The highest number of cumulative cases were reported from the states/UTs of Maharashtra, Tamil Nadu, Delhi, Gujarat, and Rajasthan (67655, 22333, 19844, 16794, and 8831 respectively), while the lowest cumulative cases were reported by states/UTs of Sikkim, Mizoram, Daman and Diu, Arunachal Pradesh, and Meghalaya (1, 1, 2, 4, and 27 cases respectively). 35, 36 We obtained daily data on the total number of cases and tests for each of 5 high- and low- burden states from website on June 4, 2020. From the start of the pandemic till 31 May, 2020 3737027 tests, 182143 cases, and 5164 deaths were reported in India. We obtained daily data on total cases and tests for India from the World Health Organization’s (WHO) COVID database, and website respectively. We also used GT to correlate information-seeking on COVID-19 with the number of tests and cases reported both at national and state levels. We explored COVID-19 information-seeking-GT data from India to understand its utility in digital surveillance. 23– 34 Most of these studies have not used comprehensive search strategy and used few COVID-19 related terms. During the current COVID-19 pandemic, many studies have been published showing the usefulness of GT, including 2 from India. 22 Information- seeking on SARS-CoV-2 can similarly be used for digital surveillance and inform policy making for containment and mitigation. 21 A study from India reported correlation between GT and IDSP reporting, in diseases such as Malaria, Dengue, Chikungunya and Enteric fever. 10– 20 With over 560000000 internet users in India, infodemiology can supplement IDSP. 9 It has been used during epidemics of H1N1 influenza, Ebola Virus Disease, Dengue Fever, Zika, MERS, and Conjunctivitis etc., as well as for cancer screening, sinusitis, and scarlet fever, etcetera. Google Trends™ (Google, Mountain View, CA, United States) (GT) is an automated digital platform which provides data on Google search queries in form of Relative Search Volume (RSV). 8 Researchers have analyzed the information- seeking behavior on Google™ Search Engine, Twitter™, and YouTube™ etc., to predict and explain infectious diseases outbreaks at the population level. 7 Such ‘digital surveillance’ has been used during the previous H1N1, Ebola, Zika, and Chikungunya outbreaks. Health information seeking, sometimes referred to as infodemiology has been suggested as another avenue of disease surveillance. People seek health information either from curiosity generated by the media, by virtue of their own, or a family member’s illness. Private health providers who cater to nearly 80% of ambulatory healthcare, do not contribute much to IDSP. 4 India’s health system consists of government-run health facilities and private health providers. 3 Real-time surveillance was initiated in the form of Integrated Health Information Platform (IHIP) in 7 states in 2018. Surveillance of infectious diseases in India has been conducted through the Integrated Disease Surveillance Project (IDSP) network since 2004. India responded with an initial travel restriction and thermal screening of inbound travelers in February 2020, which was followed by the largest population-level lockdown from 25 March, 2020 till 31 May, 2020. 1 Countries across the globe have implemented various pharmacological and non-pharmacological control measures with mixed results. With more than 63000000 cases and more than 1400000 deaths reported worldwide by December 1 2020, the COVID-19 pandemic is the biggest human health threat since the deadly Influenza Pandemic of 1918.
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