Post-lockdown spread of COVID-19 from cities to vulnerable forest-fringe villages in central India
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Description: Background: Seasonal migration of young adult males to cities is a common livelihood strategy for forest-fringe households in central India. With poor health infrastructure, low nutritional status, and high proportions of Scheduled Tribe populations, these households and surrounding villages are highly vulnerable to COVID-19 exposure as seasonal migrants return home. Objective: We identify patterns of seasonal migration in forest-fringe villages of central India, including proportions of households with migrants, their locations, and destination cities, to assess the vulnerability of village populations to COVID-19 exposure from returning migrants. We also compare effectiveness of varying physical distancing strategies to reduce the likelihood of spread between villages after the initial lockdown restrictions lift. Methods: We analyze origins and destinations of seasonal migrants over the last five years from a previously-collected, primary household survey of 5000 households across 500 forest-fringe villages in central India. Based on a median-sized village, we use an SEIR (susceptible, exposed, infectious, recovered) compartmental model to conceptually compare disease spread with varying leniency of movement restrictions within and between adjacent villages as restrictions ease after the lockdown. Results and implications: Villages with seasonal workers are widely dispersed across forest-fringe areas in central India, indicating the vulnerability of these populations to exposure and the need for widespread testing and health facilities. All 32 districts, approximately 75% of surveyed villages, and 18% of households had at least one seasonal migrant living in a city for part of the year during the last five years. 81% of the destination cities had reported COVID-19 cases at the beginning of the lockdown. As authorities ease movement restrictions after the lockdown period, lenient restrictions for people within a village combined with maximal restrictions between villages could be more effective in reducing the number of people exposed compared with moderate restrictions both within and between villages.