WikiJournal Preprints/What Impact has lockdown on SARS-CoV-2/COVID-19 incidence, prevalence and mortality during second wave of pandemic in 2021: - observational & statistical analysis of Bihar

Background
The delivery of health services is of greatest importance and major concern in India particularly populous states like Bihar with imperfect and inadequate resources, lack of modern infrastructure and enormous demand on healthcare structure. The Census 2011 calculated that Bihar has population of 10.41 Crores, an increase from figure of 8.30 Crores in 2001 census. As per 2011 census there were 54,278,157 male and 49,821,295 female respectively. As per projection of census, population of Bihar in 2021 is 13.12 Crore The SARS-CoV-2 pandemic had offered a challenge even for developed healthcare systems around the globe. A sense of panic engrossed the globe due to pandemic and the state of Bihar in India is not exclusion. The insufficient and inadequate healthcare resources including manpower, infrastructure, transportation (ambulance services) etc. have been largely utilized to tackle the situation of pandemic. This shift has tremendous effect of continuing various health programmes running formerly before the pandemic era.

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) popularly known as COVID-19 pandemic,

first found in Wuhan, China which had spread globally and causing morbidity, mortality as well as huge economic losses. The SARS-CoV-2/ Covid -19 pandemic are not over globally as well as in India and Bihar. The current healthcare system is burdened more with this new diseases added with previous NCD (non communicable diseases) & CD (communicable diseases). The First human case of this global pandemic was reported from Wuhan city of China in December 2019 .The first case ofcovid-19 in India was found in January 2020 and Bihar reported first COVID-19 case from Munger on 22 March 2020, a 38-year-old tested positive for COVID-19, he was also the first victim.

As of June 17, 2021, 07:33 GMT, covid-19 has involved 220 countries and has infected 177, 819, 445, people with a mortality of 3,849,051 deaths. The median incubation period for COVID-19 is usually 5.1 days, and may be up to 14 days. The incubation period of COVID-19 is very significant in establishing lockdown, monitoring, surveillance and control of the disease spread. The high contagious nature of COVID-19 has led to panic situation across the globe stopping entry and exit across different boundaries and even up to lowest administrative levels by implications of containment zones. The world-wide population has been under lockdown and quarantined in their homes at some point. The lockdown and quarantine methods have been implemented by many nations and states to control the spread of covid-19. The lockdown order in Bihar issued by Home Department dated 04/05/2021 announced lockdown from 05/05/2021 to 15/05/2021 and then extended up to 1 June, 2021, includes several restrictions such as isolation at homes, travel restrictions, and termination of all public events etc. The lockdown strategies in Bihar have been enforced like all over the world in order to prevent the COVID-19 infection from spreading even further. On comparing the pattern of transmission rates observed in few countries at posterior estimated change points, it is found that partial implementation of lockdown (in the United States), delayed planning in lockdown (Russia, United Kingdom, and France), and inadequate implementation of the lockdown (in India and Italy) were found to be mainly responsible for the spread of covid-19 infections.

Vaccines are known to effectively prevent a COVID-19 infection and reduce morbidity-mortality but there are multiple factors and obstacles in running smoothly the vaccination programme such as frequent change and unavailability of vaccines, guidelines, policies, interdisciplinary conflicts of medical sciences, mistrust, evil propaganda over Government data, lack of communication and health promotion in rural areas of India. Hence in current scenario of Bihar and most of states in India, public health measures such as lockdown, masks, quarantine, and social distancing appear to be the only ways to control the outbreak. Lockdown and quarantine can either be applied on a voluntary basis, or if seems necessary, can be legally forced by the authorities, and may be implemented at individual or community levels. The home quarantine, when scientifically and adequately applied and exercised according to covid-19 principles, guidelines, protocols and practices, can be quite effective for preventing the spread of covid-19 diseases. Globally, many countries have imposed a lockdown, quarantine period for over several days to months for this purpose. There are great economic concerns as well as question on the effectiveness and risks of long-term implementation of a lock-down and or quarantine. Keeping in view the rapid spread of COVID-19 cases and rise in mortality and morbidity in Bihar, the present study aimed to investigate the impact of lockdowns for 13 days before, first and second 13 days during lockdown and 13 days afterward on international epidemiological trends in the prevalence and mortality of COVID-19 cases.

Materials and methodology
It’s a novel qualitative and quantitative (mixed) intervention (i.e. lockdown) research study. The present observational study was conducted by the author during the period of May–June 2021. The data on the trends in the incidence, prevalence and mortality due to COVID-19 outbreak in Bihar were collected on daily basis from Health Department, Bihar as well as Ministry of Health and Family Welfare, Government of India also matched with online sources available in Google search. The daily reports on COVID-19 published by the Health Department, Bihar as well as Ministry of Health and Family Welfare, Government of India through website, twitter etc. were care-fully reviewed and data were collected. The lockdown data were obtained time to time from concerned authorities. The population data of Bihar was obtained from the census2011 publications. Data of all the 38 districts of Bihar have been collected and analysed as well as calculation for incidence, prevalence and mortality was done and presented as table (see table 1,2,3,4,5,6,7,8,9,10,11 and Figure / chart 1) and chart in this article.

The growth factor I considered is as a ratio equals to cases on last day of each of four observations divided by cases on the first day of observation (see table-9). A growth factor of more than 1.0 indicates an increasing pattern of prevalence, whereas values between below 1.0 show a declining pattern. A positive growth factor indicates exponential growth in the number of cases and a negative growth factor for the period indicates exponential decay in the number of new cases. A negative growth rate per observation period means an epidemic is coming under control because in that case, the number of new cases each day will be decreasing and heading in a direction toward no new cases in a day. The collected data were properly recorded and analysed because the pandemic has been changing numbers daily. I analysed the impact of lockdown on the growth factor, incidence, prevalence and mortality due to COVID-19 outbreak in Bihar, India by establishing an calculating-analysing association between the numbers, 13 days before, 26 days during (divided into two equal parts 13 days each, termed first 13 and second 13) and 13 days after the end of the lockdown period on 01/06/2021.

Statistical analysis
The data were recorded, calculated and analysed with Microsoft office and Stata software for analysis, and the output-results were expressed in numbers and percentages presented in tables 1,2,3,4,5,6,7,8,9,10,11. The average of confirmed new cases/new active cases/new cured cases/new death, prevalence and mortality of cases were calculated. The growth factor, by which quantity multiplies itself over time; here 13th day cases divided by cases on the first day was calculated. The statistical analysis is detailed below in table numbers A, B, C, D, and E in results section.

Results
The total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths due to covid-2019 pandemic 13 days before lockdown are presented in Table 1. The total number of laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths due to Covid-2019 pandemic 13 days before lockdown are presented in Table 2.

The impact of the lockdown on the epidemiological trends of covid-19 is presented in Tables 3, 4, 5, and 6. The epidemiological trends after lockdown are presented in tables 7 and 8. Table 9 shows the Growth Factor for Number of laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths/ Confirmed cases / Active Cases/ Cured/Discharged/ and deaths due to Covid-2019 pandemic. Table 10 presents the Prevalence/Incidence/Mortality of Number of laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths/ Confirmed cases / Active Cases/ Cured/Discharged/ and deaths due to Covid-2019 pandemic. Table 11 presents the average number of confirmed new cases/new active cases/new cured cases/new death, at 13 days before, 26 days during, and 13 days after the lockdown in Bihar, India and correlations were established.

Table 1 Bihar- Total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise  due to covid-2019 pandemic 13 days before lockdown since beginning of pandemic Table 2 Bihar- Number of laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic 13 days before lockdown Table-A-The statistical analysis (Table-A) of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic during 13 days before lockdown since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic during 13 days before lockdown is as follow: see table

'''Note:-Obs-observation, Std. Dev-standard deviation, Min-minimum, Max-maximum, Totalconfi~s-total confirmed cases, newconfirm~s- new confirm cases, newactivec~s- new active cases,'''

Summary – 13 days before lockdown Table-A

'''Variable |        Obs        Mean       Std. Dev. Min         Max'''

Totalconfi~s |     13        430249       50885.21      354281    509047

Totalactiv~s |      13       91836.69   15270.73       63747       109946

Totalcured |        13        336084.1   35883.66       288637      398558

Totaldeath |      13        2328.231    305.0162       1897          2821

Newconfirm~s | 13       12845.23     1171.347       11407       15853

Newactivec~s |  13       3947.154    2567.432      -2278         7392

New cured |       13        8822.692     2720.64         4774           13603

New death |       13       75.38462    13.40733         54               97

Detailed summary-13 days before lockdown- Table-A

Total Confirmed Cases

        Percentiles      Smallest

1%      354281         354281

5%      354281         365770

10%       365770         378442       Obs                  13

25%       390801         390801       Sum of Wgt. 13

50%       428001                     Mean             430249

'''Largest       Std. Dev. 50885.21'''

75%       470317         470317

90%       497640         484106      Variance       2.59e+09

95%       509047         497640       Skewness       .0673399

99%       509047         509047       Kurtosis       1.767969

Total Active Cases-13 days before lockdown

           Percentiles      Smallest

1%       63747          63747

5%       63747          69869

10%        69869          76420       Obs                  13

25%        81961          81961       Sum of Wgt. 13

50%        94276                      Mean           91836.69

'''            Largest       Std. Dev.'''      15270.73

75%       105401         105401

90%       108203         107668       Variance       2.33e+08

95%       109946         108203       Skewness      -.4785806                                                                              Table-A

99%       109946         109946       Kurtosis        2.00337

Total Cured-13 days before lockdown                                                                                             Table-A

       Percentiles      Smallest

1%      288637         288637

5%      288637         293945

10%       293945         300012       Obs                  13

25%       306753         306753       Sum of Wgt. 13

50%       331418                      Mean           336084.1

'''            Largest       Std. Dev. 35883.66'''

75%       362356         362356

90%       384955         373261       Variance       1.29e+09

95%       398558         384955       Skewness       .3140853

99%       398558         398558       Kurtosis        1.86663

  Total Death-13 days before lockdown

Percentiles      Smallest

1%        1897           1897

5%        1897           1956

10%         1956           2010       Obs                  13

25%         2087           2087       Sum of Wgt. 13

50%         2307                      Mean           2328.231

'''     Largest       Std. Dev. 305.0162'''

75%         2560           2560

90%         2739           2642      Variance       93034.86                      Table-A

95%         2821           2739       Skewness        .157749

99%         2821           2821       Kurtosis       1.762751

New Confirmed Cases-13 days before lockdown                                                                          Table-A

     Percentiles      Smallest

1%       11407          11407

5%       11407          11489

10%        11489          11801       Obs                  13

25%        12222          12222       Sum of Wgt. 13

50%        12672                      Mean          12845.23

'''Largest       Std. Dev. 1171.347'''

75%        13374          13374

90%        13789          13534       Variance        1372054

95%        15853          13789       Skewness       1.163319

99%        15853          15853       Kurtosis       4.412122

New Active Cases-13 days before lockdown

     Percentiles      Smallest

1%       -2278          -2278

5%       -2278           1743

10%         1743           2074       Obs                  13

25%         2506           2506      Sum of Wgt. 13

50%         4579                      Mean           3947.154

'''        Largest       Std. Dev. 2567.432'''

75%         5541           5541

90%         6551           6122       Variance        6591705                     Table-A

95%         7392           6551       Skewness      -.9610262

99%         7392           7392       Kurtosis       3.661296

New Cured-13 days before lockdown                                                                                      Table-A

     Percentiles      Smallest

1%        4774           4774

5%        4774           5308

10%         5308           6067       Obs                  13

25%         6741           6741       Sum of Wgt. 13

50%         8818                      Mean           8822.692

'''       Largest      Std. Dev. 2720.64'''

75%        10926          10926

90%        11694          11194       Variance        7401884

95%        13603          11694       Skewness       .0947236

99%        13603          13603       Kurtosis       1.913701

New Death-13 days before lockdown

     Percentiles      Smallest

1%          54             54

5%          54             56

10%           56             59       Obs                  13

25%           67             67       Sum of Wgt. 13

50%           80                      Mean          75.38462

'''Largest       Std. Dev. 13.40733'''

75%           84             84

90%           89             85       Variance       179.7564      Table-A

95%           97             89       Skewness      -.2742626

99%           97            97       Kurtosis       1.959424

Table statistical analysis- total confirmed cases, total active cases, total cured, totaldeath, new confirmed cases, new active cases, newcured, new death, statistics ( mean max range var count min sd cv )- 13 days before lockdown

stats | totalc~s  totala~s  totalc~d totald~h  newcon~s  newact~s newcured  newdeath                    Table-A

mean | 430249 91836.69  336084.1  2328.231 12845.23  3947.154  8822.692 75.38462

max |   509047  109946     398558     2821        15853     7392         13603       97

range | 154766  46199        109921      924         4446     9670            8829       43

variance |  2.59e+09  2.33e+08 1.29e+09  93034.86   1372054  6591705   7401884  179.7564

N |        13        13               13             13          13           13             13            13

min |    354281     63747   288637      1897       11407     -2278         4774       54

sd |     50885.21 15270.73  35883.66  305.0162 1171.347  2567.432   2720.64 13.40733

cv | .1182692  .1662813  .1067699 .1310077  .0911893  .6504514 .3083685  .1778523

tab stat, total confirmed cases, total active cases, total cured, totaldeath, new confirmed cases, new active cases, newcured, new death, statistics ( se mean kurtosis iqr p25 skewness median p1 p99 )- 13 days before lockdown

stats |      totalc~s  totala~s totalc~d  totald~h  newcon~s newact~s  newcured  newdeath

se(mean) |  14113.02  4235.338 9952.337  84.59626  324.8732 712.0774  754.5699  3.718523

kurtosis |  1.767969   2.00337  1.86663  1.762751  4.412122 3.661296  1.913701  1.959424

iqr |    79516        23440      55603      473        1152         3035         4185        17

p25 |   390801     81961      306753      2087    12222         2506         6741       67

skewness |  .0673399 -.4785806  .3140853  .157749  1.163319 -.9610262  .0947236 -.2742626

p50 |      428001     94276     331418       2307    1 2672       4579            8818       80

p1 |      354281      63747     288637     1897     11407        -2278            4774       54

p99 |   509047       109946   398558      2821     15853         7392           13603       97    Table-A

Table 3 Bihar- Total Number of laboratory-Confirmed cases / Active Cases/ Cured/Discharged/ and deaths date wise due to Covid-2019 pandemic-first 13 days of lockdown since beginning of pandemic Table 4 Bihar- Number of laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic-first 13 days of lockdown The statistical analysis of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic during first 13 days of lockdown since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic during first 13 days of lockdown is as follow: Table-B Summary of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic during first 13 days of lockdown since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic during first 13 days of lockdown is as follow:

'''   Variable |        Obs        Mean   Std. Dev. Min        Max'''

totalconfi~s |         13   595498.3     40585.3     523841    651909

totalactiv~s |         13   102939.9    12555.59      75090    115152

  totalcured |         13   489205.6    51351.34     410484    572987

  totaldeath |         13   3352.769    281.7023       2926       3832

newconfirm~s |         13   10989.38    4292.763          0     15126

newactivec~s |         13       -2506   4572.906     -13791       3049

   newcured |         13   13417.62    5970.299          0     28471

   newdeath |         13   77.76923    33.08613          0        150

detailed statistical analysis of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic during first 13 days of lockdown since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic during first 13 days of lockdown is as follow: Table-B

                   Total Confirmed Cases

     Percentiles      Smallest

1%      523841         523841

5%      523841         538677

10%       538677         553803       Obs                  13

'''25%       567269         567269      Sum of Wgt. 13                                                Table-B'''

50%       601650                      Mean           595498.3

'''                       Largest       Std. Dev. 40585.3'''

75%       622433         622433

90%       645015         630185       Variance       1.65e+09

95%       651909         645015       Skewness      -.3413298

99%       651909         651909       Kurtosis       1.970721

                    Total Active Cases

     Percentiles      Smallest

1%       75090          75090

5%       75090          82487

10%        82487          96278       Obs                  13

'''25%        99624          99624       Sum of Wgt. 13'''

50%       105104                      Mean           102939.9

'''   Largest       Std. Dev. 12555.59'''

75%       112977         112977

90%       115067         113480       Variance       1.58e+08

95%       115152         115067       Skewness      -1.043925      Table-B

99%       115152         115152       Kurtosis       3.095616

                        Total Cured

     Percentiles      Smallest

1%      410484         410484

5%      410484         422210

10%       422210         435574       Obs                  13

'''25%       449063         449063       Sum of Wgt. 13                                                    Table-B'''

50%       493189                      Mean           489205.6

'''    Largest       Std. Dev. 51351.34'''

75%       519306         519306

90%       558785         530314       Variance       2.64e+09

95%       572987         558785       Skewness      .0189448

99%       572987         572987       Kurtosis       1.910434

                        Total Death

     Percentiles      Smallest

1%        2926           2926

5%        2926           2987

10%         2987           3077       Obs                 13

'''25%         3139           3139       Sum of Wgt. 13'''

50%         3357                      Mean           3352.769

'''   Largest      Std. Dev. 281.7023'''

75%         3503           3503

90%         3743           3593       Variance       79356.19

95%         3832           3743       Skewness       .1171762                Table-B

99%         3832           3832       Kurtosis        2.00191

                    New Confirmed Cases

     Percentiles      Smallest

1%           0              0

5%           0           6894

10%         6894           7752       Obs                  13

'''25%         9863           9863       Sum of Wgt. 13                                                           Table-B'''

50%        11259                      Mean           10989.38

'''  Largest      Std. Dev. 4292.763'''

75%        14794          14794

90%        14836          14830       Variance       1.84e+07

95%        15126          14836       Skewness      -1.282402

99%        15126          15126       Kurtosis       4.245312

                     New Active Cases

     Percentiles      Smallest

1%      -13791         -13791

5%      -13791          -7397

10%        -7397          -5701       Obs                  13

'''25%        -3346          -3346       Sum of Wgt. 13'''

50%        -2172                      Mean              -2506

'''  Largest      Std. Dev. 4572.906'''

75%            0              0

90%         2763           1672       Variance       2.09e+07

95%         3049           2763       Skewness      -1.058352                                                              Table-B

99%         3049           3049       Kurtosis       3.921874

   New Cured

     Percentiles      Smallest

1%           0              0

5%           0          11008

10%        11008          11726       Obs                  13

'''25%        11926          11926      Sum of Wgt. 13                                                          Table-B'''

50%        13364                      Mean           13417.62

''' Largest      Std. Dev. 5970.299'''

75%        14202          14202

90%        15800          14962       Variance       3.56e+07

95%        28471          15800       Skewness       .4033586

99%        28471          28471       Kurtosis       5.957854

                         New Death

     Percentiles      Smallest

1%           0              0

5%           0             61

10%           61             62       Obs                  13

'''25%           67             67       Sum of Wgt. 13'''

50%           75                      Mean           77.76923

'''  Largest      Std. Dev. 33.08613'''

75%           90             90

90%          105             90       Variance       1094.692

95%          150            105       Skewness      -.1877358                         Table-B

99%          150            150       Kurtosis       4.864022

tab stat, total confirmed cases, total active cases, total cured, totaldeath, new confirmed cases, new active cases, newcured, new death, statistics ( mean sum mean mean count mean mean mean ) of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic during first 13 days of lockdown since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic during first 13 days of lockdown is as follow:

  stats |   totalc~s totala~s  totalc~d  totald~h newcon~s  newact~s  newcured newdeath

   mean | 595498.3  102939.9  489205.6 3352.769  10989.38     -2506 13417.62  77.76923

    sum |  7741478   1338219   6359673    43586    142862        -32578   174429      1011                Table-B

   mean | 595498.3  102939.9  489205.6 3352.769  10989.38     -2506 13417.62  77.76923

   mean | 595498.3  102939.9  489205.6 3352.769  10989.38     -2506 13417.62  77.76923

      N |        13             13          13           13               13              13        13             13

   mean | 595498.3  102939.9  489205.6 3352.769  10989.38     -2506 13417.62  77.76923

   mean | 595498.3  102939.9  489205.6 3352.769  10989.38     -2506 13417.62  77.76923

   mean | 595498.3  102939.9  489205.6 3352.769  10989.38     -2506 13417.62  77.76923

tab stat, total confirmed cases, total active cases, total cured, totaldeath, new confirmed cases, new active cases, newcured, new death, statistics ( mean sum min sd count max range var ) of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic during first 13 days of lockdown since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic during first 13 days of lockdown is as follow:

  stats | totalc~s  totala~s  totalc~d totald~h  newcon~s  newact~s newcured  newdeath

   mean | 595498.3  102939.9  489205.6 3352.769  10989.38     -2506 13417.62  77.76923

    sum |  7741478   1338219   6359673    43586    142862       -32578   174429      1011

    min |   523841     75090   410484          2926        0             -13791         0            0

     sd |  40585.3  12555.59  51351.34 281.7023  4292.763  4572.906 5970.299  33.08613

      N |        13        13            13               13           13            13             13           13

    max |   651909    115152    572987     3832     15126         3049         28471      150

  range |   128068     40062    162503      906     15126         16840    28471       150                      Table-B

variance |  1.65e+09 1.58e+08  2.64e+09  79356.19 1.84e+07  2.09e+07  3.56e+07 1094.692

. tab stat, total confirmed cases, total active cases, total cured, totaldeath, new confirmed cases, new active cases, newcured, new death, statistics ( cv skewness median p1 semean kurtosis iqr p99 ) of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic during first 13 days of lockdown since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic during first 13 days of lockdown is as follow: cv-coefficient of variance, se-standard error,

Table-B

  stats | totalc~s  totala~s  totalc~d totald~h  newcon~s  newact~s newcured  newdeath

     cv | .0681535  .1219701  .1049688 .0840208  .3906282 -1.824783  .4449598 .4254399

skewness | -.3413298 -1.043925  .0189448  .1171762 -1.282402 -1.058352  .4033586 -.1877358

    p50 |   601650    105104    493189     3357       11259      -2172          13364             75

     p1 |   523841     75090    410484     2926              0        -13791               0              0

se(mean) |  11256.34  3482.294  14242.3  78.13016  1190.598 1268.296  1655.863  9.176443

kurtosis |  1.970721 3.095616  1.910434   2.00191 4.245312  3.921874  5.957854 4.864022

    iqr |    55164         13353    70243           364     4931           3346        2276           23

    p99 |   651909    115152    572987        3832    15126         3049        28471       150

Table 5 Bihar- Total Number of laboratory-Confirmed cases / Active Cases/ Cured/Discharged/ and deaths date wise due to Covid-2019 pandemic-second 13 days of lockdown since beginning of pandemic Table 6 Bihar- Number of laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic-second 13 days of lockdown

The statistical analysis of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic during second 13 days of lockdown since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic during second 13 days of lockdown is as follow: Table-C

Summary of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic during second 13 days of lockdown since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic during second 13 days of lockdown is as follow:

'''   Variable |        Obs        Mean   Std. Dev. Min        Max                                                     Table-C'''

totalconfi~s |         13     686285    15500.33     657829    705648

totalactiv~s |         13   42638.77    16161.98      18378     69698

  totalcured |         13   639106.8    31211.22     584203    682166

  totaldeath |         13   4539.462    388.4962       3928       5104

newconfirm~s |         13   4133.769    1597.186       1475       6286

newactivec~s |         13  -4362.462    1447.106      -7363     -2545

   newcured |         13   8398.385    2677.519       4130       12043

   newdeath |         13   97.84615    14.75831         52          111

. tab stat, total confirmed cases, total active cases, total cured, totaldeath, new confirmed cases, new active cases, newcured, new death, statistics ( mean sum min sd count max range var ) of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic during second 13 days of lockdown since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic during second 13 days of lockdown is as follow:

  stats | totalc~s  totala~s  totalc~d totald~h  newcon~s  newact~s newcured  newdeath

   mean |    686285  42638.77 639106.8  4539.462  4133.769 -4362.462  8398.385 97.84615

    sum |  8921705    554304   8308388    59013     53739    -56712        109179     1272

    min |   657829     18378     584203       3928       1475     -7363           4130        52

     sd | 15500.33  16161.98  31211.22 388.4962  1597.186  1447.106 2677.519  14.75831

      N |        13         13            13             13           13         13                13            13

    max |   705648     69698    682166     5104      6286        -2545       12043        111

  range |    47819     51320     97963     1176        4811       4818         7913          59

variance |  2.40e+08 2.61e+08  9.74e+08  150929.3  2551004   2094115   7169109 217.8077

. tab stat, total confirmed cases, total active cases, total cured, totaldeath, new confirmed cases, new active cases, newcured, new death, statistics ( cv skewness median p1 semean kurtosis iqr p99 ) of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic during second 13 days of lockdown since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic during second 13 days of lockdown is as follow:

  stats | totalc~s  totala~s  totalc~d totald~h  newcon~s  newact~s newcured  newdeath                 Table-C

      cv |  .0225859  .3790442 .0488357   .085582  .3863753 -.3317177  .3188136 .1508318

skewness | -.4743759  .1499369 -.3199312 -.0490504  -.009441 -.4412226 -.2198114  -2.46753

    p50 |   689576      40692      644335        4549        4002        -4216        8676         99

     p1 |   657829     18378    584203          3928         1475      -7363           4130       52

se(mean) |  4299.019 4482.526  8656.435  107.7494 442.9797   401.355  742.6102 4.093219

kurtosis |  2.025863 1.963662  1.975774  1.762036 1.676102  2.521116  1.599268 8.514757

    iqr |    22284         23414      45094       604           3027     2282           4515        6

    p99 |   705648     69698       682166     5104          6286    -2545          12043      111

Table 7 Bihar- Total Number of laboratory-Confirmed cases / Active Cases/ Cured/Discharged/ and deaths date wise due to Covid-2019 pandemic-first 13 days after lockdown since beginning of pandemic Table 8 Bihar- Number of laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic- first 13 days after lockdown The statistical analysis of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic during first 13 days after lockdown since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic during first 13 days after lockdown is as follow: Table-D

Summary of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic during first 13 days after lockdown since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic during first 13 days after lockdown is as follow:

'''   Variable |        Obs        Mean   Std. Dev. Min        Max'''

totalconfi~s |         13   713334.5    3017.647     707935    717215                                 Table-D

totalactiv~s |         13   8401.231    3129.753       4516     14251

  totalcured |         13   698007.8    4505.924     688462    702411

  totaldeath |         13   6925.462    2090.263       5222       9492

newconfirm~s |         13   889.7692    485.2812        432       2287                                  Table-D

newactivec~s |         13  -1005.077     1387.21      -4127        552

   newcured |         13   1557.308    1695.272          0       6296

   newdeath |         13   337.5385    1092.067          8       3971

. tab stat, total confirmed cases, total active cases, total cured, totaldeath, new confirmed cases, new active cases, newcured, new death, statistics ( mean sum min sd count max range var ) of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic during first 13 days after lockdown since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic during first 13 days after lockdown is as follow:

  stats | totalc~s  totala~s  totalc~d totald~h  newcon~s  newact~s newcured  newdeath

   mean | 713334.5  8401.231  698007.8 6925.462  889.7692 -1005.077  1557.308 337.5385

    sum |  9273348    109216   9074101    90031     11567       -13066      20245     4388

    min |   707935      4516       688462     5222       432           -4127           0            8

     sd | 3017.647  3129.753  4505.924 2090.263  485.2812   1387.21 1695.272  1092.067

      N |        13        13              13            13              13           13            13             13

    max |   717215     14251    702411     9492      2287           552          6296       3971

  range |     9280      9735     13949       4270     1855            4679        6296     3963

variance |   9106195  9795356  2.03e+07   4369198 235497.9   1924351   2873947  1192610

tab stat, total confirmed cases, total active cases, total cured, totaldeath, new confirmed cases, new active cases, newcured, new death, statistics ( cv skewness iqr p50 semean kurtosis p1 p99 ) of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic during first 13 days after lockdown since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic during first 13 days after lockdown is as follow:

  stats | totalc~s  totala~s  totalc~d totald~h  newcon~s  newact~s  newcured newdeath

     cv | .0042303  .3725351  .0064554 .3018229  .5454012 -1.380203  1.088591 3.235384

skewness |  -.411078 .4031437 -.9606283  .4719014  1.890376 -1.126724  1.688896 3.171883

    iqr |        4540       4713         5672        4133         441         827           1781          22

    p50 |    713879      8231      700224      5424          762        -681           1196       28

se(mean) |  836.9448 868.0374  1249.719  579.7346 134.5928  384.7428  470.1838 302.8848

kurtosis |  1.934036  2.01356  2.597036   1.22643 6.385639  3.424112  5.761439 11.06952

     p1 |     707935     4516       688462     5222         432         -4127           0             8

    p99 |   717215     14251    702411        9492     2287          552           6296     3971                    Table-D

The statistical analysis from first 13 days before lockdown upto first 13 days (total 52 days observation) after lockdown of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic is as follow: Table-E

Summary first 13 days before lockdown upto first 13 days (total 52 days observation) after lockdown of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic

'''   Variable |        Obs        Mean   Std. Dev. Min        Max                                                    Table-E'''

totalconfi~s |         52   606341.7    116347.2     354281    717215

totalactiv~s |         52   61454.15    40465.07       4516    115152

  totalcured |         52   540601.1    145882.3     288637    702411

  totaldeath |         52   4286.481    2023.695       1897       9492

newconfirm~s |         52   7214.538     5444.66          0     15853

newactivec~s |         52  -981.5962    4137.047     -13791       7392

   newcured |         52        8049    5546.55          0      28471

   newdeath |         52   147.1346    541.6311          0       3971

tab stat, total confirmed cases, total active cases, total cured, totaldeath, new confirmed cases, new active cases, newcured, new death, statistics ( mean sum min sd count max range var ) first 13 days before lockdown upto first 13 days (total 52 days observation) after lockdown of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic

  stats | totalc~s  totala~s  totalc~d totald~h  newcon~s  newact~s newcured  newdeath

   mean | 606341.7  61454.15  540601.1 4286.481  7214.538 -981.5962      8049 147.1346

    sum | 3.15e+07   3195616  2.81e+07   222897    375156    -51043   418548      7651

    min |   354281      4516    288637         1897        0             -13791        0         0                               Table-E

     sd | 116347.2  40465.07  145882.3 2023.695   5444.66  4137.047  5546.55  541.6311

      N |        52          52            52           52              52           52              52           52

    max |   717215    115152    702411     9492     15853      7392        28471         3971

  range |   362934    110636    413774     7595     15853     21183    28471      3971

variance |  1.35e+10 1.64e+09  2.13e+10   4095340 2.96e+07  1.71e+07  3.08e+07 293364.2

tab stat, total confirmed cases, total active cases, total cured, totaldeath, new confirmed cases, new active cases, newcured, new death, statistics ( cv skewness median p1 semean kurtosis iqr p99 ) first 13 days before lockdown upto first 13 days (total 52 days observation) after lockdown of total number of laboratory-confirmed cases / active cases/ cured/discharged/ and deaths date wise due to covid-2019 pandemic since beginning of pandemic & laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths per day date wise due to Covid-2019 pandemic

  stats | totalc~s  totala~s  totalc~d totald~h  newcon~s  newact~s newcured  newdeath

     cv | .1918838  .6584594  .2698521  .472111  .7546789 -4.214612   .689098 3.681194

skewness | -.8165001 -.1422879 -.3861551  1.404477  .0798102 -.1763979  .7000481 6.962723

    p50 |       654869      67198.5   578595      3880         6172.5     -1141       8393.5     78.5

     p1 |        354281      4516       288637      1897            0          -13791         0               0

se(mean) |  16134.45 5611.495  20230.24   280.636 755.0385  573.7052  769.1681 75.11072

kurtosis |   2.26633 1.450324  1.639856  4.574773 1.389889  3.470068   4.69367 49.66685

    iqr |       190347.5  83908.5    280793    2289.5     11321.5     5663      8259         45

    p99 |     717215    115152     702411      9492    15853          7392    28471      3971                          Table-E

Table 9 Bihar-Growth Factor- Number of laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths/ Confirmed cases / Active Cases/ Cured/Discharged/ and deaths due to Covid-2019 pandemic Table 10 Bihar- Prevalence/Incidence/Mortality - Number of laboratory-Confirmed New cases / New Active Cases/ New Cured/ New Discharged/ and New deaths/ Confirmed cases / Active Cases/ Cured/Discharged/ and deaths due to Covid-2019 pandemic

Table 11- Average of confirmed new cases/new active cases/new cured cases/new death The average calculation shows that majority of these coronavirus new cases/new active cases/new discharged cases, was reported during the period 13 days before lockdown whereas average maximum new death were reported  during 13 day period after lockdown(Table 11).

Regarding the impact of lockdown on the prevalence and mortality of the COVID-19 outbreak in Bihar, India, I found that 13  days after the lockdown there was no decline in the mean prevalence and the mean number

of daily deaths due to COVID-19 compared to 13  days before and 13 days during the lockdown (Tables 10). However, the growth rate in the number of new daily cases of COVID-19 per 13 day (table9) and growth rate in the

number of new deaths per13 day attributed to COVID-19 each showed a positive but falling trend 13 days

after the lockdown period in Bihar, India. This data show a negative growth factor per 13 day during the 13 days following the lockdown for new daily cases and for new deaths per day. The change in growth rates

and growth rates per 13 day are expressed as: pre-lockdown vs. lockdown and after lockdown periods. Post-lockdown time periods, there was a declining rate of change per day for most except average new death. Regarding the mean prevalence of COVID-19 cases 13 days before, 26 days during and 13 days after lockdown, I found that the mean numbers of cases increased and there was no important impact of lockdown on the prevalence of COVID-19 cases (Tables 10). I calculated growth rate for new cases of COVID-19. The mean growth rate for number of new cases on a 13day basis was 0.21294272 and for new mortality rate was 0.06779661(table 9). It was found that, 13 days after the lockdown, the growth factor of the number of new daily cases decreased and the growth factor of new daily deaths was increased after the lockdown period (table 9). There is continuous decrease in Incidence/100000/ confirmed new cases, Incidence /100000/ confirmed new active cases, Incidence /100000/ new discharged cases, Prevalence/100000/active cases from beginning of pandemic during the period of observation while the other parameters have shown an increase during the observation periods (see table 9).

Discussion
The COVID-19 pandemic is a major public health problem which has infected millions of people worldwide. The idea of lockdown is associated with the incubation period of COVID-19, which is from 1-14 days (3). The lockdown methods have been implemented in many countries to control the spread of COVID-19 when other measures fail to achieve desired effect. For keeping an epidemic under control we must first control the rate of growth per day to become negative. In this study, I observed the impact of lockdown 13  days before(for comparison), two period of 13 days during and 13 days after(for comparison) lockdown on the epidemiological basis in the growth factor, incidence, prevalence and mortality because of the outbreak of novel coronavirus SARS-COV-2 in Bihar, India. I observed that 13 days after the Bihar  lockdown there was no significant decline in the mean prevalence and mean mortality rate due to COVID-19 compared to 13 days before and 13-13(two observation) days during the lockdown in Bihar, India. However, daily cases of COVID-19 and growth rates showed declining trends by the end

of the lockdown and after the lockdown period, leading to a critically important negative growth rate by end of the lockdown period for both new daily cases. This negative growth rate per day shows that from a public health perspective, the lockdown had a positive effect on the pandemic. However, the growth rate never fell immediately following the lockdown and moreover lockdown cannot be enforced for a longer time due to economic and various other reasons of public concern, so the lockdown is not the only way to control the pandemic. However when all measures fail the government is forced to impose new lockdowns and encourage residents to isolate themselves in their houses for saving lives.

Through this article I recommend that along with other public health measures, lockdown should be enforced at

an early stage to prevent the COVID-19 infection from spreading to a large section of population causing increased morbidity and mortality as well as overburden on the health system. The study also demonstrates evidence that

lockdown measures are consistently beneficial. My study observation showed that the lockdown was beneficial in decreasing the rate of growth. The concept of a lockdown is theoretically very attractive because it minimizes the number of people exposed to contagious patients and therefore fewer people will be susceptible to getting infected but practically in poor states like Bihar it’s like a tragedy for people who are not able to afford food if they are not getting works on daily basis.

A lockdown may play a significant role when vaccination or prophylactic treatment is not available, as seen in

the case with COVID-19 pandemic. In this research, I observed and analysed the impact of 13 days before 26 days during and 13 days after lockdown on the prevalence and other epidemiology of COVID-19 cases in Bihar, India. My study findings support hypothesis that lockdown will significantly decrease the number of cases.

I have done this study in a different way and new people in public health may have little problem in understanding my observations. In many countries especially the developing countries long-term lockdown is not sustainable and practically possible as it has various mental, social, psychological and economic impacts. Future lockdown strategy should think of optimizing behavior, health promotion such as social distancing and mask wearing associated with social and cultural factors that can help in controlling the COVID-19 pandemic, because lockdown alone will not be effective if people will not adhere to this policy.

Study strength and limitation
This is the first article in the literature, to my knowledge, that have investigated the impact of a lockdown on

epidemiological trends of prevalence and mortality of the COVID-19 pandemic in Bihar, India. During the COVID-19 pandemic, to date, several mathematical modelling-based reviews/articles have been published to hypothesize the impact of a lockdown on the prevalence of COVID-19 cases. This is the first study, which analysed the impact of 13 days before, 13-13 days during and 13  days after lockdown on the prevalence trends of COVID-19 in Bihar especially point prevalence.

One of the peculiar strength is that the study data were gathered using reliable accredited sources including Government Health Department. I have analysed the growth factor and the growth rate per 13 day, which are

exceptional and totally new my idea to determine the epidemiological trends of a pandemic. A limitation is that I am unable to investigate confounding factors and bias such as how much people varies in: (1) adherence to lockdown, (2) adoption of protocols and guidelines of social distancing, (3) practice of health hygienic guidelines and (4) experience disease testing systems of nearest health centres.

Conclusion
My research shows that 13 days after lockdown there was no significant decline in the mean prevalence and mean mortality rate due to novel coronavirus SARS-COV 2 compared to 13  days before and 13-13  days during the lockdown in Bihar, India. '''The study found that daily cases of SARS-COV-2 patients, and the growth factor results declined and the growth rate per day both declined to an impressive negative level in the case of the growth rate. The Bihar model of lockdown is of significance in reducing the daily new cases as well as it''' was found that, 13 days after the lockdown, the growth factor of the number of new daily cases decreased and the growth factor of new daily deaths was increased after the lockdown period (table 9).

These findings may be useful for policy-makers who are thinking of further lockdowns to control the spread of the COVID-19 pandemic. Future lockdown policies should better work for optimizing health behaviour like social distancing and mask wearing associated with cultural factors that can halt spreading the COVID-19 pandemic, because lockdown will not be effective if people will not adhere to this policy, guidelines and protocols added with negative impacts of lockdown on livelihood in poor states like Bihar.

Declarations
-This paper has not been previously published and is not currently under consideration by another journal. The document is Microsoft word with English (United States) language & 8823 words Total.

- Ethics approval and consent to participate: Not applicable. This study has not involved any human or animals in real or for experiments. The data on the prevalence and mortality due to COVID-19 pandemic were taken from the Health Department, Bihar and other organizations which are also available online, hence ethical approval was not required.

-Consent for publication: Not applicable

-Availability of data and materials: The data & materials for study are mentioned in article and available as reference.

-Conflicts of Interest/ Competing Interest: There are no conflicts / competing of interest

- Funding-Self sponsored. No aid taken from individual or agency etc.

- Authors' contributions: The whole work is solely done by the Author - Dr Piyush Kumar, M.B.B.S. - Sri Krishna Medical College, EMOC- General Medical Officer- Bihar Health Services- Government of Bihar, India.

- Acknowledgements- I am thankful to Advocate Anupama my wife and daughters Aathmika and Atheeva for cooperation.

- Author information: The author is currently working as general medical officer for the government of Bihar.

-Financial Support & sponsorship: Nil

Author contact information

1 Department of Health, Government of Bihar, MOBILE - +919955301119/+917677833752,

Email drpiyush003@gmail.com

'''The article preprint is also submitted as preprint to various preprint server and preprint is having doi as well as searchable on various search engine. The article is not published in any peer reviewed journal.'''

Acknowledgements
I am thankful to Advocate Anupama my wife and daughters Aathmika and Atheeva for cooperation.

Competing interests
There are no conflicts / competing of interest

Ethics statement
Not applicable. This study has not involved any human or animals in real or for experiments. The data on the prevalence and mortality due to COVID-19 pandemic were taken from the Health Department, Bihar and other organizations which are also available online, hence ethical approval was not required.