Our findings are based on extensive surveillance and contact-tracing data collected from 36 Indian states/UTs.Present investigation was carried out in different states of India and moreover comparative study was conductedin different age groups and several co-morbidities in India. Similarly,the finding based on comprehensive surveillances from the Indian state of Tamil Nadu and Andhra Pradesh [1].
COVID-19 had been reported from 58 countries and territories around the world as of February 28, 2020, and one international conveyance, the Diamond Princess Cruise Ship [36]. As of February 28, 2020, there had been 121 million confirmed cases of COVID-19 worldwide, with 2.68 million deaths [37]. This study shows that, in India a total number of 11.06 Million Covid-19 cases, total 0.16 Million death cases and 10.75 Million recovered cases have been reported. Out of the total cases, 2.13 Million cases mostly reported from Maharashtra, with 51,993 death cases. Similarly, the vast majority of cases (78,824 out of 83,704; 0.9416 - 95 percent CI 0.94 to 0.9433) and deaths (2,790 out of 2,859; 0.9758 95 percent CI 0.9696 to 0.9809) have been reported from mainland China [37].
This study was compared, the CFR among states that reported a large number of COVID-19 cases at 13 months (>above 1 year) of pandemic, namely Jan 2020 to Feb 2021 reported that Maharashtra (2.441%), Punjab (3.215%) and Sikkim (2.201%) had highest CFR than other states of India. Similarly, COVID-19 cases rate were calculated in two different states (Tamil Nadu and Andhra Pradesh) of India. However, the CFR was calculated in different countries at two-time point of the pandemic namely 12 March 2020 to 23 March 2020 reported that Italy (6.22%), China (3.91%), Iran (3.62%), USA (3.07%) and Spain (2.12%) had highest CFR [38]. The case fatality ratio was calculated in Turkey as well as European countries [39].
To begin, assume that the number of deaths reported is equal to or very close to the actual value in the investigation, which may not be the case in many countries.The CFR was calculated for each Interval class, namely January to March 2020, April to June 2020, July to September 2020, October-December 2020, and January to February 2021.Our findingalso proved that the CFR was significantly increased due to lack of facilities in initially days then after decreased as facilities were more there at time as well as identified cancer at co-morbidities disease. Ideally, the CFR should be low at first due to the incubation time and delay in developing complications from the infection, which wasgradually increased until it reaches a plateau that will eventually become the ultimate CFR for the diseases.
In the present investigation, Covid-19 patients were suffered with several co morbidities which were further classified into two: Acute and Chronic. The incidence percent of acute and chronic were 12.87% and 87.13%, respectively. Among the acute co morbidities include Heart disease, Asthma, Bronchitis and Neuromuscular. While Chronic includes hypertension, diabetes, liver disease, chronic renal disease, COPD, immune compromised and malignancy. From the all co morbidities, hypertension was the most reported followed by diabetes and liver disease. CFR for COVID was shown to be increased with presence of co-morbidities[40–42] such as hypertension (CFR=6.0%), diabetes (CRF=7.3%), cardiovascular disease (CFR=10.5%), chronic respiratory disease (CFR= 6.3%) and cancer (5.6%) In India, it is important to know the mortality rates related to different age groups and underlying co-morbidities. So it could be implemented for high risk population and utilize the limited resources effectively.
Furthermore, elderly patients with underlying co-morbidities such as diabetes,hypertension, cerebrovascular disease and cardiovascular disease, are more likely to have negative outcomes [43].People of any age who have underlying medical conditions such as hypertension or diabetes have a worse prognosis [44].Diabetic patients have higher morbidity and mortality rates, as well as more hospitalizations and intensive care unit (ICU) admissions [44]. People with chronic obstructive pulmonary disease (COPD) or any other respiratory illness are more likely to develop severe COVID-19 illness [45].COVID-19 infection is four times more likely in patients with COPD than in patients without COPD[45].The elderly, particularly those in long-term care facilities and people of any age with serious underlying medical conditions are at a higher risk of contracting COVID-19, according to current research and clinical expertise [46].The population having chronic health conditions like cardiovascular, diabetes or lung disease is not only at a higher risk of developing severe illness, but also have higher chances of mortality if they become ill[47].People with uncontrolled medical conditions such as hypertension, diabetes, lung, liver, and kidney disease, smokers, transplant recipients cancer patients on chemotherapy, and patients on long-term steroid therapy are more likely to contract COVID-19 [46].Chronic obstructive pulmonary disease (COPD), among other co-morbidities, has been linked to poor disease progression. A four-fold increase in mortality in patients with pre-existing COPD who were diagnosed with COVID-19 has been found in a meta-analysis of multiple Chinese studies[45].
In this particular study, age criteria was classified into 4 different class interval namely: Below 20years, above 21-50years, above 51-80years and above 80 years. Out of these, the incidence percentage was higher in 21-50 class of interval followed by others. It is essential to know age groups which are affected most by the infection in a pandemic situation, so that the effective preventive measures can be under taken for the high risk group. It is shown that the CFR of Covid-19 increase with ages [46, 48] across different countries. Italian population (23%) was either 65year at age or older [49]. This would explain the higher mortality rates of Italy compared other countries.
This study shows that the globally mortality cases was 2.68M. The mortality cases were higher in United State (538K) followed by Brazil(282K) and India(157K). It represents that India was the third highest country in respect to mortality cases. In India, Maharashtra was having the most higher number of mortality cases followed by Tamil Nadu and others. And the overall percentage of mortality Covid-19 cases was significantly higher in Western zone as compared to other zones. Wuhan had a higher mortality rate of 4.9 percent, while Hubei province had a lower mortality rate of 3.1%. In China, a significant proportion of deaths (26%) occurred in people over the age of 60. However, at this stage in the epidemic's evolution, temptations to make policy decisions based on mortality data should be avoided[50].
Similarly, two groups of countries emerged, one with a higher mortality rate (Spain, Italy, and the United Kingdom) and the other with a lower mortality rate (USA, Germany, China).This analysis showed that the mortality in Maharashtra was higher because of the poor adherence to the safety norms and due to the mostly visited, crowded place of India. Furthermore, Iran must have begun to report or test care only after seeing facilities due to the disease [51]. Higher CFR values have reported at the start of the pandemic.