An After-Action Review of COVID-19 Cases and Mitigation Measures at US Mission India, March 2020-July 2021

Abstract

AbstractIntroductionBetween March 2020-June 2021, over 30 million COVID-19 cases were reported in India. We assessed the COVID-19 response across the US Mission India (US Embassy New Delhi, US Consulates – Mumbai, Hyderabad, Chennai and Kolkata) to plan future mitigation efforts and fill gaps in knowledge about COVID-19 transmission in a unique community like the US Mission.MethodWe described COVID-19 mitigation activities undertaken by the five US Mission India posts and conducted a secondary analysis of case investigation and contact tracing program data collected by the Health Unit from March 2020–July 2021.ResultsUS Mission in India, in collaboration with multiple internal agencies, initiated COVID-19 mitigation activities in March 2020. Activities included educational sessions, training for infection prevention and control, health and safety assessments, and the development of standard operating procedures (SOPs). The Health Unit and US CDC India office initiated COVID-19 case investigations and conducted contact tracing. Between March 2020-July 2021, 636 COVID-19 cases (72% males), including 48 clusters (size range 2-10 cases), were reported. Overall case fatality rate was 1.5%. Of case patients, 82% (523) were Indians, and 18% (113) were Americans. On presentation, 22% (138/625) of cases were asymptomatic. The median time from symptom onset to notification to the Health Unit was three days (Interquartile range 1-5). The Health Unit identified 2,484 contacts (positivity rate 25%). Frequency of case presentation in the US Mission India closely resembled the pattern of COVID-19 waves in India. The attack rates ranged over the time period between 10-19%, the highest at 19% in Delhi.ConclusionsCOVID-19 mitigation strategies were implemented in collaboration with multiple agencies and helped prevent the transmission of COVID-19 and large COVID-19 clusters in the US Mission India.