the relationship between daily death and recovery

Conclusion

India is currently a developing country, with many projects underway. India has 1.21 billion people and a population density of 382 per sq. km (Census of India, 2011). This huge population presents challenges to containing the spread of the coronavirus. The Government of India took initial steps to combat the COVID-19 pandemic. This study estimated the COVID-19 condition on a global basis and particularly in the context of India. The novel coronavirus started in Wuhan, China, in December 2019. By June 2020, the virus had spread over 216 countries (WHO report 2020). As of June 2020, the USA, Spain, France, Russia, Italy and India were the most affected nations worldwide, and there were no drugs to shield against the pandemic. Many countries revealed weaknesses in their health capability, and some countries managed a positive report from the pandemic. Presently, the number of people who have recovered from COVID-19 continues to increase. Worldwide, people, governments, health workers and doctors are struggling with this virus.

In India, the situation is similar to the rest of the world. India reported its first COVID-19 case on 30 January 2020, and the conditions have changed since the preliminary phase. The affected statistics have progressively increased, and the government is trying to reduce them. Central and state governments are working together to combat this worldwide pandemic. The government implemented ‘Janta curfew’, five phases of lockdown and the first unlock phase. The number of infected increased, and gradually, the number of recovered improved. The economy of India has been very much affected by this situation. Some industries are facing a huge amount of financial degradation. The GDP has decreased gradually, and it is at its lowest. The situation depends on the common people, the Government cannot stop this pandemic through their policy or other related information until the people are cautious about the pandemic and practice social distancing. Nevertheless, the recovery rate is very high in India. If people take some initial steps to reduce their chances of infection, it can have wonderful results in the future, and we shall break the chains of the coronavirus pandemic.