Utility of the Comprehensive Health and Stringency Indexes in Evaluating Government Responses for Containing the Spread of COVID-19 in India: Ecological Time-Series Study

Background: Many nations swiftly designed and executed government policies to contain the rapid rise in COVID-19 cases. Government actions can be broadly segmented as movement and mass gathering restrictions (such as travel restrictions and lockdown), public awareness (such as face covering and hand washing), emergency health care investment, and social welfare provisions (such as poor welfare schemes to distribute food and shelter). The Blavatnik School of Government, University of Oxford, tracked various policy initiatives by governments across the globe and released them as composite indices. We assessed the overall government response using the Oxford Comprehensive Health Index (CHI) and Stringency Index (SI) to combat the COVID-19 pandemic.

Objective: This study aims to demonstrate the utility of CHI and SI to gauge and evaluate the government responses for containing the spread of COVID-19. We expect a significant inverse relationship between policy indices (CHI and SI) and COVID-19 severity indices (morbidity and mortality).

Methods: In this ecological study, we analyzed data from 2 publicly available data sources released between March 2020 and October 2021: the Oxford Covid-19 Government Response Tracker and the World Health Organization. We used autoregressive integrated moving average (ARIMA) and seasonal ARIMA to model the data. The performance of different models was assessed using a combination of evaluation criteria: adjusted R², root mean square error, and Bayesian information criteria.

Results: implementation of policies by the government to contain the COVID-19 crises resulted in higher CHI and SI in the beginning. Although the value of CHI and SI gradually fell, they were consistently higher at values of >80% points. During the initial investigation, we found that cases per million (CPM) and deaths per million (DPM) followed the same trend. However, the final CPM and DPM models were seasonal ARIMA (3,2,1)(1,0,1) and ARIMA (1,1,1), respectively. This study does not support the hypothesis that COVID-19 severity (CPM and DPM) is associated with stringent policy measures (CHI and SI).

Conclusions: Our study concludes that the policy measures (CHI and SI) do not explain the change in epidemiological indicators (CPM and DPM). The study reiterates our understanding that strict policies do not necessarily lead to better compliance but may overwhelm the overstretched physical health systems. Twenty-first-century problems thus demand 21st-century solutions. The digital ecosystem was instrumental in the timely collection, curation, cloud storage, and data communication. Thus, digital epidemiology can and should be successfully integrated into existing surveillance systems for better disease monitoring, management, and evaluation.