Affiliation:
1. Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
2. Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
Abstract
Introduction: Maharashtra, India, remained a hotspot during the COVID-19 pandemic. After the initial complete lockdown, the state slowly relaxed restrictions. We aim to estimate the lockdown’s impact on COVID-19 cases and associated healthcare costs. Methods: Using daily case data for 84 days (9 March–31 May 2020), we modeled the epidemic’s trajectory and predicted new cases for different phases of lockdown. We fitted log-linear models to estimate the growth rate, basic (R0), daily reproduction number (Re), and case doubling time. Based on pre-restriction and Phase 1 R0, we predicted new cases for the rest of the restriction phases, and we compared them with the actual number of cases during each phase. Furthermore, using the published and gray literature, we estimated the costs and savings of implementing these restrictions for the projected period, and we performed a sensitivity analysis. Results: The estimated median R0 during the different phases was 1.14 (95% CI: 0.85, 1.45) for pre-lockdown, 1.67 (95% CI: 1.50, 1.82) for phase 1 (strict mobility restrictions), 1.24 (95% CI: 1.12, 1.35) for phase 2 (extension of phase 1 with no restrictions on agricultural and essential services), 1.12 (95% CI: 1.01, 1.23) for phase 3 (extension of phase 2 with mobility relaxations in areas with few infections), and 1.05 (95% CI: 0.99, 1.123) for phase 4 (implementation of localized lockdowns in high-case-load areas with fewer restrictions on other areas), respectively. The corresponding doubling time rate for cases (in days) was 17.78 (95% CI: 5.61, −15.19), 3.87 (95% CI: 3.15, 5.00), 10.37 (95% CI: 7.10, 19.30), 20.31 (95% CI: 10.70, 212.50), and 45.56 (95% CI: 20.50, –204.52). For the projected period, the cases could have reached 631,819 without the lockdown, as the actual reported number of cases was 64,975. From a healthcare perspective, the estimated total value of averted cases was INR 194.73 billion (USD 2.60 billion), resulting in net cost savings of 84.05%. The Incremental Cost-Effectiveness Ratio (ICER) per Quality Adjusted Life Year (QALY) for implementing the lockdown, rather than observing the natural course of the pandemic, was INR 33,812.15 (USD 450.83). Conclusion: Maharashtra’s early public health response delayed the pandemic and averted new cases and deaths during the first wave of the pandemic. However, we recommend that such restrictions be carefully used while considering the local socio-economic realities in countries like India.
Subject
Health Information Management,Health Informatics,Health Policy,Leadership and Management
Reference145 articles.
1. (2022, December 31). Worldometers.info. Countries Where COVID-19 Has Spread. Available online: https://www.worldometers.info/coronavirus/countries-where-coronavirus-has-spread/.
2. A cost–benefit analysis of COVID-19 lockdowns in Australia;Lally;Monash Bioeth. Rev.,2022
3. Strzelecki, A., Azevedo, A., Rizun, M., Rutecka, P., Zagała, K., Cicha, K., and Albuquerque, A. (2022). Human Mobility Restrictions and COVID-19 Infection Rates: Analysis of Mobility Data and Coronavirus Spread in Poland and Portugal. Int. J. Environ. Res. Public Health, 19.
4. Spiliopoulos, L. (2022). On the effectiveness of COVID-19 restrictions and lockdowns: Pan metron ariston. BMC Public Health, 22.
5. A sharp increase in the number of COVID-19 cases and case fatality rates after lifting the lockdown in Kurdistan region of Iraq;Hussein;Ann. Med. Surg.,2020