Abstract

BackgroundThere have been over 30 million cases of COVID-19 in India and over 430,000 deaths. Transmission rates vary from region to region, and are influenced by many factors including population susceptibility, travel and uptake of preventive measures. To date there have been relatively few studies examining the impact of the pandemic in lower income, rural regions of India. We report on a study examining COVID-19 burden in a rural community in Tamil Nadu.MethodsThe study was undertaken in a population of approximately 130,000 people, served by the Rural Unit of Health and Social Affairs (RUHSA), a community health center of CMC, Vellore. We established and evaluated a COVID-19 PCR-testing programme for symptomatic patients—testing was offered to 350 individuals, and household members of test-positive cases were offered antibody testing. We also undertook two COVID-19 seroprevalence surveys in the same community, amongst 701 randomly-selected individuals.ResultsThere were 182 positive tests in the symptomatic population (52.0%). Factors associated with test-positivity were older age, male gender, higher socioeconomic status (SES, as determined by occupation, education and housing), a history of diabetes, contact with a confirmed/suspected case and attending a gathering (such as a religious ceremony, festival or extended family gathering). Amongst test-positive cases, 3 (1.6%) died and 16 (8.8%) suffered a severe illness. Amongst 129 household contacts 40 (31.0%) tested positive. The two seroprevalence surveys showed positivity rates of 2.2% (July/Aug 2020) and 22.0% (Nov 2020). 40 tested positive (31.0%, 95% CI: 23.02 − 38.98). Our estimated infection-to-case ratio was 31.7.ConclusionsA simple approach using community health workers and a community-based testing clinic can readily identify significant numbers of COVID-19 infections in Indian rural population. There appear, however, to be low rates of death and severe illness, although vulnerable groups may be under-represented in our sample. It’s vital these lower income, rural populations aren’t overlooked in ongoing pandemic monitoring and vaccine roll-out in India.

Highlights

  • IntroductionTransmission rates vary from region to region, and are influenced by many factors including population susceptibility, travel and uptake of preventive measures

  • There have been over 30 million cases of COVID-19 in India and over 430,000 deaths

  • Symptoms amongst participants are presented in Table 3; those most strongly associated with a positive test were fever with fatigue (p = 0.004), cough (p ≤ 0.001), loss of smell (p = 0.001) and loss of taste (p ≤ 0.001)

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Summary

Introduction

Transmission rates vary from region to region, and are influenced by many factors including population susceptibility, travel and uptake of preventive measures. To date there have been relatively few studies examining the impact of the pandemic in lower income, rural regions of India. In India, the world’s second most populous nation, there was a rapid rise in cases from the onset of the pandemic in March 2020, mostly from the urban areas, yet there was relatively little information on the infection rate in the rural areas [2, 3]. Available evidence shows that there is much variation in transmission rates from region to region in India, depending upon factors including the susceptibility of the population, population density, and feasibility and uptake of COVID-19 preventive measures [7, 8]. As of August 13th 2021, there have been over 32.1 m cases of COVID-19 reported in India with over 430,000 deaths [9]

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