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India imposed one of the world\'s strictest population-wide lockdown on 25 March 2020 for COVID-19. We estimated epidemiological parameters, evaluated the effect of control measures on the epidemic in India and explored strategies to exit lockdown. We obtained patient-level data to estimate the delay from onset to confirmation and the asymptomatic proportion. We estimated the basic and time-varying reproduction number (R0 and Rt)after adjusting for imported cases and delay to confirmation, using incidence data from 4 March to 25 April 2020. Using a SEIR-QDPA model, we simulated lockdown relaxation scenarios and increased testing to evaluate lockdown exit strategies. R0 for India was estimated to be 2·08 while the Rt decreased from 1·67 on 30 March to 1·16 on 22 April. We observed that the delay from date of lockdown relaxation to start of second wave increases as lockdown is extended farther after the first wave peak- this delay is longer if lockdown is relaxed gradually. Aggressive measures like lockdowns may be inherently enough to suppress an outbreak, however other measures need to be scaled up as lockdowns are relaxed. Lower levels of social distancing when coupled with a testing ramp-up, could achieve similar outbreak control as an aggressive social distancing regime where testing was not increased.
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Transmission dynamics of the COVID-19 epidemic in India and modelling optimal lockdown exit strategies
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