Impact of Lockdown on Chain Break of Pandemic COVID-19: The Current Status and Forecast

Coronavirus disease 2019 (COVID-19) is an outbreak of epidemic disease origin in Wuhan city, China. The virus transmits rapidly in worldwide and the rate of fatality also elevated by passing each day. But, action taken by World Health Organization failed to stop outbreak of COVID-19. Wuhan city in China has controlled the pandemic disease with lockdown strategy and present all other countries also followed the same strategy for a month. Hence, present study has been designed to observe the impact of lockdown on COVID-19 in worldwide population and future prophecy with present circumstances. Online database ( www.channelnewsasia.com) was used to ensure that number of COVID-19 cases, death and recovery are recorded in the period of 20 days lockdown (6 th - 26 th April 2020) in worldwide and as well as country wise population. The data shows signicant elevation of COVID-19 cases was observed since 71447, on Feb 18 th to 1.3 million by 6 th April and then to 2.96 million by 26 th April 2020 in worldwide. The fatality rate of COVID-19 were shown to be increased from 2.48% on Feb 18 th to 5.51% by 6 th April and then to 6.95% on 26 th April 2020 in worldwide. We have found increased morbidity (2.21 folds) and fatality (6.95%) of COVID-19 in worldwide and country wise population. In fact lockdown might help to reduce register new cases, but not made zero. However, present situation demands continuation of lockdown and social distance should be maintained with strict rules otherwise probabilities are more to reach unimaginable number of cases in coming days.

The common complications reported with COVID-19 are acute respiratory distress syndrome (61.1%), arrhythmia (44.4%) and Shock (30.6%). The other complications associated with COVID-19 include Acute Cardiac Injury (ACI), Acute Renal Injury (ARI), Pneumothorax, and Secondary Bacterial Infections. The majority of populations affected with COVID-19 are old age group population 51-66 years (30.6 -72.2 %), Hypertension (31%), Cardiovascular Disease (14.5) and Diabetes (10%) with symptoms of cough, fever and fatigue [1]. The similar reports of various studies underlying co-morbidities and mortality rates may helpful to health professional to triage and risk stratify the patient population who might require a high level of care [6 -10].
Present 213 countries are affected rapidly with new novel epidemic disease COVID-19 in worldwide [11]. However, Wuhan city in China where this pandemic disease was origin is under control now due to lockdown and maintain social distance for a period of more than two months (to prevent local transmission) [12]. Lockdown is a popular word using worldwide to control epidemic disease COVID-19.
This lockdown helps to break the transmission chain by maintaining social distance in public and stay at home. Hence the study has been designed to observe the impact of lockdown on COVID-19 in global population and present situation with irrespective of lockdown.

Material And Methods
Online database www.channelnewsasia.com was used to ensure that numbers of COVID-19 cases are recorded in worldwide and country wise. The data was collected in 3 different dates (18 th Feb, 6 th April and 21 th April 2020) to ensure the severity of epidemic disease and how rapid the transmission of virus happens within short span. The fatality rate of majorly affected countries are calculated by using data collected from online www.channelnewsasia.com in three different dates (18 th Feb, 6 th April and 21 th April 2020) to analyze increasing fatality rate in a short period and goes on [13]. The study also calculated recovery percentage of COVID-19 cases in worldwide as well as country wise.
Symptoms of COVID-19: The suspected cases have following symptoms include cold, sneezing, dry cough, sore throat, severe fever, fatigue and breathing issue. Sometimes this epidemic disease is asymptomatic and symptoms can be appearing within 14 days of contact with diseased person and in some cases appears even after 20 days. Throat or Nasal swab samples are used to diagnose COVID-19 by RT-PCR method, but present rapid COVID-19 test kits are using to diagnose the disease with blood sample [14]. Figure 1 shows current 2.96 million peoples are affected with COVID-19 by 26 th April 2020 in worldwide, whereas Americans and European countries badly affected include United States 0.96 million followed by Spain 0.23 million, Italy 0.19 million, France 0.16 million, Germany 0.157 million , United Kingdom 0.15 million. However other countries also affected with low cases compared to America and European countries. Table 2 shows increasing the COVID-19 cases by passing day to day on 18 th Feb it was 0.07 million and it reaches 1.3 million by 6 th April in 47 days and further reaches to 2.96 million by 26 th April 2020 (20 days) in worldwide. Out of 2.96 million COVID-19 cases, the following countries has shown both increase in number of cases and its percentage include United States 27.50 -32.61% followed by United Kingdom 3.85 -5.16%, Turkey 2.26 -3.72%, Russia 0.47 -2.73% (12.76 fold), Brazil 0.90 -1.98%, Netherlands 0.13 -1.28% (20.99 fold), and remaining countries status has shown in table 2.

Results
The fatality rate was observed as 0.2 million (205,892) in worldwide by 26 th April 2020 Figure 2. The high rate of fatality was seen in following countries include United States of America 27%, Spain 11%, Italy 13%, France 11%, United Kingdom 10%, Germany 3% etc and others countries shown < 3% of fatality gure 3.
As of 6 th April the fatality rate was 5.51% (73,918) in worldwide and it has reached 6.95% (

Discussion
The epidemic disease COVID-19 belongs to family of coronavirus; out of six CoVs two viruses are more pathogenic and raised its impact on population include SARS (Severe Acute Respiratory Syndrome) in 2003, where the fatality rate is 10%; while MERS (Middle East Respiratory Syndrome) killed 34% of people [15]. But, current novel coronavirus COVID-19 widen very province of China as well as 27 other countries and region with more than 70,000 cases with 2-3% mortality as of Feb 18, 2020 [1,16]. However, the number of COVID-19 cases and its fatality rate increasing by passing every day, on 6th April the fatality rates is 5.51% out of 1.3 million and by 26 th April 2020 reaches 6.95% fatality out of 2.96 million COVID-19 cases in worldwide.
In Wuhan, China lockdown strategy implemented for more than two months and succeeded to control COVID-19 transmission. Hence, present all countries following lockdown strategy since last one month to break the transmission chain of COVID-19. Lockdown makes peoples to go for self isolation at home, which facilitate to maintain social distance in public. The present study was observed that the impact of lockdown might reduce the addition of new cases but failed to register zero new cases, because lack of awareness in public about seriousness of pandemic disease and failure to maintain social distance.
Morbidity rate of COVID-19: The prevalence of COVID-19 is increasing rapidly in all over the world. In earlier WHO reported that COVID-19 was transmitted to 25 countries in worldwide, but present it has spreads to 213 countries [1,11]. The present online data con rms that increased ratio of COVID-19 cases in worldwide as well as country wise from 18 th Feb to 26 th April 2020 in a period of 20 days. On 18 th Feb 2020, the number of COVID-19 cases con rmed as 71,447 in worldwide and it reaches 1.  [17]. This data has con rms that lockdown has impact on epidemic disease, but it fails to register zero cases due to lack of maintaining social distance and negligence in public. We have to understand that without social distance lockdown cannot show full impact on epidemic disease. Another major issue is asymptomatic carriers of COVID-19, where more than 69% of cases are registered as asymptomatic and they are more dangerous than symptomatic carriers. If precise preventive precautions are not taking possibilities are there to increase addition of new COVID-19 cases in coming days. Lockdown must be continuing with strict rules until register zero new cases to avoid signi cant circumstances in future.  table 4. Severe acute respiratory distress syndrome is the major reason to cause death of patients with COVID-19. The fatality rate is high in COVID-19 patients with co-morbidity like cardiovascular disease, hypertension and diabetes, and old age is another factor [14]. The reason might be due to age factor and treatment variation.
Since, there was no speci c treatment to cure pandemic disease, the only way to prevent transmission of disease are lockdown and maintaining social distance. Almost all countries done lockdown for a month, but the impact was less due to misuse of lockdown, lack of social distance and zero knowledge of COVID-19/ignoring seriousness of pandemic disease. Even though in 20 days of lockdown period, the number of cases was reached more than double in worldwide. In this situation, if withdraw lockdown we cannot imagine the gure of COVID-19 cases in coming days. However, it's better to extend lockdown until register zero new cases at least for a week, otherwise morbidity and fatality will be uncountable since this pandemic disease also spreading asymptomatically.

Conclusion
We have found increased morbidity and fatality of COVID-19 cases in worldwide population as well as country wise. Within 20 days the morbidity rate was more than double (2.21), where the fatality rate increases from 5.51% to 6.95%. In fact lockdown might help to reduce the register new cases, but not made zero. Present lockdown should be continue, where social distance must be maintained with strict rules otherwise probabilities are more to reach unimaginable number of cases in coming days.

Declarations
Compliance with Ethical Standards