COVID-19 & India: The Lancet Reveals the Most Vulnerable Districts

Which of India’s districts are most vulnerable to COVID-19? Where should we focus preparedness efforts? 

3 min read
Which of India’s districts are most vulnerable to COVID-19? Where should we focus preparedness efforts? 

On Friday, 17 July, India officially crossed the 1 million mark in cases. We are the third country to cross this number after the US at 3.4 million and Brazil at 1.92 million.

According to data from the Heath Ministry, there are a total of 1,003,832 cases, 635,757 recoveries and 25,602 deaths in India so far.

The most affected states are still Maharashtra with 284,281 cases on 17 July, followed by Tamil Nadu and Delhi.

According to The Lancet, cases have been reported in 627 of 640 districts, which is 98 per cent in total.

However, only two states, Maharashtra and Tamil Nadu, now constitute 48% of the country’s total active caseload, according to the ministry data. Just 10 states account for 85% of the total active caseload, Livemint reported.

So which are the most vulnerable districts? And what is the best way to curb the rapid spread? The Lancet report has come up with a ‘vulnerability index’.

“A number of districts in nine large states—Bihar, Madhya Pradesh, Telangana, Jharkhand, Uttar Pradesh, Maharashtra, West Bengal, Odisha, and Gujarat—located in every region of the country except the northeast, were found to have high overall vulnerability (index value more than 0·75).”

What is a ‘Vulnerability Index’?

The districts and states mentioned in the report are not the ones with the most COVID-19 cases. The Lancet also says it is not making predictions on the next hit states as well, what it is simply doing is assessing the conditions prevalent in districts across India and seeing how prepared they are to handle a surge in COVID cases.

As India is on the road to unlocking, we are facing higher case numbers everyday. The threat of an outbreak is multiplied due to the many issues within the country, namely:

  • “ A large population
  • Challenges in practising social distancing,
  • Densely populated urban areas,
  • Non-universal access to water and soap for handwashing,
  • A large number of people with chronic morbidities,
  • A substantial proportion of the population living below the poverty line,
  • A large number of migrant workers who move from one state to another for their livelihoods. “
For now, the spread seems to be in larger, densely populated areas but the report suggests that COVID-19 cases are likely to spread rapidly to the “rural hinterlands.”

The report calculated the vulnerability of districts via five domains: socioeconomic, demographic, housing and hygiene, epidemiological, and health system.

Which District is the Most Vulnerable?

Nine states with an overall vulnerability index more than 0·75 mostly ran through the centre of the country, from West Bengal in the east to Gujarat in the west, covering Bihar, Odisha, Jharkhand, Uttar Pradesh, Madhya Pradesh, Telangana, and Maharashtra.

The north-east regions and “hilly regions in the North like Himachal Pradesh” in general had lower vulnerabilities.

According to the data, as of June 17, 2020, “there are eight states in India that have contributed to over 80% of the confirmed COVID-19 cases in the country—Maharashtra (115 650 [33%]), Delhi (50 278 [14%]), Tamil Nadu (47 366 [13%]), Gujarat (25 577 [5%]), Rajasthan (16 799 [7%]), Uttar Pradesh (14 229 [4%]) West Bengal (12 127 [3%]), and Madhya Pradesh (10 751 [3%]). Of these eight states, five states had a high overall vulnerability index value (ranging from 0·771 to 1·000) and the remaining three had medium vulnerability (ranging from 0·514 to 0·686;)‘.

While it seems like the states with the most cases also had the highest vulnerability, this is not always the case.

For example, districts of Delhi and Haryana have high clusters of infections but were among those with low overall vulnerability.

The report also suggested that delving into each districts domain vulnerability can provide some answers.

“Several states and union territories that had very low overall vulnerability (eg, Daman and Diu, Chandigarh, Puducherry, Lakshadweep, Goa, and Kerala) have high vulnerability in terms of their demography.”
The Lancet

Let’s take Mumbai for example. It has reported 17 per cent of all COVID-19 cases and is situated in the worst-hit state. But the data reveals that it has a low overall vulnerability (0·394) but has a high vulnerability in terms of demographic (0·951) and epidemiological (0·609) factors.

What Influences Vulnerability?

In other words, which of the five domains correlates most closely to overall vulnerability? In no surprise, the answer is both housing and hygiene condition and availability of health-care facilities.

In India, one of the reasons for high fatalities is also the lack of infrastructure and the shortage of bed availability in the initial months of the pandemic. Experts worry that as the disease travels towards smaller towns, districts and rural areas, the lack of quality healthcare facilities will prove to be a real burden.

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