Epidemiologic trends of SARS-Cov-2 virus

The real-time reverse transcription-polymerase chain reaction (RT-PCR) is considered as the sensitive proof for detecting the viral infection obtained from respiratory samples due to infection of the SARS-CoV-2 virus. The quantitative values for the analysis are beneficial for estimating the infectiousness of SARS-CoV-2-positive persons. This can be further achieved by analyzing the samples by semiquantitative means through the interpretation of cycle threshold (Ct) values of RT-PCR that represents the first cycle of PCR at which a detectable signal appears during the assays. Ct value shows a correlation between high viral load and disease severity and infectiuosness which is observed with other respiratory viruses involving influenza B infection or rhinovirus infection. Hence, the present study has aimed for analyzing the surveillance of COVID-19 to monitor longer-term epidemiologic trends and monitor trends in COVID-19 deaths. 

The research objectives of the study focuses on contributing towards the surveillance of COVID-19 to monitor longer-term epidemiologic trends and monitor trends in COVID-19 deaths. Some of the specific research questions have been illustrated below that will be effective in analyzing the research study:

• What are the major impacts of the COVID-19 pandemic on the health care system and society? 
• How does the surveillance of COVID-19  monitor the epidemiological trends and COVID-19 deaths? 
• Can the surveillance of COVID-19 with a threshold value (Ct) be represented in the form of an epidemiologic curve?
• What is the relationship between the fatality rate and epidemiological trends of SARS-CoV-2? 

The ability to predict likely prognosis and infectiousness for patients with
COVID-19 would aid patient management decisions as India's COVID death toll nears 3.5 lakh mark.

The COVID-19 pandemic in India is a part of the worldwide pandemic of COVID-19 disease.India currently has the largest number of confirmed cases in Asia.As of 23 May 2021 , India has the second highest number of confirmed cases in the world after United States with 26.7 million reported cases of COVID-19 infection and third highest number of COVID-19 deaths after United States and Brazil at 307,231 deaths.

Disease surveillance in India faces perpetual shortage of funds and manpower resulting in weak nation wide data collection system.There is no tracking of deaths taking place outside hospitals , or deaths due to COVID-19 of those not tested, one of the main reasons under-counting in built into the system.The lack of epidemiologists in senior decision making positions of COVID-19 related committees has been evident in the country.Indian Council of Medical Research has been criticised for not updating the "treatment protocol" between July 2020-April 2021.

I want to propose a model of epidemiologic surveillance as a part of my PhD project.

The main aim of the study is to focus on contributing towards the surveillance of COVID-19 to monitor longer-term epidemiologic trends and monitor trends in COVID-19 deaths. The following are objectives that will be aidful in ascertaining the major aim of the study:

• To contribute to surveillance of COVID-19 to monitor longer-term epidemiologic trends and monitor trends in COVID-19 deaths
• To serve surveillance of COVID-19 as an epidemiologic parameter and a representative of surveillance data with an impact for reporting to the World Health Organization
• To evaluate the impact of the pandemic on the health care system and society. 

The Principal Scientific Advisor the the Government of India said on 5 and 7 May 2021 that Phase 3 of the Corona wave is inevitable in India.It is however not clear on what time scale this phase 3 will occur.

Therefore, it becomes necessary to get prepared for new waves.If we take measures depending on how well guidance is implemented at the local level, states, districts and cities the third wave can be restricted.

The lockdown phases during COVID-19 have left millions of migrant workers unemployed.The small business establishments in the urban and rural areas have been seriously affected.With factories and workplaces shutdown many workers were left with no livelihood.

The Central and the State Governments have launched projects specially for migrant workers and under served communities but this move has its own complications.Free food, shelter and transport to stranded migrant workers and the under served communities have not solved the issues of detecting COVID-19 disease affected individuals and their contact tracing has posed as a big challenge.

The suggestion is if the RT-PCR tests for COVID-19 detection are made free and mandatory to the migrant workers and under served population we can calculate the cycle threshold values and determine the epidemiologic trends in a bigger section of the population in India for proper utilisation of preventive and curative resources.

Another group of people on whom the mentioned research methodology can have a great impact are the Health Care workers and the Frontline workers.Tens and thousands of doctors , nurses and health care workers had died due to COVID-19 inspite of getting vaccinated.The trend of the Ct value based determination of infectiousness with high viral load can save many lives among the said population. 

In real life situations of migrant workers and underserved population the viral load among the affected may show variations as per age, gender, sex, comorbidities, and other related parameters which will be determining the epidemiologic trends among this group which constitute a major portion of the population of India.

The analysis of viral load among healthcare workers clearly implicated that the transmission rate of the virus entirely depends upon the Ct value and they are being transmitted due to the direct contact while treating the patients. Hence, isolation and quarantine are preventive measures to control the transmission of the virus.                 

This is a part of my PhD project. I have started working on the literature review and collecting data from the above mentioned populations mainly the Health Care workers and the underserved population. Although, the piloting has been done and we have established certain parameters due to the phases of lockdown I cannot avail the University resources to enhance my work.

The present study has followed literature reviews for analyzing the cycle threshold (Ct) value-based epidemic curve and calculation of case fatality rate to monitor long-term epidemiologic trends of the SARS-CoV-2 virus.

Correlations between the viral load of SARS-CoV-2 and related parameters of 

age, gender, sex, comorbidities of  the infected patients admitted in hospitals have been implicated in the study. 

We want to apply this model to reinforce the community health programs in the migrant worker population for better utilisation of preventive and curative resources. 

Based on the viral load through the prediction of cycle threshold values will help in segregation along with contact tracing of past 5 days will be an useful measure to determine the infectiousness among the migrant workers in an effective way as it is a difficult task to trace their contacts of infection due to their migratory nature.

Also applying the same principle in the Health care workers we can trace an epidemiologic curve for reducing death rates.

A sample size of 200 people have been taken so far.

The idea is to expand the idea  to cater millions of migrant workers in the state of West Bengal and then gradually implement the policy to the country of India in general.

As per projection the population of West Bengal in 2021 is 10.19 crore.

In India the total population is 1,391.99 million in 2021.

Review of literature and research has given us an idea that segregating patients can be the key to control the COVID-19 infections.The Cycle-threshold value of RT-PCR tests which indicates the viral load of the patient should be an integral part of the COVID management strategy has already become mandatory to be mentioned in each individual report of the tested individual.

I want to publish more research on the topic which will help to contact tracing and segregation of higher viral load individuals. Accordingly home quarantine, institutional quarantine and hospitalization based on symptomatology can be adopted.

I want to see my ideas get implemented at the national and international level and make a mark in policy making.

I am doing my PhD research at Dept. of Physiology, University of Calcutta.

I have been working on  the prerequisites of the PhD degree since the year 2019.I was given the project on COVID-19 since March 2020.

As this is a PhD Project I'm working alone in this project with help from my research guides.

I am fortunate to get the cooperation and blessings of my Research Guides who are directing me in my PhD program.However, the idea of participating in the "Health Security and Pandemic Challenge" from MIT SOLVE has been a decision of mine.

My Primary Research Guide:

Dr. Diptendu Chatterjee:

Associate Professor, Dept. of Anthropology, University of Calcutta and Deputy Registrar(Acting) University of Calcutta, India.

Associate Research Guide:

Prof. Bibhuti Saha, HOD, Calcutta School of Tropical Medicine, Consultant Infectious Diseases at The Calcutta Medical Research Institute(CMRI), Kolkata, India

Myself Dr. Aditi Munmun Sengupta

Academic Qualifications: MBBS, DECT, ADPC, MS (Clinical Chemistry), Pursuing
Ph.D. (Department of Physiology, University of Calcutta), FMRC, MRSB.

Designation: Medical Officer, Critical Care Unit, CMRI Hospital, Kolkata, India

The goals as set by our team are as follows:

1.Customize the vision and strategy. Customize the organization's diversity visions, definition and rationale to fit the organization's unique culture in collaborating and making partnerships at the national and international levels.

2.Focus on impact and metrics.

3.Focus on recruiting and selection practices.

4.Invest in leadership development.

5.Prompt ongoing discussion.

6.To emphasize and focus on the fund raising strategy.

I have submitted one of my proposals to MIT Solve once before this year for the "Trinity Challenge." I got an overwhelming response from my peer support group and many doors opened for me to continue with the projects I have been working on. 

I want to make my network strong and get mentored from impact- minded leaders across the globe.

Also while applying for the challenges through MIT SOLVE, I accessed the mentorship, coaching and strategic advices from the MIT SOLVE networks. The evaluation support is sure to bring in more content to my study and research work.

I have gained exposure in the scientific world and is preparing myself for the ethical committee meetings for further continuation of my research works.Thanks to the MIT SOLVE pitches which have taught me many critical issues to be taken into consideration.

I have also got the first hand knowledge about the places where I can apply for funding at the International levels. 

Even when I'm  satisfied with the progress of my work, there are key areas of professional development that can help to improve the personal productivity and can help to attain valuable skills that can benefit all aspects of my career development. Taking help in all the areas mentioned above will be making me more self- confident and will lead to self- improvement.Though it takes some effort to identify the specific areas where support is needed, developing each and every area will be a worthwhile pursuit.The discussed 8 areas of partnership and development will surely increase productivity and improve my morale.

Besides strengthening the internal bonds of support and partnerships within the University of Calcutta I would like to partner with US Universities for research opportunities, international experiences, culture awareness and study abroad programs.

Another desire of mine is to collaborate with Universities in China as my research topic is on COVID-19 and the source of the disease is in China.This global link can open up new ideas, knowledge tools and other resources to reach my goals.

International support is important for strengthening skills in communities around the world.

At present most probably I'm not eligible for the award as the award specifically deals with US population.But if i can standardize my model in my own home country i can put forth the same at an international level and it can be adapted by the public health programmers of the respective country.

A part of my project involves the migrant workers. In my home country India the migrant workers and their families are mostly under priviledged and usually refugees from neighbouring countries or even even interstate refugees. Taking this perspective into consideration I applied for this award.

I think Innovation for Women Prize should be given to women who are smashing stereotypes and breaking boundaries in innovation.

For me this project is very challenging as there are severe obstacles posed to me in carrying out this project.If I become successful it will be a breakthrough innovation with cost effectivity of the single pennies spent on detection of COVID-19 disease which will make a tremendous impact not only in India but also in other developing and under developed nations.It will be an inspiration to the  public health policy makers while implementing policies that each and every monetary contribution from the under priviledged groups have been utilised for their own protection and not gone waste.

The vulnerable areas of the Kolkata Metropolitan city houses nearly one third of the population in slums and one- fifth below poverty level, under compromised living conditions.Therefore with the massive second wave attack of COVID- 19 in India these areas have been the worst hit areas but due to lack of adequate testing and inability to carry our risk assessment it is difficult to estimate the damage done.It is very similar to the underprivileged and poorer sections of the communities spread across India.Moreover it has been a difficult process to do the contact tracing in the migrant workers who have travelled interstate in crowded trains or buses to their home states.

Therefore, it is an urgent need to carry out risk assessment based on demographics and help policy makers to make an appropriate prevention and/ or intervention strategies to allocate resources to these most vulnerable areas.i.e. the areas with high risk and high needs.

Such an approach would help control the transmission of the disease , and minimize the impact of our already stressed existing health care infrastructures.

My research study will help to support the focussed planning to protect people from contracting COVID-19 in the future by giving an idea of  measuring the flattening of the epidemic curve.

The implementation of viral load based segregation and detection measures will also help in implementing lockdown measures that have helped to a great extent to slow the spread of the virus.However, the stringent measures adopted by the Government have impacted the economy badly resulting in an almost economic shut down.

Therefore cost effective prevention or intervention strategies should be adopted and this research will surly help in that process besides taking various humanitarian steps to protect the vulnerable population of the country.