Urban Sprawl of Covid-19 Epidemic in India: Lessons in the First Semester

Background & Objective The covid-19 epidemic is rapidly escalating in India and unlike developed countries there is no evidence of plateau or decline in the past 6 months. To evaluate association of state-level sociodemographics with incident cases and deaths we performed an ecological study. Methods Publicly available data sources were used. Absolute number of covid-19 cases and deaths were obtained and cases and deaths/million in each state calculated from February to July 2020. To assess association of state level disease burden with sociodemographic variables (urbanization, human development, healthcare availability, healthcare access and quality etc.) we determined Pearson’s correlation and logarithmic trends. Results Covid-19 in India has led to >2,000,000 cases and 45,000 deaths by end July 2020. There is large variation in state-level cases/million ranging from 7247 (Delhi), 3728 (Goa) and 3427 (Maharashtra) to less than 300/million in a few. Deaths/million range from 212 (Delhi), 122 (Maharashtra) and 51 (Tamilnadu) to 2 in north-eastern states. Most of the high burden states (except Delhi) are reporting increasing burden and deaths with the largest increase in July 2020. There is a significant positive correlation of urbanization with covid-19 cases (r=0.65, R 2 =0.35) and deaths (r=0.60, R 2 =0.28) and weaker correlation with other sociodemographic variables. From March to July 2020, stable R 2 value for urbanization is observed with cases (0.37 to 0.39) while it is increasing for deaths (0.10 to 0.28). Conclusions Covid-19 epidemic is escalating in India and cases as well as deaths are significantly greater in more urbanized states. Prevention, control and treatment should focus on urban health systems.