Effect of Countrywide Lockdown in Reducing the Incidence of COVID-19 in India: A

Modelling Study

Abstract:

Background:

Several studies have estimated the effect of country level lockdown on COVID-19 incidence.

However, the evidence is sparse on the effect of a country-wide lockdown for 27 days,

involving the 1.3 billion people. We estimated the effect of countrywide lockdown on

cumulative incidence of COVID-19 in India.

Methods:

Data on confirmed COVID-19 cases in India were obtained separately upto 31 st March and

upto April 20th, 2020. Susceptible-Exposed-Infected-Removed (SEIR) model with maximum

likelihood estimation method was considered for estimating R 0. The expected number of

cases between 1st and 20th April was projected from R0 based on incident cases upto 31st

March and previous reported serial intervals. Projection was performed using a branching

process model (“projections” package) in R software 3.6.3. The effect of lockdown was

expressed in terms of percentage difference between projected and the observed cumulative

cases.

Results:

Between March 2nd and April 20th 2020, 18,596 COVID-19 confirmed cases were reported in

India. However, India was predicted to have 61,314 cases (95%CrI: 58,404-64,284) by April

20th 2020 based on the transmission dynamics till March 31 st 2020 (R0=3.08; 95%CI: 2.87-

3.30). This indicates 69% reduction in the incidence of COVID-19 due to countrywide

lockdown.
Conclusion:

Our model suggests that the lockdown had successfully reduced the total number of COVID-

19 cases in India by more than two-third, to a level that the country's healthcare system could

handle.

Keywords: COVID-19, India, Infectious Disease Modelling, Projections, Social Distancing,

Non-pharmacological intervention

Introduction:

The current outbreak of COVID-19, caused by infection with SARS-CoV-2 originated from

the Wuhan Province of China in December 2019.1–3 With a global burden of more than 2.5

million positive cases in 225 countries as on 23 rd April 2020, the spread of COVID-19 has

been rapid.4–6 Spread of this contagious disease through droplet infection, with no available

vaccine or definitive pharmacological agent has placed the health systems around the globe

under huge stress.7

Evidence from a previous pandemic of similar magnitude and caused by a disease with

similar transmission, Influenza pandemic (H1N1) of 1918-19, suggests that non-

pharmacological interventions (NPIs) can help by reducing the contact rates in the general

population thereby reducing the incidence of disease. 8 Major lockdown actions, such as

shutting down of public places, transport systems, religious places and educational

institutions, helped to bring down the burden of that outbreak. Learning and understanding

the ongoing COVID-19 pandemic based on the previous H1N1 evidences and the principles

of infectious disease epidemiology & modelling learnt over the post pandemic century has
9,10
helped to reduce the burden of disease in China. Strict travel restrictions and lockdown

measures were employed to bring down the incidence of COVID-19. NPIs help the system in

two major ways. Firstly, it helps reduce the transmission of disease by reducing the mixing of
population and thereby reducing the transmissibility of the disease. Secondly, as the

incidence of disease is attenuated, the shear on the health system resources reduces which

gives the country's administration time to effectively draft strategies to fight the disease. 10

This could result in a reduction in the case burden of COVID-19 as it was the case in

China.9,11

Although India reported its first imported case of COVID-19 as early as 30 th January 2020,

the number of cases started increasing steadily only since the first week of March 2020. With

the Epidemic Diseases Act of 1897 invoked, the districts with significantly large number of

cases were shut down by mid-March itself. Owing to the rapid rise in the number of cases,

the country decided to observe a 14-hour voluntary public curfew on the 22 nd of March

2020.12 The curfew was a prelude to the 21-day nation-wide lockdown initiated from 24 th

March 2020.13 All non-essential services were shut down and all international and domestic

transport were suspended. Citizens were urged not to step out of their homes unnecessarily,

and to follow social distancing and hand hygiene norms comprehensively.14

Compliance to lockdown has been disparate across different states and regions. Some states

and union territories used social control mechanisms to ensure the completeness of lockdown,

while others were relaxed in their efforts to stage an effective lockdown. Since there was a

steady increase in the incidence of new cases of disease, the lockdown was further extended

until the 3rd of May 2020 by a Union Government notification. 15 However, certain relaxations

have been proposed after April 20th 2020 to those regions with no active disease transmission.

Despite four weeks of countrywide lockdown, India still stands prominent in the corona

world map with over 21,483 confirmed cases and 683 deaths as of 23rd April 2020.16

Adequate literature showing the effectiveness of NPIs on the incidence of infectious diseases

in various settings are available. 11,17–19 But, there is a sparsity of evidence concerning the
effectiveness of a large scale NPI in the form of a nation-wide lockdown for 21 days,

involving 1.3 billion people. We estimated the effect of a countrywide lockdown on the

cumulative incidence of COVID-19 in India.

METHODS:

Data collection methods:

We obtained data on daily incident cases from Ministry of Health and Family Welfare,

Government of India website.20,21 The number of daily incident cases starting from the point

of case surge (March 2nd 2020) up to April 20 th were recorded for India and separately for

four high burden states in India. The number of cases upto March 31 st would correspond to

transmission rates prior to the implementation of countrywide lockdown as we assumed that

at least one week (median incubation period) would be necessary to perceive the effect of the

lockdown on the number of incident cases. The basic reproduction number calculate between

March 2nd and March 31st would represent pre-lockdown transmissibility of the disease.

Similarly effective reproduction number (Rt) was estimated from the number of daily incident

cases between April 1st and April 20th and this shall correspond to reproduction number post

lockdown measures. The methods for calculation of R0 is described below.

Subsequently, we performed projection to simulate the possible epidemic trajectories and

future daily incidence from April 1st to April 20th 2020. Actual steps of forecasting future

incident cases is described below. The projected cumulative number of cases upto April 20 th

were calculated by combining the actual number of cases upto 31st March together with the

projected incident cases between 1st to 20th April. We compared the projected cumulative

cases with the actual cumulative cases to obtain the percentage reduction in the incidence of

total COVID-19 attributable to the countrywide lockdown.

Estimation of R0:
Basic reproduction number (R0) is referred to as the number of secondary cases expected

from an average index case given that all the individuals in the community are susceptible to

infection.22,23 This would have been the scenario during the early phase of outbreak in India,

where no control measures were implemented. On an average, if R 0 value is more than or

equal to one, it means that an infected individual would infect more than one individual and

the infection is likely to cause a sustained and exponential chain of transmission.24

We calculated reproduction numbers for India at two time points: First (R 0) during the pre-

lockdown period (March 2nd to March 31st 2020) and second (Rt) during the lockdown effect

period (April 1st to April 20th 2020). The difference between these two values (estimated and

observed) were used to calculate the percentage reduction in transmission potential of

COVID-19 in India.

To calculate R0, data on daily incident cases of COVID-19 and generation time (GT) of

COVID-19 were used. Since we have limited primary data on generation time from Indian

setting, we assumed the GT as a function of gamma distribution similar to other studies

(mean GT=7.5 days; SD=3.4 days).25

We used the SEIR model26 to describe the early transmission dynamics of COVID-19 in

India. As per this model, each individual can be in one and only one of the following four

states at a particular time (t): S – Susceptible; E – Exposed; I – Infectious; R – Recovered.

We used the Maximum likelihood estimation (MLE) method to estimate the R 0 from this

model.27 It is one of the commonly used method to estimate R 0 based on the available

surveillance data during a disease epidemic. It has an assumption that the secondary cases

generated by the index case follows a Poisson distribution with expected R 0 value.27 Hence,

R0 is calculated by maximizing the log-likelihood as:

 T
¿( R)=∑ log (exp(− μ )∗μ t N t )/N t !
t

t=1

t
where μt =R ∑ N t −1ω i
i=1

Here, Nt denotes the incident number of cases at time T, ω denotes the GT distribution and R

is the maximum value of log-likelihood function. We assumed that the GT follows gamma

distribution. All the analyses were done using R software 3.6.3 (R Foundation for Statistical

Computing, Vienna, Austria) using “R0” package.28 We obtained the R0 value with 95%

confidence interval (CI).

Projection:

Data required to perform the projections were daily COVID-19 incidence, discrete daily

distribution of serial interval (time interval between the onset of symptoms in the primary

case and the secondary case) and basic reproduction number. We assigned gamma

distribution to the serial interval and obtained the shape (alpha=4.86) and scale parameter

(beta=1.54) from which we obtained the relative daily infectiousness of COVID-19.25

This analysis was performed in R software 3.6.3 using the “projections” package.29 It uses a

branching process model in which the daily incidence follows a Poisson distribution

determined by the daily relative infectiousness.29 It is computed as:

t −1
λ t=∑ y s ω(t−s)
s=1

Here, “ω” is the probability mass function of the serial interval and ys is the incidence at time

s. We performed 1000 iterations using Markov Chain Monte Carlo (MCMC) simulation and

reported the 2.5th, 50th and 97.5th percentile values to obtain the median with 95% credible

interval (CrI) of the future daily incidence of COVID-19. Difference between the actual
incidence and the median projected incidence at the end of compete lockdown period (April

20th 2020) was calculated. Finally, percentage reduction in the COVID-19 cases due to the

impact of countrywide lockdown was obtained from this difference.

Sensitivity analysis:

Since, GT is an uncertain parameter, we performed an additional sensitivity analysis by

varying it from 5.5 to 9.5 days. R 0 calculated by varying GT parameter was used for

projection. We checked whether the percentage reduction significantly varies across the

varying GTs.

RESULTS:

Description of the outbreak:

Between March 2nd and April 20th 2020, 18596 COVID-19 cases were confirmed in India

(Figure-1). Of these, 3,252 patients have recovered as of April 20 th 2020, and 590 patients

have died. During the initial phase of the outbreak, majority of the cases were linked to an

event in New Delhi that happened between 1 st and 22nd March. As on April 1st, about 20% of

the total cases in India were members who attended the high spreader event/ religious

congregation. However, in between this period, countrywide lockdown was announced from

March 25th 2020. Hence, the impact of countrywide lockdown is estimated to demonstrate the

extent to which the increase in COVID-19 incidence is shrunken by this intervention.

Estimation of effect of countrywide lockdown:

In India, we took the data from March 2nd 2020 to calculate R0 and assign incidence

distribution required for the projection as the surge of cases started from this date. From

March 2nd to March 31st 2020, 1632 confirmed COVID-19 cases were reported. For this

period, R0 calculated by MLE method was 3.08 (95%CI: 2.87-3.30). In our model, assuming
that this epidemic continues unabated without any intervention, the number of cases was

projected to increase from 1,632 to 61,314 (95%CrI: 58,404-64,284) in a span of 20 days.

However, the actual burden was 18,596, indicating that the countrywide lockdown has

contributed to about 69% reduction in the incidence of COVID-19 during this period (Figure

1). The reproduction number has also reduced by almost 38% from 3.08 (March 2nd to March

31st) to 1.98 (between April 1 to April 20 2020) (Figure 2).

Estimates of percentage reduction in disease burden across four high burden states (Table-1)

also reveal that maximum reduction in R0 was observed in Delhi (decrease from 3.73 to 1.66)

followed by Kerala (2.28 to 1.07). All states have reported a decrease in R 0 following

lockdown (Figure2). The maximum percentage reduction in the number of cumulative

incident cases was observed in Kerala (88%). The percentage reduction in total cases was

least in Maharashtra as the R0 did not diminish considerably following lockdown (figure 3).

Sensitivity analysis:

The percentage reduction in COVID-19 incidence due to lockdown was robust to the changes

in GT. The projected number of cases varied from 60,164 to 61,899 for the varying GT

parameter, indicating that the countrywide lockdown had a significant effect in reducing the

COVID-19 cases.

Discussion

Our analysis shows that the actual number of COVID-19 cases in India during the period of

country-wide lockdown beginning 25 March 2020 have been much lower than that expected

based on estimates from a deterministic SEIR model, based on data prior to implementation

of lockdown. At the country level, the gap between the expected and the observed cases was

69%. Besides, the reproduction number of the disease observed post-lockdown has been

considerably lower than that in the period immediately preceding it. Similar results have been
observed across four high burden states. These findings, in our opinion, indicate that the

lockdown in India has contributed significantly in preventing disease transmission during the

lockdown period.

Globally, over 2.5 million cases have been reported, and almost 170 000 people have died.

This rapid spread of infection has burdened global health systems, and has resulted in

widespread social and economic disruption.30 As a response to the ongoing COVID-19

pandemic many countries such as Italy, Spain, France, New Zealand have employed partial to

complete lockdown, ban on international and domestic travel. 31 Our results focusing on the

effectiveness of the lockdown are in line with evidence published from several others

countries that implemented restrictions to defer the spread of infection. 32,33 In India, several

projections have shown that the number of cases would steadily increase and the projected

cases ranges from few thousands to over a million cases. 21,34 It was estimated that a

significant proportion of these cases would require hospitalization and close to 5% would die

of COVID-19. Exponential growth of cases within a short period would cause a huge strain

on the existing health system.34 India responded swiftly to the pandemic, by roping in NPI to

contain the unprecedented public health catastrophe COVID-19 can bring, starting with the

implementation of Countrywide curfew on 22nd March, followed by countrywide lockdown

from 25th March to 20th April.35 Prior to imposing complete countrywide lockdown,

strategies were initially focused on screening of passengers at international ports and airports

for symptoms of COVID-19, isolation and contact tracing of positive cases. Asymptomatic

travelers from outside India were advised to quarantine themselves at home for a period of 14

days. However, the compliance to these interventions remained unmonitored due to huge

immigration following global spread of COVID-19 pandemic.

However, the lockdown included a larger variety of restrictions, such as stoppage of all

international and domestic flights, rail travel, major curbs on inter-city road travel, social

distancing measures, closure of all non-essential services (government offices, commercial

establishments, industries including the hospitality and transport services), closure of schools,

colleges and universities, and prohibition of political, social, sports, entertainment and

religious gatherings. Though, several large health institutions limited their activities to

serving only emergency patients, the field level healthcare workers were used for contact

tracing of positive cases, early detection, testing and treatment of positive cases.36

Every state in India implemented several comprehensive public health measures – such as

imposing section 144 of Criminal Procedure Code (prohibition of unlawful assembly), rapid

case identification, testing and isolation of cases, comprehensive contact tracing and

quarantine of contacts. The results from our study show that complete lockdown despite

being an extreme measure, has definitely reduced the rate of disease transmission and has

contained the rapid spread of disease in India. The effectiveness of such NPIs solely depend

on the compliance by individuals and public health measures instituted by various state health

systems. Studies have also showed that 50% compliance to the quarantine measures is

necessary to reverse the epidemic growth curve.34

Early and rigorous testing had always been a pivotal tool adopted by most affected countries

in their fight against COVID-19 pandemic. Though India had a stringent testing criterion to

test only symptomatic individuals with history of travel to COVID endemic countries

initially, the testing strategy was periodically revised to comprehensively include all suspects

of COVID-19. The apex institution for medical research in India has also advised to increase

the number of tests to maximize the benefit of early detection.37 India has also hastened

testing by evolving several testing strategies, improving testing rates from 14.5 per million
population in mid-march to 166 per million as on 14th April, aided by 183 operational testing

laboratories.38,39 The only other way to prevent transmission from undetected infective cases

to susceptible population is to implement universal NPI measures.

Our analysis has several limitations. Most importantly, it makes the usual assumptions used

by deterministic disease transmission models. These include: the presence of spread from a

single point-source, homogeneity of population (and subpopulations) in terms of transmission

and contact pattern, lack of any immune or other protection in the population, lack of any

major subclinical transmission leading to perceptible herd protection, and constant rate of

transmission over time, which may not always apply. In particular, in a diverse country with

varying population density, socio-economic status, cultural practices, across various

geographic regions and within each region, this may not be true. It is also clearly evident that

the outbreak in India initially began with multiple discrete importations. However, this has

been true for many other countries where similar models have been used, and one can

possibly assume that beyond the initial few days, the combined measurements from such

disparate micro-outbreaks can be treated as one combined outbreak. Also, we lacked

information on the several important model parameters (e.g. distribution parameters of

generation time, serial interval) and used data from other similar outbreaks.

Second, from the data widely available in the public domain, it is apparent that a large

proportion of cases observed in many parts of India were related to attendance at an event in

New Delhi which lasted from 1st to 15th March 2020, and this cannot be accounted for by the

deterministic model that we used. However, this ‘high-spreader’ event would have, if

anything, led to underestimation of the effect of lockdown in our analysis, since the cases

related to this were mostly diagnosed after the lockdown was in place. Furthermore, several

other measures were introduced before and after the introduction of lockdown, e.g. an
increase in case detection and isolation, and contact tracing and quarantine; these could have

served to amplify the containment. Finally, once a massive lockdown is introduced, at least a

subset of the population may be split into very small subpopulations, and transmission from

any cases in these may no longer follow the deterministic model and instead become a

stochastic process. Since our model is not robust to account for clustered outbreaks and

sudden importation of large number of cases from other territories, we did not include the

state of Tamil Nadu in this analysis as close to 80% of the cases reported in the state were

linked to the ;high spreader event' in New Delhi.

What may one expect from a lockdown, or other similar measures, these are applied when all

or most persons in a population are believed to be susceptible to a serious infection for which

a specific highly-effective preventive or therapeutic modality is not available. In such a

situation, if the disease is allowed to spread unchecked, one would expect a rapid ramp-up in

cases, far more than the capacity of the health system to handle till a certain proportion of the

population has acquired herd protection. The lockdown measures help reduce the inter-

personal effective contact rate, such that each infectious person would transmit the disease to

fewer naïve persons that otherwise expected, leading to a reduction in the exponential rise.

However, this phenomenon cannot by itself be expected to reduce the total number of

infections or cases, but only to spread these over a much longer time, the so-called ‘flattening

of the epidemic curve’. However, this slower ramp-up of the epidemic can help keep the

number of cases at any given time smaller, and possibly below the limit of capacity of the

healthcare delivery system, thereby reducing the mortality and other adverse consequences.

Second, such a slow rise in the number of cases may allow time for the health system to ramp

up its capacity by creating additional healthcare facilities, stock-piling of supplies, increasing

testing capacity, training staff, etc. We believe that the lockdown in India has certainly helped

by allowing these. In addition, such slowed spread opens up the possibility of development of
successful interventions (e.g. an effective vaccine or drug) for those who are not infected

early on in the epidemic. Fourth, it allows time for the pathogen to change its characteristics

such that it becomes less pathogenic – the RNA genome of pathogens such as the SARS-

CoV-2 are highly prone to genomic alterations, allowing emergence of strains which favor

the viral survival, such as higher transmissibility but lower propensity to cause death of the

host. It remains open to speculation whether the observation that a large proportion of recent

cases in India have had no or mild symptoms represents this phenomenon. If that is true, then

the benefit of the lockdown has been much greater than what our analysis indicates.

Despite successful attempts in alleviating the burden of COVID-19 disease, the negative

impact of lockdown on individuals, communities, and societies has been tremendous. The

lockdown has brought social and economic life to a near stop, especially affecting the

disadvantaged groups such as poor, laborers in unorganized sectors, migrants, internally

displaced people and refugees. Subsequently, it is important to plan for a managed transition

out from the complete lockdown, such that socio-economic benefit and epidemiological risk

are balanced.40 Further research is warranted to examine the implications of various strategic

plans for phasing out from lockdown in India.

Conclusion:

The present study focuses on the effectiveness of countrywide lockdown in reducing the total

number of COVID-19 cases by two-thirds in India. Early implementation of lockdown in

India has significantly suppressed the magnitude and spread of COVID-19 well below the

threshold that the country's health system can handle. The findings of this study would pave

way for forecasting the epidemic in India and thereby guide the policymakers to plan

withdrawal of lockdown in a phased manner despite flattening the epidemic curve.

REFERENCES
1. Lu H, Stratton CW, Tang Y-W. Outbreak of pneumonia of unknown etiology in

Wuhan, China: The mystery and the miracle. Journal of Medical Virology.

2020;92(4):401–2.

2. Tang JW, Tambyah PA, Hui DSC. Emergence of a novel coronavirus causing

respiratory illness from Wuhan, China. Journal of Infection [Internet]. 2020 Jan 27

[cited 2020 Feb 2];0(0). Available from:

https://www.journalofinfection.com/article/S0163-4453(20)30038-4/abstract

3. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical

characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a

descriptive study. The Lancet. 2020 Jan;S0140673620302117.

4. Countries where Coronavirus has spread - Worldometer [Internet]. [cited 2020 Apr

17]. Available from: https://www.worldometers.info/coronavirus/countries-where-

coronavirus-has-spread/

5. Corona Virus Disease 2019. Situation Report 87.16-04-2020. World Health

Organisation. Geneva, Switzerland. 20200416-sitrep-87-covid-19.pdf [Internet].

[cited 2020 Apr 17]. Available from: https://www.who.int/docs/default-

source/coronaviruse/situation-reports/20200416-sitrep-87-covid-19.pdf?

sfvrsn=9523115a_2

6. Situation update worldwide, as of 16 April 2020 [Internet]. European Centre for

Disease Prevention and Control. [cited 2020 Apr 17]. Available from:

https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases

7. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation

and Treatment Coronavirus (COVID-19). In: StatPearls [Internet]. Treasure Island

 (FL): StatPearls Publishing; 2020 [cited 2020 Apr 17]. Available from:

http://www.ncbi.nlm.nih.gov/books/NBK554776/

8. Bootsma MCJ, Ferguson N. The effect of public health measures on the 1918

influenza pandemic in U.S. cities. Proceedings of the National Academy of Sciences

of the United States of America. 2007 Jun 1;104:7588–93.

9. Kucharski AJ, Russell TW, Diamond C, Liu Y, Edmunds J, Funk S, et al. Early

dynamics of transmission and control of COVID-19: a mathematical modelling study.

The Lancet Infectious Diseases [Internet]. 2020 Mar 11 [cited 2020 Apr 17];0(0).

Available from: https://www.thelancet.com/journals/laninf/article/PIIS1473-

3099(20)30144-4/abstract

10. Ferguson NM, Laydon D, Nedjati-Gilani G, Imai N, Ainslie K, Baguelin M, et al.

Impact of non-pharmaceutical interventions (NPIs) to reduce COVID- 19 mortality

and healthcare demand. 2020;20.

11. Lai S, Ruktanonchai NW, Zhou L, Prosper O, Luo W, Floyd JR, et al. Effect of non-

pharmaceutical interventions for containing the COVID-19 outbreak in China

[Internet]. Infectious Diseases (except HIV/AIDS); 2020 Mar [cited 2020 Apr 17].

Available from: http://medrxiv.org/lookup/doi/10.1101/2020.03.03.20029843

12. PM addresses nation on combating COVID-19 [Internet]. [cited 2020 Apr 17].

Available from: pib.gov.in/Pressreleaseshare.aspx?PRID=1607248

13. Government of India issues Orders prescribing lockdown for containment of COVID-

19 Epidemic in the country [Internet]. [cited 2020 Apr 17]. Available from:

pib.gov.in/Pressreleaseshare.aspx?PRID=1607997
14. Ministry of Health and Family Welfare. Guidelines on the measures to be taken by

Ministries/Departments of Government of India, State/Union Territory Governments

and State/Union Territory Authorities for containment of COVID-19 Epidemic in the

country. [Internet] 2020 [cited 2020 Apr 18] Available from:

https://www.mohfw.gov.in/pdf/Annexure_MHA.pdf

15. PIB’S DAILY BULLETIN ON COVID-19 [Internet]. [cited 2020 Apr 17]. Available

from: pib.gov.in/Pressreleaseshare.aspx?PRID=1614457

16. COVID-19 Tracker | India [Internet]. [cited 2020 Apr 17]. Available from:

https://www.covid19india.org

17. Ahmed F, Zviedrite N, Uzicanin A. Effectiveness of workplace social distancing

measures in reducing influenza transmission: a systematic review. BMC Public

Health. 2018 Dec;18(1):518.

18. Koo JR, Cook AR, Park M, Sun Y, Sun H, Lim JT, et al. Interventions to mitigate

early spread of SARS-CoV-2 in Singapore: a modelling study. The Lancet Infectious

Diseases. 2020 Mar;S1473309920301626.

19. Chang SL, Harding N, Zachreson C, Cliff OM, Prokopenko M. Modelling

transmission and control of the COVID-19 pandemic in Australia. arXiv:200310218

[cs, q-bio] [Internet]. 2020 Apr 1 [cited 2020 Apr 17]; Available from:

http://arxiv.org/abs/2003.10218

20. National Institute of Epidemiology. Indian Council of Medical Research. COVID

Resource centre. [Internet] 2020 [cited 2020 Apr 18] Available from:

http://covidindiaupdates.in
21. Ministry of Health and Family Welfare. COVID-19 State wise Status. [Internet] 2020

Apr 14. [cited 2020 Apr 18] Available from: https://www.mohfw.gov.in/

22. Liu Y, Gayle AA, Wilder-Smith A, Rocklöv J. The reproductive number of COVID-

19 is higher compared to SARS coronavirus. J Travel Med. 2020; 27(2).

23. Delamater PL, Street EJ, Leslie TF, Yang YT, Jacobsen KH. Complexity of the basic

reproduction number (R0). Emerg Infect Dis. 2019; 25(1):1.

24. Diekmann O, Heesterbeek JAP, Metz JAJ. On the definition and the computation of

the basic reproduction ratio R0 in models for infectious diseases in heterogeneous

populations. J Math Biol. 1990; 28:365–82.

25. Wallinga J, Teunis P. Different epidemic curves for severe acute respiratory

syndrome reveal similar impacts of control measures. Am J Epidemiol 2004; 160(6):

509-16.

26. Pastor-Satorras R, Castellano C, Mieghem PV, et al. Epidemic processes in complex

networks. RevMod Phys. 2015;87(3):925–979.

27. White LF, Pagano M. A likelihood-based method for real-time estimation of the serial

interval and reproductive number of an epidemic. Stat Med 2008; 27(16): 2999-3016.

28. R Core Team (2013). R: A language and environment for statistical computing. R

Foundation for Statistical Computing, Vienna, Austria. URL http://www.R-

project.org/

29. R Epidemics Consortium. Projections package. Available from:

https://www.repidemicsconsortium.org/projections/

30. World Health Organisation. Coronavirus disease 2019 (COVID-19) Situation Report

– 88. [Internet] [Updated 2020 17 April; cited 2020 April 18] Available from:
 https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200417-

sitrep-88-covid-191b6cccd94f8b4f219377bff55719a6ed.pdf?sfvrsn=ebe78315_6

31. World Health Organisation. 2019 Novel Coronavirus (2019‐nCoV): Strategic

Preparedness and Response plan. [Internet] [Updated 2020 3 February; cited 2020

April 18]. Available from: https://www.who.int/docs/default-source/coronaviruse/srp-

04022020.pdf

32. Chang SL, Harding N, Zachreson C, Cliff OM, Prokopenko M. Modelling

transmission and control of the COVID-19 pandemic in Australia. arXiv preprint

arXiv:2003.10218. 2020 Mar 23.

33. Leung K, Wu JT, Liu D, Leung GM. First-wave COVID-19 transmissibility and

severity in China outside Hubei after control measures, and second-wave scenario

planning: a modelling impact assessment. The Lancet. 2020 Apr 8.

34. Chatterjee K, Chatterjee K, Kumar A, Shankar S. Healthcare impact of COVID-19

epidemic in India: A stochastic mathematical model. Medical Journal Armed Forces

India. 2020 Apr 2.

35. Coronavirus lockdown extended in India: Full list of new rules, guidelines and

restrictions. India Today 2020 April 16. [Internet] Available from:

https://www.indiatoday.in/india/story/lockdown-2-0-rules

36. Ministry of Home Affairs. Guidelines on the measures to be taken by Ministries/

Departments of the Government of India, State/ Union territory governments and

State/ Union territory authorities for the containment of COVID-19 epidemic in the

country.[Internet] [Updated 2020 March 24; cited 2020 April 18]. Available from:

https://www.mohfw.gov.in/pdf/Annexure_MHA.pdf
37. Indian Council of Medical Research. COVID-19. Government of India. [Internet]

[accessed April 18, 2020]. Available at: https://icmr.nic.in/node/39071

38. Indian Council of Medical Research. List of Private Laboratories to test COVID-19.

Government of India. [Internet] [accessed April 18, 2020]. Available at:

https://icmr.nic.in/sites/default/files/upload_documents/Private_Labs_17042020.pdf

39. National Institute of Epidemiology. Indian Council of Medical Research. Government

of India. [Internet] [accessed April 18, 2020]. Available at: http://www.nie.gov.in

40. World Health Organisation. COVID-19 Strategy Update. [Internet] [Updated 2020

April 14; cited 2020 April 18]. Available from: https://www.who.int/publications-

detail/covid-19-strategy-update---14-april-2020