No difference in mortality in COVID-19 ‘first’ and ‘second wave’: ICMR

Those over 60 years continue to be most at risk from dying.

: There was no difference in mortality among COVID-19 patients in the first and second wave, leading doctors, who are in charge of India’s national COVID-19 management strategy have said. There was a relative increase in instances of those manifesting shortness of breath as a symptom of COVID-19 but those over 60 years — like in the first wave — continued to be most at risk from dying.

A “marginally higher” proportion of patients younger than 20 were present in the second wave (4.2%) compared to the first (5.8%) and in the first wave, 25.5% of the patients were 20-40 compared to 23.7% in the ongoing second wave.

Citing data from a section of hospitalised patients from the first and second wave, Dr Balram Bhargava, Director-General, Indian Council of Medical Research said that 47% of symptomatic patients presented ‘shortness of breath’ in the second wave (March-April 2021) compared to 41% in the first wave (Sep-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 641 admitted patients from September-November last year, 9.6% succumbed where from March-April, 9.7% died but the former group had 6,650 patients compared to 351 in the second.

There was no difference in the proportion of patients who required mechanical ventilation in the first and second waves.

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 that 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 VK 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.

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.


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