The burden of active infection and anti-SARS-CoV-2 IgG antibodies in the general population: Results from a statewide survey in Karnataka, India

Babu, Giridhara R; Sundaresan, Rajesh; Athreya, Siva; Akhtar, Jawaid; Pandey, Pankaj; Maroor, Parimala S; Mr, Padma; Lalitha, R. V. S.; Shariff, Kareem; Krishnappa, Lalitha; Manjunath, CN; Sudarshan, Mysore Kalappa; Gururaj, Gopalkrishna; Ts, Ranganath; De, Vasanth Kumar; Banandur, Pradeep; Deepa, R; Shiju, Shilpa; Lobo, Eunice; Satapathy, Asish; Alahari, Lokesh; Prameela,; Vinitha, T; Desai, Anita; Ravi, Vasanthapuram

doi:10.1101/2020.12.04.20243949

Cited by 16 publications

(47 citation statements)

References 27 publications

(29 reference statements)

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“…We estimated an IFR of 12.8 per 10000 infections or 0.13%, which is comparable to what is reported from the Indian subcontinent (0.27-1.03) and other countries like USA (0.12-0.2%) Iran (0.08-0.12%), Brazil and Spain (1%) [8,21,24]. Estimating IFR is a challenge as it will depend on infection rate (seroprevalence) and the robustness of system capturing mortality.…”

Section: Discussionsupporting

confidence: 83%

“…This shows that most of the infections were picked up the existing testing infrastructure. CIR in Bangalore rural district was close to reported estimates of Bangalore city (1.10), can be accounted to its proximity to the city [21]. CIR reported in this study, is much lower than other studies in the western countries, probably due to high testing rate in India during recent months [8,18].…”

Section: Discussionsupporting

confidence: 77%

“…Our study revealed that a large proportion of the rural population remains susceptible to infection and far from reaching the seroprevalence required for herd immunity. A serosurvey from Karnataka during the same period (3-16 September) has reported a sightly higher seroprevalence of 15.2% in the same district [21]. The variation can be attributed to samples collected from multiple settings, including hospital settings and among the high-risk group.…”

Section: Discussionmentioning

confidence: 95%

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Seroprevalence of COVID-19 infection in a rural district of South India: A population-based seroepidemiological study

2021

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Objectives We aimed to estimate the seroprevalence of COVID-19 in a rural district of South India, six months after the index case. Methodology We conducted a cross-sectional study of 509 adults aged more than 18 years. From all the four subdistricts, two grampanchayats (administrative cluster of 5–8 villages) were randomly selected followed by one village through convenience. The participants were invited for the study to the community-based study kiosk set up in all the eight villages through village health committees. We collected socio-demographic characteristics and symptoms using a mobile application-based questionnaire, and we tested samples for the presence of IgG antibodies for SARS CoV-2 using an electro chemiluminescent immunoassay. We calculated age-gender adjusted and test performance adjusted seroprevalence. Results The age-and gender-adjusted seroprevalence was 8.5% (95% CI 6.9%- 10.8%). The unadjusted seroprevalence among participants with hypertension and diabetes was 16.3% (95% CI:9.2–25.8) and 10.7% (95% CI: 5.5–18.3) respectively. When we adjusted for the test performance, the seroprevalence was 6.1% (95% CI 4.02–8.17). The study estimated 7 (95% CI 1:4.5–1:9) undetected infected individuals for every RT-PCR confirmed case. Infection Fatality Rate (IFR) was calculated as 12.38 per 10000 infections as on 22 October 2020. History of self-reported symptoms and education were significantly associated with positive status (p < 0.05) Conclusion A significant proportion of the rural population in a district of south India remains susceptible to COVID-19. A higher proportion of susceptible, relatively higher IFR and a poor tertiary healthcare network stress the importance of sustaining the public health measures and promoting early access to the vaccine are crucial to preserving the health of this population. Low population density, good housing, adequate ventilation, limited urbanisation combined with public, private and local health leadership are critical components of curbing future respiratory pandemics.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 95%

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Seroprevalence of COVID-19 infection in a rural district of South India: A population-based seroepidemiological study

2021

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“…According to these studies, the IFR for India is roughly 0.1% using observed death counts and 0.4% after incorporating underreporting of deaths (Table 1). The former resembles early estimates for Mumbai, Srinagar, and Karnataka using observed fatalities (0.09%, 0.06%, and 0.05%, respectively) [8,9] . We note that anecdotal and media reports corroborate model estimates.…”

Section: Underreporting Of Infections and Deathssupporting

confidence: 78%

Estimating COVID-19 Related Mortality in India: An Epidemiological Challenge with Insufficient Data

Zimmermann

Salvatore

Babu

et al. 2021

Preprint

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The harrowing second wave of COVID-19 in India has led to much discussion over the quality and timeliness of reporting of deaths attributed to the pandemic. In this brief report, we aim to present the existing evidence, as well as the broader complexities surrounding the mortality burden of COVID-19 in India. This article sheds light on the following epidemiological issues: (1) general and India-specific challenges to COVID-19 death reporting, (2) latest COVID-19 mortality estimates in India as of May 16, 2021, (3) the apparent scale of uncaptured COVID-19 deaths, and (4) the role of disaggregated historic mortality trends in quantification of excess deaths attributed to COVID-19. We conclude with a set of high-level policy recommendations for improving the vital surveillance system and tracking of causes of death in India. We encourage direct efforts to integrate health data and indirect strategies for cross-validation of registered deaths. Such system-wide advances would drastically aid epidemiological research efforts and strengthen India’s position to overcome future public health crises.

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“…For Pune, in a study conducted between July 20 and Aug 5, 2020, an overall seropositivity of 51.3% was reported [8]. For the state of Karnataka, an overall infected population fraction of 27.3% – with that fraction including a large number of active cases – was obtained in a study conducted from early to mid-September, 2020 [9]. These studies point to extensive spread, dominated by the urban agglomerations that account for about 30% of the Indian population [10].…”

Section: Introductionmentioning

confidence: 99%

Optimizing testing for COVID-19 in India

Cherian

Krishna

Menon

2021

Preprint

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COVID-19 testing across India uses a mix of two types of tests. Rapid Antigen Tests (RATs) are relatively inexpensive point-of-care lateral-flow-assay tests, but they are also less sensitive. The reverse-transcriptase polymerase-chain-reaction (RT-PCR) test has close to 100% sensitivity and specificity in a laboratory setting, but delays in returning results, as well as increased costs relative to RATs, may vitiate this advantage.India-wide, about 49% of COVID-19 tests are RATs, but some Indian states, including the large states of Uttar Pradesh (pop. 227.9 million) and Bihar (pop. 121.3 million) use a much higher proportion of such tests. Here we show, using simulations based on epidemiological network models, that the judicious use of RATs can yield epidemiological outcomes comparable to those obtained through RT-PCR-based testing and isolation of positives, provided a few conditions are met. These are (a) that RAT test sensitivity is not too low, (b) that a reasonably large fraction of the population, of order 0.5% per day, can be tested, (c) that those testing positive are isolated for a sufficient duration, and that (d) testing is accompanied by other non-pharmaceutical interventions for increased effectiveness. We assess optimal testing regimes, taking into account test sensitivity and specificity, background seroprevalence and current test pricing. We find, surprisingly, that even 100% RAT test regimes should be acceptable, from both an epidemiological as well as a economic standpoint, provided the conditions outlined above are met.Author summaryUsing network models, we study optimal ways of combining low sensitivity, relatively inexpensive point-of-care rapid antigen tests for COVID-19 with higher sensitivity but more expensive laboratory RT-PCR tests. We take into account background seroprevalence and current test pricing for such tests in India, finding that even purely rapid antigen test-based regimes can produce the same reduction in overall infections that pure RT-PCR tests are capable of. This is provided one can test at scale and isolate those testing positive effectively, that the sensitivity of the rapid test is not too low and that non-pharmaceutical interventions proceed in parallel for increased effectiveness.

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The burden of active infection and anti-SARS-CoV-2 IgG antibodies in the general population: Results from a statewide survey in Karnataka, India

Cited by 16 publications

References 27 publications

Seroprevalence of COVID-19 infection in a rural district of South India: A population-based seroepidemiological study

Seroprevalence of COVID-19 infection in a rural district of South India: A population-based seroepidemiological study

Estimating COVID-19 Related Mortality in India: An Epidemiological Challenge with Insufficient Data

Optimizing testing for COVID-19 in India

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