The COVID-19 pandemic's footprint in India: An assessment on the district-level susceptibility and vulnerability

In this nationwide study, we trace the COVID-19 global pandemic's footprint across India's districts. We identify its primary epicentres, which are the major international airports of Mumbai and Delhi. We then track the outbreak into India's hinterlands in four separate time-steps that encapsulate the different lockdown stages implemented. Using a detailed district-level database that encompasses climatic, demographic and socioeconomic parameters, we identify hotspots and significant clusters of COVID-19 cases, which are examined to discern temporal changes and predict areas where the pandemic can next spread into. Of prime concern are the significant clusters in the country's western and northern parts and the threat of rising numbers in the east. Encouraging insights emerge from Kerala in South India, where virus hotspots have been eradicated through effective contact-tracing, mass testing and accessible treatment. Allied with this, we perform epidemiological and socioeconomic susceptibility and vulnerability analyses. The former elicits areas whose resident populations are likely to be physiologically weaker in combating the virus and therein we expect a high incidence of cases. The latter shows regions that can report high fatalities due to ambient poor demographic and health-related factors. Correlations derived from the generalised additive model show that a high share of urban population and high population density (1500-2500 people/km2), particularly in slum areas, elevate the COVID-19 risk. Aspirational districts have a higher magnitude of transmission (susceptibility) as well as fatality (vulnerability). Discerning such locations can allow targeted resource allocation by governments to combat the next phase of this pandemic in India.