Background and aims The impact of measures taken to contain COVID-19 on lifestyle-related behaviour is undefined in Indian population. The current study was undertaken to assess the impact of COVID-19 on lifestyle-related behaviours: eating, physical activity and sleep behaviour. Methods The study is a cross-sectional web-based survey. A validated questionnaire to assess the changes in lifestyle-related behaviour was administered on adults across India using a Google online survey platform. Results A total of 995 responses (58.5% male, mean age 33.3 years) were collected. An improvement in healthy meal consumption pattern and a restriction of unhealthy food items was observed, especially in the younger population (age <30 years). A reduction in physical activity coupled with an increase in daily screen time was found especially among men and in upper-socio-economic strata. Quarantine induced stress and anxiety showed an increase by a unit in nearly one-fourth of the participants. Conclusions COVID-19 marginally improved the eating behaviour, yet one-third of participants gained weight as physical activity declined significantly coupled with an increase in screen and sitting time. Mental health was also adversely affected. A detailed understanding of these factors can help to develop interventions to mitigate the negative lifestyle behaviours that have manifested during COVID-19.

India imposed one of the world's strictest population-wide lockdowns on March 25, 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 (R 0 and R t ) after adjusting for imported cases and delay to confirmation using incidence data from March 4 to April 25, 2020. Using a SEIR-QDPA model, we simulated lockdown relaxation scenarios and increased testing to evaluate lockdown exit strategies. R 0 for India was estimated to be 2Á08, and the R t decreased from 1Á67 on March 30 to 1Á16 on April 22. We observed that the delay from the date of lockdown relaxation to the start of the second wave increases as lockdown is extended farther after the first wave peak-this delay is longer if lockdown is relaxed gradually.Aggressive measures such as 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.

Background and aims There seems to be hesitation in the general population in accepting COVID 19 vaccine because of associated myths and/or misinformation. This study is dedicated to develop and validate a tool to interpret vaccine acceptance and/or hesitancy by assessing the knowledge, attitude, practices, and concerns regarding the COVID vaccine. Material and methods Mixed methods study design was used. In phase 1, the questionnaire was developed through literature review, focus group discussion, expert evaluation, and pre-testing. In phase 2, the validity of the questionnaire was obtained by conducting a cross-sectional survey on 201 participants. The construct validity was established via principal component analysis. Cronbach's alpha value was used to assess the reliability of the questionnaire. Results The 39-item questionnaire to assess the knowledge, attitude, practices, and concerns regarding the COVID-19 vaccine was developed. The Cronbach's alpha value of the questionnaire was 0.86 suggesting a good internal consistency. Conclusion The developed tool is valid to assess the knowledge, attitude, practices and concerns regarding the COVID-19 vaccine acceptance and/or hesitancy. It has the potential utility for healthcare workers and government authorities to further build vaccine literacy.

Background: After SARS-CoV-2 set foot in India, the Government took a number of steps to limit the spread of the virus in the country. This included restricted testing, isolation, contact tracing and quarantine, and enforcement of a nation-wide lockdown starting 25 March 2020. The objectives of this study were to i) describe the age, gender distribution, and mortality among COVID-19 patients identified till 14 April 2020 and predict the range of contact rate; and ii) predict the number of  COVID-19 infections after 40 days of lockdown. Methods: We used a cross-sectional descriptive design for the first objective and a susceptible-infected-removed model for in silico predictions. We collected data from government-controlled and crowdsourced websites. Results: Studying age and gender parameters of 1161 Indian COVID-19 patients, the median age was 38 years (IQR, 27-52) with 20-39 year-old males being the most affected group. The number of affected patients were 854 (73.6%) men and 307 (26.4%) women. If the current contact rate continues (0.25-27), India may have 110460 to 220575 infected persons at the end of 40 days lockdown. Conclusion: The disease is majorly affecting a younger age group in India. Interventions have been helpful in preventing the worst-case scenario in India but will be unable to prevent the spike in the number of cases.

Background India has experienced the second largest outbreak of COVID-19 globally, yet there is a paucity of studies analysing contact tracing data in the region which can optimise public health interventions (PHI’s). Methods We analysed contact tracing data from Karnataka, India between 9 March and 21 July 2020. We estimated metrics of transmission including the reproduction number (R), overdispersion (k), secondary attack rate (SAR), and serial interval. R and k were jointly estimated using a Bayesian Markov Chain Monte Carlo approach. We studied determinants of risk of further transmission and risk of being symptomatic using Poisson regression models. Findings Up to 21 July 2020, we found 111 index cases that crossed the super-spreading threshold of ≥8 secondary cases. Among 956 confirmed traced cases, 8.7% of index cases had 14.4% of contacts but caused 80% of all secondary cases. Among 16715 contacts, overall SAR was 3.6% [95% CI, 3.4–3.9] and symptomatic cases were more infectious than asymptomatic cases (SAR 7.7% vs 2.0%; aRR 3.63 [3.04–4.34]). As compared to infectors aged 19–44 years, children were less infectious (aRR 0.21 [0.07–0.66] for 0–5 years and 0.47 [0.32–0.68] for 6–18 years). Infectors who were confirmed ≥4 days after symptom onset were associated with higher infectiousness (aRR 3.01 [2.11–4.31]). As compared to asymptomatic cases, symptomatic cases were 8.16 [3.29–20.24] times more likely to cause symptomatic infection in their secondary cases. Serial interval had a mean of 5.4 [4.4–6.4] days, and case fatality rate was 2.5% [2.4–2.7] which increased with age. Conclusion We found significant heterogeneity in the individual-level transmissibility of SARS-CoV-2 which could not be explained by the degree of heterogeneity in the underlying number of contacts. To strengthen contact tracing in over-dispersed outbreaks, testing and tracing delays should be minimised and retrospective contact tracing should be implemented. Targeted measures to reduce potential superspreading events should be implemented. Interventions aimed at children might have a relatively small impact on reducing transmission owing to their low symptomaticity and infectivity. We propose that symptomatic cases could cause a snowballing effect on clinical severity and infectiousness across transmission generations; further studies are needed to confirm this finding.

Purpose Brand communities are an increasingly important way for brands to interact with their customers, as they give brands an opportunity to learn from and interact with people with a demonstrated interest in the brand. Literature has explored the difference between lurkers and posters within these brand communities. However, there are other ways to segment members, just as there are many ways to segment customers of products and services – and this paper aims to be a step toward going beyond simple lurking vs posting behavior as a means of differentiating community members. As such, the purpose of this paper is to segment brand communities based on not only their participation behavior but also their identification with the brand community, loyalty and benefits gained from membership. Design/methodology/approach This study used a cross-sectional survey of members of various brand communities in North America. Partial least squares structural equation modeling together with finite mixture partial least squares and prediction-oriented segmentation was used to discover the distinct segments of brand community members. Findings The findings indicate that there are two distinct segments that behave differently regarding their behavior, attitudes and motives. Segment one has a stronger relationship between identification and other outcomes and is also more motivated by social enhancement than segment two. Thus, it is clear that brand community members can be segmented and served based on more than their posting behavior. Originality/value The members of brand communities have often been thought of as homogeneous. This paper is unique in identifying heterogeneity among the members of the brand community and demonstrates the need for brand community managers to identify these differences and manage the brand community accordingly.

Background: The coronavirus disease 2019 (COVID-19) has caused over 3 200 000 cases and 230 000 deaths as on 2 May 2020, and has quickly become an unprecedented global health threat. India, with its unique challenges in fighting this pandemic, imposed one of the worlds strictest and largest population-wide lockdown on 25 March 2020. Here, we estimated key epidemiological parameters and evaluated the effect of control measures on the COVID-19 epidemic in India. Through a modelling approach, we explored various strategies to exit the lockdown. Methods: We obtained data from 140 confirmed COVID-19 patients at a tertiary care hospital in India to estimate the delay from symptom onset to confirmation and the proportion of cases without symptoms. We estimated the basic reproduction number (R0) and time-varying effective reproduction number (Rt) after adjusting for imported cases and reporting lag, using incidence data from 4 March to 25 April 2020 for India. We built upon the SEIR model to account for underreporting, reporting delays, and varying asymptomatic proportion and infectivity. Using this model, we simulated lockdown relaxation under various scenarios to evaluate its effect on the second wave, and also modelled increased detection through testing. We hypothesised that increased testing after lockdown relaxation will decrease the epidemic growth enough to allow for a greater resumption of normal social mixing thus minimising the social and economic fallout. Findings: The median delay from symptom onset to confirmation (reporting lag) was estimated to be 2·68 days (95% CI 2·00−3·00) with an IQR of 2·03 days (95% CI 1·00−3·00). 60·7% of confirmed COVID-19 cases (n=140) were found to be asymptomatic. The R0 for India was estimated to be 2·083 (95% CI 2·044−2·122 ; R2 = 0·972), while the Rt gradually down trended from 1·665 (95%CI 1·539−1·789) on 30 March to 1·159 (95% CI 1·128−1·189) on 22 April. In the modelling, we observed that the time lag from date of lockdown relaxation to start of second wave increases as lockdown is extended farther after the first wave peak. This benefit was greater for a gradual relaxation as compared to a sudden lifting of lockdown. We found that increased detection through testing decreases the number of total infections and symptomatic cases, and the benefit of detecting each extra case was higher when prevailing transmission rates were higher (as when restrictions are relaxed). Lower levels of social restrictions when coupled with increased testing, could achieve similar outcomes as an aggressive social distancing regime where testing was not increased. Interpretation: The aggressive control measures in India since 25 March have produced measurable reductions in transmission, although suppression needs to be maintained to achieve sub-threshold Rt. Additional benefits for mitigating the second wave can be achieved if lockdown can be feasibly extended farther after the peak of active cases has passed. Aggressive measures like lockdowns may inherently be enough to suppress the epidemic, however other measures need to be scaled up as lockdowns are relaxed. Expanded testing is expected to play a pivotal role in the lockdown exit strategy and will determine the degree of return to normalcy that will be possible. Increased testing coverage will also ensure rapid feedback from surveillance systems regarding any resurgence in cases, so that geo-temporally targeted measures can be instituted at the earliest. Considering that asymptomatics play an undeniable role in transmission of COVID-19, it may be prudent to reduce the dependence on presence of symptoms for implementing control strategies, behavioral changes and testing.

Case fatality rate (CFR) and doubling time are important characteristics of any epidemic. For coronavirus disease 2019 (COVID-19), wide variations in the CFR and doubling time have been noted among various countries. Early in the epidemic, CFR calculations involving all patients as denominator do not account for the hospitalised patients who are ill and will die in the future. Hence, we calculated cumulative CFR (cCFR) using only patients whose final clinical outcomes were known at a certain time point. We also estimated the daily average doubling time. Calculating CFR using this method leads to temporal stability in the fatality rates, the cCFR stabilises at different values for different countries. The possible reasons for this are an improved outcome rate by the end of the epidemic and a wider testing strategy. The United States, France, Turkey and China had high cCFR at the start due to low outcome rate. By 22 April, Germany, China and South Korea had a low cCFR. China and South Korea controlled the epidemic and achieved high doubling times. The doubling time in Russia did not cross 10 days during the study period.