Spatial Heterogeneity in the Severity of COVID-19 Pandemic in India

The coronavirus disease (COVID-19) pandemic has affected all states and union territories in India, but the spread of infections and the fatality rate across regions have been disproportionate. In this study, inequalities in the severity of the pandemic are examined for a 15-month period, covering both the first and second waves of the virus, using alternate measures based on the official estimates of deaths from COVID-19 as a ratio of all-cause mortality. The observed differences in the severity indicators are explained using socioeconomic, meteorological, and geographical factors. A comparison of severity ratios across states and over time gives a region-specific flavor of the severity of the pandemic and increases understanding of the pressure points in the health system. Our findings are helpful for public health professionals to develop control measures and plan environmental and health policies as an alternative strategy to respond to new COVID-19 outbreaks and prevent future crises.