The ongoing second COVID wave presented itself with a lowered mean age of patients, higher percentage of hospitalisations despite lesser comorbidities and had patients with breathlessness in greater frequency, said a new government study — “Clinical profile of hospitalized COVID-19 patients in first and second wave of the pandemic: Insights from an Indian registry-based observational study”.
Recently published in the Indian Journal of Medical Research , the study was jointly conducted by the Indian Council of Medical Research (ICMR), the All India Institute of Medical Sciences (AIIMS), and the National Centre for Disease Control (NCDC), using data collected under the National Clinical Registry for Covid-19 (NCRC).
The study looked at data from patients enrolled in 40 hospitals between September 1, 2020 and January 31, 2021, and then February 1 and May 11, 2021. It took into account 18,961 individuals enrolled in NCRC, which included 12,059 hospitalised patients from the first and 6,903 second COVID wave.
Doctors and researchers across the country have expressed concern about the fact that the study found a greater percentage of younger patients being more affected during the second wave and worse, mortality increased for all age groups except in the less-than-20 age group.
As per the study, mortality among hospitalised patients increased by 3.1% in the second wave. Also a higher proportion of patients complained of shortness of breath, developed Acute Respiratory Distress Syndrome (ARDS), and required oxygen support and ventilators in the second wave.
Sanjeev Dutta, HOD and senior consultant Pediatrics, QRG Health City, Faridabad, speaking about the study which analyses the characteristics of the first wave (which started around April 2020 to Jan 2021) and the second wave (which started around Feb-Mar 2021), said: “In both the waves, people above 60 years were mostly affected, but the second wave also affected a significantly younger population under 40 years and many had no comorbid conditions like diabetes, hypertension and diminished immunity status.”
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He explained that in both waves, most people had fever as the commonest symptom, but in the second wave, a greater number of affected people had chest problems like difficulty in breathing, oxygen need and pneumonia.
“Fatalities have also been higher in the second wave. Higher usage of healthcare facilities ( ICU, oxygen beds) is hence projected in the anticipated third wave of the pandemic,” he said.
Dr. Dutta added that COVID-appropriate behaviour will be an essential prevention for the third wave of the pandemic. Greater vaccination coverage is the global strategy of prevention. “While we are awaiting vaccination approval for children ( under 18 yrs), it's assumed that the adult vaccination campaign will result in lessened risk of infection to the children,” he said.
Dr. Gopi Krishna Yedlapati, consultant interventional pulmonologist, Yashoda Hospitals, Hyderabad added that the second wave was worse in terms of outcomes of treatments with several young and middle-aged patients requiring high oxygen and ventilation support and with different symptoms.
“It is expected that the third wave will be different than the second wave, as a lot of the active working population has had exposure to the disease, thereby developing immunity to fight against the disease. As per scientific estimates, the third wave might be shorter and milder, in lieu of mortality and morbidity, just like the Spanish flu. With the advancements in treatments and preparedness of the healthcare sector, we can fight against the third wave effectively,” he said.
Speaking exclusively to The Hindu , Samiran Panda, head, Epidemiology and Communicable Diseases Division, ICMR noted that this study presents comparison of information collected during two different phases of the COVID-19 epidemic in India and these are the findings obtained from in-patient facilities.
He noted that the proportion of asymptomatic and mildly symptomatic infections occurring in the community during these two waves should also be taken into consideration while discussing such issues.
“It is also important to appreciate that inferring about clinical severity that could be encountered in time to come — should there be a third wave — based on the data obtained from first and second wave will be inappropriate as any trend analysis requires data from at least three time points,” he said.
Dr. Panda further noted that multiple factors such as heterogeneity between patient groups, immunity developed at the community level from earlier two waves of SARS-CoV-2 infection in India, vaccination coverage as well as the characteristics of the infecting viral variant would be the determinants of clinical manifestation of COVID-19 disease in future.
“There is no scientific basis, as yet, to be alarmed and to think that the third wave is going to be presenting with clinically more severe diseases,” he said.
- The mortality among hospitalized patients increased by 3.1% in the second wave
- 20-39 age group saw an increase in hospitalised patients from 23.7% to 26.5%
- 40-60 age bracket saw a rise in hospitalisations from 40 per cent to 41.3%
- Fewer patients over 60 years old were hospitalised in the second wave (27.8%) as compared to the first wave (32.5%)
- Lesser proportion of hospitalised patients across all age groups had comorbidities in the second wave (21.1%) compared to the first wave (21.7%).
- The cumulative distribution of patients enrolled was: 5,763 (30.4%) from the north, 5,673 (29.9%) from the east, 2,555 (13.5%) from the south, 2,503 (13.2%) from the central, 2,044 (10.8%) from the west and 423 (2.2%) from the Northeast region.
