BACKGROUND: COVID-19 is spreading rapidly in India and other parts of the world. Despite the Indian Government's efforts to contain the disease in the affected districts, cases have been reported in 627 (98%) of 640 districts. There is a need to devise a tool for district-level planning and prioritisation and effective allocation of resources. Based on publicly available data, this study reports a vulnerability index for identification of vulnerable regions in India on the basis of population and infrastructural characteristics. METHODS: We computed a composite index of vulnerability at the state and district levels based on 15 indicators across the following five domains: socioeconomic, demographic, housing and hygiene, epidemiological, and health system. We used a percentile ranking method to compute both domain-specific and overall vulnerability and presented results spatially with number of positive COVID-19 cases in districts. FINDINGS: A number of districts in nine large states-Bihar, Madhya Pradesh, Telangana, Jharkhand, Uttar Pradesh, Maharashtra, West Bengal, Odisha, and Gujarat-located in every region of the country except the northeast, were found to have high overall vulnerability (index value more than 0·75). These states also had high vulnerability according to most of the five domains. Although our intention was not to predict the risk of infection for a district or a state, we observed similarities between vulnerability and the current concentration of COVID-19 cases at the state level. However, this relationship was not clear at the district level. INTERPRETATION: The vulnerability index presented in this paper identified a number of vulnerable districts in India, which currently do not have large numbers of COVID-19 cases but could be strongly impacted by the epidemic. Our index aims to help planners and policy makers effectively prioritise regions for resource allocation and adopt risk mitigation strategies for better preparedness and responses to the COVID-19 epidemic. FUNDING: None.

Acharya R, Porwal A

Lancet Glob Health. 2020 Sep;8(9):e1142-e1151. doi: 10.1016/S2214-109X(20)30300-4. Epub 2020 Jul 16.

Brotherton H, Usuf E, Nadjm B, Forrest K, Bojang K, Samateh AL, Bittaye M, Roberts CA, d'Alessandro U, Roca A

Lancet Glob Health. 2020 Sep;8(9):e1125-e1126. doi: 10.1016/S2214-109X(20)30318-1. Epub 2020 Jul 14.

BACKGROUND: COVID-19 has the potential to cause substantial disruptions to health services, due to cases overburdening the health system or response measures limiting usual programmatic activities. We aimed to quantify the extent to which disruptions to services for HIV, tuberculosis, and malaria in low-income and middle-income countries with high burdens of these diseases could lead to additional loss of life over the next 5 years. METHODS: Assuming a basic reproduction number of 3·0, we constructed four scenarios for possible responses to the COVID-19 pandemic: no action, mitigation for 6 months, suppression for 2 months, or suppression for 1 year. We used established transmission models of HIV, tuberculosis, and malaria to estimate the additional impact on health that could be caused in selected settings, either due to COVID-19 interventions limiting activities, or due to the high demand on the health system due to the COVID-19 pandemic. FINDINGS: In high-burden settings, deaths due to HIV, tuberculosis, and malaria over 5 years could increase by up to 10%, 20%, and 36%, respectively, compared with if there was no COVID-19 pandemic. The greatest impact on HIV was estimated to be from interruption to antiretroviral therapy, which could occur during a period of high health system demand. For tuberculosis, the greatest impact would be from reductions in timely diagnosis and treatment of new cases, which could result from any prolonged period of COVID-19 suppression interventions. The greatest impact on malaria burden could be as a result of interruption of planned net campaigns. These disruptions could lead to a loss of life-years over 5 years that is of the same order of magnitude as the direct impact from COVID-19 in places with a high burden of malaria and large HIV and tuberculosis epidemics. INTERPRETATION: Maintaining the most critical prevention activities and health-care services for HIV, tuberculosis, and malaria could substantially reduce the overall impact of the COVID-19 pandemic. FUNDING: Bill & Melinda Gates Foundation, Wellcome Trust, UK Department for International Development, and Medical Research Council.

Hogan AB, Jewell BL, Sherrard-Smith E, Vesga JF, Watson OJ, Whittaker C, Hamlet A, Smith JA, Winskill P, Verity R, Baguelin M, Lees JA, Whittles LK, Ainslie KEC, Bhatt S, Boonyasiri A, Brazeau NF, Cattarino L, Cooper LV, Coupland H, Cuomo-Dannenburg G, Dighe A, Djaafara BA, Donnelly CA, Eaton JW, van Elsland SL, FitzJohn RG, Fu H, Gaythorpe KAM, Green W, Haw DJ, Hayes S, Hinsley W, Imai N, Laydon DJ, Mangal TD, Mellan TA, Mishra S, Nedjati-Gilani G, Parag KV, Thompson HA, Unwin HJT, Vollmer MAC, Walters CE, Wang H, Wang Y, Xi X, Ferguson NM, Okell LC, Churcher TS, Arinaminpathy N, Ghani AC, Walker PGT, Hallett TB

Lancet Glob Health. 2020 Sep;8(9):e1132-e1141. doi: 10.1016/S2214-109X(20)30288-6. Epub 2020 Jul 13.