There was no difference in mortality among COVID-19 patients in the first and second wave, said leading doctors in charge of India’s national COVID management strategy. There was a relative increase in instances of those manifesting shortness of breath as a symptom of the infection but those over 60 — as in the first wave — continued to be most at risk from dying.
A “marginally higher” proportion of patients younger than 20 years were present in the second wave (5.8%) compared to the first (4.2%). In the first wave, 25.5% of the patients were 20-40 years old compared to 23.7% in the ongoing second wave.
Citing data from a section of hospitalised patients from the first and second wave, Director-General, Indian Council of Medical Research (ICMR) Dr. Balram Bhargava said 47% of symptomatic patients presented ‘shortness of breath’ in the second wave (March-April 2021) compared to 41% in the first wave (Sept.-Nov.’20).
In all other symptoms associated with COVID-19 — ‘fast breathing,’ cough, chills, joint pain, fatigue — there was a greater proportion who manifested these symptoms in the first wave than in the ongoing second wave. A key caveat to the data was that for the first wave analysis, 6,642 patients were analysed, and in the second wave, only 1,405 were analysed.
Of 6, 650 admitted patients from September-November last year, 9.6% succumbed whereas from March-April, 9.7% of a group of 351died from the virus.
There was no difference in the proportion of patients who required mechanical ventilation in the first and second waves, Dr. Bhargava said.
The second wave — apart from a steep rise in coronavirus cases — has been characterised by unprecedented demand for medical-grade oxygen leading to severe shortages. Dr. Bhargava said the sudden surge may have triggered panic and a demand for more oxygen. “This is data from hospital settings and so we don't yet know what's triggering the demand from outside these settings,” he said at an online meeting.
Dr V.K. Paul, who chairs the empowered group on vaccinations and COVID management (NEGVAC), said there was no difference in mortality, in the first and second wave, in those 40 and under. “There is no overarching extra/ excess risk of younger becoming COVID positive,” he said.
On drug protocol for treatment, Dr. Randeep Guleria stressed that none of the antiviral drugs — Remdesivir, Fapiravir — as well as convalescent plasma had any established benefit in curing the disease. Other medication — the use of the steroids such as dexamethasone, tocilizumab — too had limited use especially in instances of critically ill patients who were experiencing an immune-system over-reaction, called a cytokine storm.
“Steroids, Tocilizumab, Remdesivir these are to be given, if need be, at the right time. Giving a cocktail of drugs (unsupervised) can be fatal. Remdesivir is useful in moderate illness and to treat a decrease in oxygen saturation but has a limited role. If given too early, dexamethasone (steroid) is harmful and Tocilizumab is only useful during a cytokine storm,” he added.
