The incubation period of coronavirus disease (COVID-19): A tremendous public health threat-Forecasting from publicly available case data in India

Association of greenness with COVID-19 deaths in India: An ecological study at district level

BACKGROUND

The world has witnessed a colossal death toll due to the novel coronavirus disease-2019 (COVID-19). A few environmental epidemiology studies have identified association of environmental factors (air pollution, greenness, temperature, etc.) with COVID-19 incidence and mortality, particularly in developed countries. India, being one of the most severely affected countries by the pandemic, still has a dearth of research exploring the linkages of environment and COVID-19 pandemic.

OBJECTIVES

We evaluate whether district-level greenness exposure is associated with a reduced risk of COVID-19 deaths in India.

METHODS

We used average normalized difference vegetation index (NDVI) from January to March 2019, derived by Oceansat-2 satellite, to represent district-level greenness exposure. COVID-19 death counts were obtained through May 1, 2021 (around the peak of the second wave) from an open portal: covid19india.org. We used hierarchical generalized negative binomial regressions to check the associations of greenness with COVID-19 death counts. Analyses were adjusted for air pollution (PM2.5), temperature, rainfall, population density, proportion of older adults (50 years and above), sex ratio over age 50, proportions of rural population, household overcrowding, materially deprived households, health facilities, and secondary school education.

RESULTS

Our analyses found a significant association between greenness and reduced risk of COVID-19 deaths. Compared to the districts with the lowest NDVI (quintile 1), districts within quintiles 3, 4, and 5 have respectively, around 32% [MRR = 0.68 (95% CI: 0.51, 0.88)], 39% [MRR = 0.61 (95% CI: 0.46, 0.80)], and 47% [MRR = 0.53 (95% CI: 0.40, 0.71)] reduced risk of COVID-19 deaths. The association remains consistent for analyses restricted to districts with a rather good overall death registration (>80%).

CONCLUSION

Though cause-of-death statistics are limited, we confirm that exposure to greenness was associated with reduced district-level COVID-19 deaths in India. However, material deprivation and air pollution modify this association.

Characterizing COVID-19 waves in urban and rural districts of India

Understanding spatial determinants, i.e., social, infrastructural, and environmental features of a place, which shape infectious disease is critically important for public health. We present an exploration of the spatial determinants of reported COVID-19 incidence across India's 641 urban and rural districts, comparing two waves (2020-2021). Three key results emerge using three COVID-19 incidence metrics: cumulative incidence proportion (aggregate risk), cumulative temporal incidence rate, and severity ratio. First, in the same district, characteristics of COVID-19 incidences are similar across waves, with the second wave over four times more severe than the first. Second, after controlling for state-level effects, urbanization (urban population share), living standards, and population age emerge as positive determinants of both risk and rates across waves. Third, keeping all else constant, lower shares of workers working from home correlate with greater infection risk during the second wave. While much attention has focused on intra-urban disease spread, our findings suggest that understanding spatial determinants across human settlements is also important for managing current and future pandemics.

Rhino-orbito-cerebral mycosis and COVID-19: From bad to worse?

Background:

There has been an increase an alarming rise in invasive mycoses during COVID-19 pandemic, especially during the second wave.

Aims:

Compare the incidence of invasive mycoses in the last three years and study the risk factors, manifestations and outcomes of mycoses in the COVID era.

Methodology:

Multicentric study was conducted across 21 centres in a state of western India over 12-months. The clinico-radiological, laboratory and microbiological features, treatment and outcomes of patients were studied. We also analysed yearly incidence of rhino-orbito-cerebral mycosis.

Results:

There was more than five-times rise in the incidence of invasive mycoses compared to previous two-years. Of the 122 patients analysed, mucor, aspergillus and dual infection were seen in 86.9%, 4.1%, and 7.4% respectively. Fifty-nine percent had simultaneous mycosis and COVID-19 while rest had sequential infection. Common presenting features were headache (91%), facial pain (78.7%), diplopia (66.4%) and vison loss (56.6%). Rhino-orbito-sinusitis was present in 96.7%, meningitis in 6.6%, intracranial mass lesions in 15.6% and strokes in 14.8%. A total of 91.8% patients were diabetic, while 90.2% were treated with steroids during COVID-19 treatment. Mortality was 34.4%.

Conclusion:

Invasive fungal infections having high mortality and morbidity have increased burden on already overburdened healthcare system. Past illnesses, COVID-19 itself and its treatment and environmental factors seem responsible for the rise of fungal infection. Awareness and preventive strategies are the need of hours and larger studies are needed for better understanding of this deadly disease.