Association of national and regional lockdowns with COVID-19 infection rates in Pune, India

Assessing the impact of lockdowns on COVID-19 incidence may provide important lessons for management of pandemic in resource-limited settings. We examined growth of incident confirmed COVID-19 patients before, during and after lockdowns during the first wave in Pune city that reported the largest COVID-19 burden at the peak of the pandemic. Using anonymized individual-level data captured by Pune’s public health surveillance program between February 1st and September 15th 2020, we assessed weekly incident COVID-19 patients, infection rates, and epidemic curves by lockdown status (overall and by sex, age, and population density) and modelled the natural epidemic using the compartmental model. Effect of lockdown on incident patients was assessed using multilevel Poisson regression. We used geospatial mapping to characterize regional spread. Of 241,629 persons tested for SARS-CoV-2, 64,526 (26%) were positive, contributing to an overall rate of COVID-19 disease of 267·0 (95% CI 265·3–268·8) per 1000 persons. The median age of COVID-19 patients was 36 (interquartile range [IQR] 25–50) years, 36,180 (56%) were male, and 9414 (15%) were children < 18 years. Epidemic curves and geospatial mapping showed delayed peak of the patients by approximately 8 weeks during the lockdowns as compared to modelled natural epidemic. Compared to a subsequent unlocking period, incident COVID-19 patients were 43% lower (IRR 0·57, 95% CI 0·53–0·62) during India’s nationwide lockdown and were 22% lower (IRR 0·78, 95% CI 0.73–0.84) during Pune’s regional lockdown and was uniform across age groups and population densities. Both national and regional lockdowns slowed the COVID-19 infection rates in population dense, urban region in India, underscoring its impact on COVID-19 control efforts.