Research Highlight

Indian states and districts highly vulnerable to COVID-19 identified

doi:10.1038/nindia.2020.182 Published online 8 December 2020

Researchers have identified districts highly vulnerable to COVID-19 in nine large Indian states, based on socioeconomic, health and other indicators 1. North-east Indian states are less vulnerable to this disease, the researchers found.

The study will help local authorities prepare for and to help mitigate the increasing threat of the virus spreading in their districts, the researchers say.

The underlying burden of COVID-19 is expected to be much higher than has been estimated, given the possible under detection in India.

To assess the spread of COVID-19 in India, scientists from the Population Council in New Delhi, India, computed a composite index of vulnerability at the state and district levels, based on 15 indicators across five domains: socioeconomic, demographic, housing and hygiene, epidemiological, and health system.

They found that the movement of migrant workers during the lockdown period contributed considerably to spikes of COVID-19 cases in Bihar, Madhya Pradesh, Telangana, Jharkhand, Uttar Pradesh, Maharashtra, West Bengal, Odisha and Gujarat.  

A separate team from the Harvard T. H. Chan School of Public Health in the US and the National Institute of Transforming India (NITI) Aayog in India also analysed the case fatality rate (CFR) and COVID-19 cases and deaths per 100,000 of population across 543 parliamentary constituencies and 721 districts of India2,3.

Both studies found a substantial variation of COVID-19 burden within each state and across the country. These studies will help planners and policy makers effectively prioritise resource allocation for the regions to deal with the COVID-19 epidemic, the researchers say.


1. Acharya, A. et al. A vulnerability index for the management of and response to the COVID-19 epidemic in India: an ecological study. Lancet. Glob. Health. 8, e1142-51 (2020)

2. Kim, R. et al. Estimating vulnerability to COVID-19 in India. Lancet. Glob. Health. 8 (2020)

3. Wang, W. et al. COVID-19 metrics across parliamentary constituencies and districts in India.  HCPDS Working Paper, 20 (2020)