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Has Baramulla cracked the COVID code? Lancet study puts district among the best in India

Srinagar: Baramulla in the north of Kashmir has made it to the list of 20 districts in India which are least vulnerable to COVID-19 scoring well on key vulnerability indicators, according to a recent study published in Lancet, one of the world’s best medical journals.  

Authored by Dr Rajib Acharya and A Porwal of the Population Council, New Delhi, the study ‘A vulnerability index for the management of and response to the COVID-19 epidemic in India: an ecological study’ has gauged the vulnerability of several states in India on five factors.


They include socioeconomic vulnerability, demographic vulnerability, vulnerability due to housing and hygiene condition, vulnerability due to non-availability of health care, and epidemiological vulnerability.

Baramulla has scored 0.025 in overall vulnerability and stands at 16th position among the 20 best districts. The top three districts include the south, north and west districts of Sikkim with an overall vulnerability of 0.000, 0.002, and 0.003 respectively.

As far as the scores in the five individual vulnerability factors is concerned, Baramulla scores stand at: socioeconomic (0.261), demographic (0.189), housing and hygiene (0.039), non-availability of health care (0.383), and epidemiological vulnerability (0.338).

Source: Lancet

While Baramulla figures are quite encouraging, the same cannot be said about overall numbers for Jammu and Kashmir.

The Union Territory is the 11th most vulnerable state/UT in India with an overall vulnerability score of 0.714. The scores for the five individual factors for J&K are: Socioeconomic (0.629), Demographic (0.171), housing and hygiene (0.571), non-availability of health care (0.686), and epidemiological (0.829)

The 10 worst states include Madhya Pradesh (1.000), Bihar (0.971), Telengana (0.943), Jharkhand (0.914), Uttar Pradesh (0.886), West Bengal (0.829), Maharashtra (0.829), Odisha (0.800), Gujarat (0.771), and Andhra Pradesh (0.714).

Source: Lancet

Metrics and calculation

The researchers computed a composite index of vulnerability at the state and district levels based on 15 indicators across the following five domains: socioeconomic, demographic, housing and hygiene, epidemiological, and health system.

They used a percentile ranking method to compute both domain-specific and overall vulnerability and presented results spatially with number of positive COVID-19 cases in districts.

The 15 indicators include:

Scheduled tribe or caste households, Education level, poor households comprising the Socioeconomic domain.

Elderly population, Urbanisation, Population density comprising the demographic domain.

People per room, Households with no toilet facility, Households with no hand-hygiene facility comprising the housing and hygiene domain.

Households with health insurance, Households without easy access to public health facility, Availability of public hospitals (at district level), and Availability of hospital beds (at state level) comprising the Healthcare domain.

And lastly, men and women with any chronic morbidity, and men who smoke comprising the epidemiological domain.

Why these domains

According to researchers the reasons they chose socioeconomic vulnerability was because the social and economic repercussions of the COVID-19 epidemic might be far reaching and will be felt long after it is over. Epidemic-induced economic shock will be felt mostly by the poorest section of society,23 hence it is important to consider the socioeconomic condition of a population when creating a vulnerability index.

Similarly, demographic vulnerability was included because the nature of the COVID-19 epidemic is such that both the pace of transmission and mortality due to infection depend on the demographic composition of the population.

Housing and hygiene domain, in which Baramulla has done well, was included in the research because housing conditions, particularly intrahousehold crowding, sanitation, and hand hygiene, are important factors in COVID-19 transmission and thus constitute an important domain of vulnerability.

The management of an epidemic and the treatment seeking ability of a population depend on easy and affordable access to well capacitated health-care systems and health security, and thus availability of healthcare was included as a domain in the study.

And lastly the epidemiological vulnerability was included because, the researchers say, there are several known epidemiological factors that might put a population at risk of higher morbidity and mortality by COVID-19 infection and thus merit inclusion in the index.