The effect of extended closure of red-light areas on COVID-19 transmission in India

The novel coronavirus disease (COVID-19) pandemic has resulted in over 200,000 cases in India. Thus far, India has implemented lockdown measures to curb disease transmission. However, commercial sex work in red-light areas (RLAs) has potential to lead to COVID-19 resurgence after lockdown. We developed a model of COVID-19 transmission in RLAs, evaluating the impact of extended RLA closure compared with RLA reopening on cases, hospitalizations, and mortality rates within the RLAs of five major Indian cities, within the cities, and across India. Closure lowered transmission at all scales. More than 90% of cumulative cases and deaths among RLA residents of Kolkata, Pune, and Nagpur could be averted by the time the epidemic would peak under a re-opening scenario. Across India, extended closure of RLAs would benefit the population at large, delaying the peak of COVID-19 cases by 8 to 23 days, and avert 32% to 60.2% of cumulative cases and 43% to 67.6% of cumulative deaths at the peak of the epidemic. Extended closure of RLAs until better prevention and treatment strategies are developed would benefit public health in India.