Effective Lockdown and Role of Hospital-Based COVID-19 Transmission in Some Indian States: An Outbreak Risk Analysis

Several reports in India indicate hospitals and quarantined centers are COVID-19 hotspots. To study the transmission occurring from the hospitals and as well as from the community, we developed a mechanistic model with a lockdown effect. Using daily COVID-19 cases data from six states and overall India, we estimated several important parameters of our model. Moreover, we provided an estimation of the effective (R-T), the basic (R-0), the community (R-C), and the hospital (R-H) reproduction numbers. We forecast COVID-19 notified cases from May 3, 2020, till May 20, 2020, under five different lockdown scenarios in the seven locations. Our analysis suggests that 65% to 99% of the new COVID-19 cases are currently asymptomatic in those locations. Besides, about 1-16% of the total COVID-19 transmission are currently occurring from hospital-based contact and these percentage can increase up to 69% in some locations. Furthermore, the hospital-based transmission rate (beta(2)) has significant positive (0.65 to 0.8) and negative (-0.58 to -0.23) correlation with R-0 and the effectiveness of lockdown, respectively. Therefore, a much larger COVID-19 outbreak may trigger from the hospital-based transmission. In most of the locations, model forecast from May 3, 2020, till May 20, 2020, indicates a two-times increase in cumulative cases in comparison to total observed cases up to April 29, 2020. Based on our results, we proposed a containment policy that may reduce the threat of a larger COVID-19 outbreak in the future.