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Districts in Madhya Pradesh may be more vulnerable to COVID-19 and its effects than districts in any of the other states in India, according to a new "vulnerability index". Sikkim districts emerged as the least vulnerable on the index.

The index, shared in an article in the scientific journal The Lancet Global Health, comes at a time when the number of COVID-19 cases in India has crossed one million and there is a growing need to understand why the viral infection has been spreading so quickly despite interventions like lockdowns and movement restrictions.

Based on 15 parameters around five domains—socioeconomic factors, housing and hygiene, health infrastructure, public health systems (epidemiology) and demographics (population data)—the index is not a reflection of current cases or even a projection of what will definitely happen. It is merely a tool to understand which districts could be worst affected based on these parameters and plan accordingly.

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The study, co-authored by Rajib Acharya and Akash Porwal of the Population Council, Delhi, who looked into publicly available data and created a "vulnerability index" to identify the most vulnerable regions in the country based on various parameters. Population Council is a US-headquartered non-governmental research organization with an interest in biomedicine and public health.

Vulnerability in this context covers the risk of spread of infection, deaths due to infection and the potential social and economic impact of an outbreak at the district level.

The authors of the study didn't necessarily identify states with already high numbers of cases, but presented a case for those that could be heavily impacted by the epidemic in the not-so-distant future. Based on a vulnerability index value between 0 and 1, states with an index score higher than 0.75 were determined to be the most vulnerable.

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The central Indian state of Madhya Pradesh, which had the highest index score of 1, was identified as the most vulnerable out of all of India's regions, followed by Bihar with 0.971. Telangana (0.943), Jharkhand (0.914) and Uttar Pradesh (0.886) were next on the list with high vulnerability scores.

Bihar scored poorly in the vulnerability index largely because of the non-availability of healthcare, followed by its poor ratings in hygiene and socioeconomic conditions, while Madhya Pradesh fared poorly due to poor housing and hygiene, the poorest among all states. 

Telangana, on the other hand, had a poor overall score due to a higher epidemiological vulnerability, which means a large number of people were living with comorbidities and poor healthcare standards.

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Along with the states that figure high on the vulnerability index, other large states such as West Bengal, Maharashtra (which has the highest number of COVID-19 cases in the country currently), Odisha and Gujarat also had a large number of districts with high overall vulnerability to the epidemic.

With an overall vulnerability score of 0, the northeastern state of Sikkim emerged as the least vulnerable of all Indian states to suffer the consequences of the epidemic. Overall, other states in the North-East and the smaller states of the country fared better on the vulnerability index.

The vulnerability of these states was also high due to their poor index score across all five domains the study focused on. Interestingly, the states that have scored poorly in the vulnerability index also have a high concentration of COVID-19 cases already. However, the same could not be said at the district level.

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It is also estimated that those regions with a higher vulnerability will also get poorer as a result, as an already poor state would have a greater economic impact due to the epidemic.

  1. Findings based on 15 different markers

Many factors go into determining how vulnerable a state is to exposure from the SARS-CoV-2 virus that has affected over 13.8 million people and claimed more than 590,000 lives around the world. 

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For this study titled A vulnerability index for the management of and response to the COVID-19 epidemic in India: an ecological study, the authors used 15 different indicators across five different domains—socioeconomic, demographic, housing and hygiene, epidemiological and health system—to determine which regions in India are at a greater risk of suffering from the consequences of the outbreak.

An ecological study is done to assess the risk on health and other outcomes based on population, which can be either geographical (location-based) or temporal (duration or time-based). 

Vulnerability, according to the authors of the study, is key in preparing for natural disasters and outbreaks of epidemics in order to minimise the consequences of the disaster itself. Taking the above-mentioned domains into account, the study intends to assess the risk of the consequences of COVID-19 rather than who is more at risk of contracting the disease itself. The study can be used as a tool for policymakers to allocate the right amount of resources to the states or regions that need it most while managing and rebuilding.

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A prior study titled Estimating the Global Spread of COVID-19 conducted by researchers from the Massachusetts Institute of Technology had pointed out that India could become the worst-hit country if effective treatment methods are not devised in time. In the absence of vaccines and effective treatments, India could be looking at as many as 287,000 new cases per day by February 2021. The study developed an epidemiological model to assess the spread of the virus in different parts of the world, which also suggested that there could be nearly 250 million cases across the world by February 2021.

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  1. Acharya R and Porwal A. A vulnerability index for the management of and response to the COVID-19 epidemic in India: an ecological study. The Lancet Global Health. 2020 July. [Internet]
  2. Rahmandad H et al. Estimating the Global Spread of COVID-19. SSRN. 2020 July. [Internet]
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