AMDAVAD MUNICIPAL CORPORATION.

TITLE:

ASSESSING SEROPOSITIVITY AGAINST SARS COV2 IN AMDAVAD.

INTRODUCTION:

Being a newly identified virus, we are largely unaware of the immune response to the SARS
nCOV2 infection. Amdavad city was among the first few cities severely affected by the
spread of the pandemic. Being one of the earliest cities to witness the high case load in the
initial months of the pandemic in India, Amdavad is ideally suited to study the percentage
sero-positivity to help understand the pandemic status and predict the future situations.

AIM:

• To study the sero-positivity for Covid19 in Amdavad City

OBJECTIVES:

• To assess the level of sero-positivity for Covid19 in Amdavad city.

• To correlate the positivity with various factors for better understanding of the
pandemic situation
• To identify the status of herd immunity for valid & precise predictions for the future.

METHODOLOGY:

A field level cross sectional serological study was carried out in the city of Amdavad
covering about 30,054 samples (~0.5% of city’s population) at its 75 Urban Health Centers
across 48 wards and 7 zones from 16th June to 11th July 2020.

RESULTS:

▪ With 5263 positives out of 29891 result obtained of sero samples, the seropositivity
is 17.61%.
▪ The seropositivity among female (17.98%) was slightly higher as compared to
males (17.29%) but the difference is statistically not significant.
▪ The level of Sero-positivity in Health Workers was found 13.64% and in general
population 18.71%.
▪ The zone wise seropositivity range from 6.43% to 28.43% and closely correlate with
the case load and disease situation, Central zone with highest case load showing the
highest seropositivity of 28.43%. In other zones sero positivity is 27.42% in North
zone, 23.22% in East zone, 16.15% in South zone, 13.43% in South West zone,
10.50% in West zone, and 6.43% in North West zone.

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35

30 28.43
27.42

25 23.22
Percent Positivity

20
16.15
15 13.43
10.5
10
6.43
5

0
CZ NZ EZ SZ SWZ WZ NWZ

Figure: Zone wise sero positivity

▪ The age group wise seropositivity range between 15.49% to 22.22% and closely
correlate for both the genders.

25.00 22.22
19.86 19.55 19.28
20.00 18.21
17.35
15.88 15.55 16.35
15.49
15.00

10.00

5.00

0.00
Age group 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-100
Percent positivity

▪ UPHC wise positivity shows close association between high cases and high
positivity. However, the UPHCs with highest positivity are those with recent
increasing trend of positivity and the wards with highest case load during the very

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early phase of pandemic have comparatively low level of positivity. As compared to
all the other zones which have comparatively recent increase in cases, the Central
zone has wider gap between the cases per lakh population and positivity rate. Both
these facts may be suggestive of vanishing immunity over a long period (2-3
months) and requires further in-depth scientific research.

▪ Another important aspect is comparison of percentage positivity with per million

positive cases. It was observed that zones who were affected in initial days (South
zone and Central zone) having more cases per million population but that is not
being reflected in terms of sero positivity in the same proportion as in case of other
zones who got recent infection. Central zone having 5743 cases per million
population is having 28.43% sero positivity and South Zone having 3028 cases per
million population is having sero positivity of only 16.15% but areas of recent
infection like North Zone and East zone are having higher sero positivity (27.42%
and 23.22% respectively) with less cases per million (2649 and 1777 cases per
million population respectively) in comparison to south zone.

70
57.43
60

50

40
28.4 30.28 26.49
30 27.33 23.06
15.89 17.76 18.1 16.59
20
10.46 9.56 12.61
10 6.4

0
CZ SZ NZ EZ WZ NWZ SWZ
PERCENT POSITIVITY CASES PER 100 MILLION POPULATION

▪ The seropositivity of all the zones is higher in 2nd and 3rd week of study as compared
to the first week. The day wise positivity trend during the study period is also
showing slightly increasing trend and is suggestive of increasing seropositivity with
increasing cumulative cases.
▪ The zone & age group wise analysis shows that while the test conducted is more in
the younger age group but the test positivity is more in later age groups.
▪ The seropositivity analysis shows that among the close contacts non health care
workers (HCWs) have higher positivity as compared to the health care workers.

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Even among the health care workers, those working at the field area have higher
positivity (8.98%) as compared to HCW working at the hospitals (5.26%) suggesting
that the HCWs and that too from hospital are generally better protected with
various preventive measures and practices as compared field workers and general
population.

30
HCW non HCW
26.76
25
22.22 21.43
20 21.54
19.18
PERCENT POSITIVITY

18.09 17.65
15
12.50
11.29
10
7.69 8.42
5 6.92
5.36

0
Age group 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89
Figure: Comparison of sero positivity among health care workers and non-health care person.

▪ The positivity at the non-Covid hospital is lower than that of Covid hospital, but the
non-covid hospital with multiple known incidents of covid transmission has almost
similar rates as that of Covid hospital.

CONCLUSIONS

• This seems to be the biggest ever study conducted in the world in terms of sample
population ratio to find out sero positivity in general population. This study has
4770 samples per million population in comparison to Spanish study “Prevalence of
SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based sero
epidemiological study” where the sample population ratio was 1302 samples per
million population and US study “Seroprevalence of Antibodies to SARS-CoV-2 in Six
Sites in the United States” where the sample population ratio was 255 samples per
million population.
• The level of seropositivity of just 17.61% points that the level of immunity seen for
Covid19 is much less and a majority of the population is still susceptible.

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• Some results may be pointing towards difference in the level of positivity, which
might be indicating a vanishing protection over a period of time and that the
immunity against covid19 may not be long lasting and indicates the need for further
in-depth scientific research. Considering the level of immunity required for the
effective control of any viral disease (generally beyond 80%), the level of immunity
seen for Covid19 is much less. So, a majority of the total population has not yet
suffered from the disease and has not yet developed the immunity. Based on these
results, along with the absence of an evidence of lifelong immunity after an
infection, we can say that the herd is not immune and is still largely susceptible.
• This is study is very much in the line of the similar studies conducted in the other
part of world in the very recent past especially in the Spain, Switzerland and United
States of America and the conclusion is also the same that there is widespread
infection and countries are at constant risk. The herd is still susceptible to get new
infection so we cannot rely upon onset of the herd immunity and we have to rely
upon preventive measures till the invention of vaccine and it is made available to
large number of people.
• Some sections of media have reported about a study of ICMR showing around 49%
sero-positivity in Amdavad. This matter was taken up today with Director-General,
ICMR Dr. Balram Bhargav. He has clarified as follows: -
1. ICMR study has not been declared officially.
2. ICMR study was conducted with only 496 samples taken from containment zones
only during lockdown period in early May 2020.
3. ICMR study shows a ratio of 79 per million population as against AMC study of 4770
per million population, therefore, it is not at all representative of actual existing
situation and cannot be relied upon for any conclusion. The sample size of present
study is 60 times larger than ICMR study.
AMC study is the most recent with widest possible sample size taken anywhere in the
world. But the results are on the same lines as in case of Spain, Switzerland and US studies
that there is no herd immunity. The herd is still susceptible to get new infection and hence
we cannot rely upon onset of the herd immunity and we have to rely upon preventive
measures till the vaccine is invented and made available to large number of people.
Therefore, AMC strongly recommends adoption of preventive measures like wearing of
masks, maintaining social distance, frequent hand wash, cough etiquettes, personal
hygiene, getting tested at the earliest at onset of symptoms, not to go to work place if
symptoms like cold, cough, fever etc. are experienced and downloading Aarogya Setu App
as a good technological protection.

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AUTHORS

Dr. Om Prakash
Deputy Municipal Commissioner (Health), Amdavad Municipal Corporation.

Dr. Jay K. Sheth

Associate Professor, Department of Community Medicine, AMCMET Medical College,
Amdavad.

Dr. Bhavin Solanki

Incharge Medical Officer of Health, Amdavad Municipal Corporation.

Dr. Bhavin Joshi

Additional Medical Officer of Health, Amdavad Municipal Corporation.

Dr. Meena Kadam

Professor & Head, Department of Microbiology, AMCMET Medical College, Amdavad.

Dr. Sheetal Vyas

Professor & Head, Department of Community Medicine, AMC MET Medical College,
Amdavad.

Dr. Aparajita Shukla

Professor & Head, Department of Community Medicine,
Convener, MCI Nodal Centre for Faculty Development Smt. NHL Municipal Medical College,
Amdavad.

Dr. Hemant Tiwari

Assistant Professor cum Statistician, Department of Community Medicine
Smt. NHL Municipal Medical College, Amdavad.

Dr. Anand Solanki

Assistant Professor cum Epidemiologist, Department of Community Medicine
AMC MET Medical College, Amdavad.

Dr. Vaibhav Ramanuj

Assistant Professor cum Epidemiologist, Department of Community Medicine
Smt. NHL Municipal Medical College, Amdavad.