Covid-19: “Second Wave less Severe than the First:” ICMR

Manas Dasgupta

NEW DELHI, Apr 19: Even as the country touched yet another new peak of daily cases registering over 2.73 lakh cases in the last 24 hours till Monday morning, leading doctors who are in charge of India’s national COVID-19 management strategy have claimed that there was no difference in mortality among COVID-19 patients in the first and second wave.

The Indian Council of Medical Research chief Dr Balram Bhargava and several other senior doctors said India’s second wave of coronavirus disease (Covid-19) was “less severe” than the previous one in as far as fatalities are concerned.

Establishing the contrast, the ICMR director general said the only difference was shortness of breath which was higher among the patients this time as a higher requirement of oxygen was found in this wave.

The ICMR DG said there was no difference seen in the rate of fatalities between the first and the second wave. 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.

“Very clearly, we find that the symptoms are much less. As I mentioned that the symptoms of joint ache, fatigue, muscle ache, loss of smell, or sore throat are much less compared to the first wave. However, shortness of breath is higher in this wave,” Dr Bhargava 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 Bhargava said 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.

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.

Pointing out at major loopholes in India’s fight against the viral contagion, Dr Bhargava said, “We have had a tremendous amount of laxity and Covid-19 inappropriate behaviour was seen.”

It is not yet clear if the surge in infection spread and cases is the result of the double mutant found in India or the higher rate of transmissibility, the ICMR chief said.

Contradicting the stand being taken by several state governments  opting for laboratory tests to reduce the pressure on the RT-PCR tests, Dr Bhargava stressed that the RT-PCR was a gold standard test that measures two or more genes in the body, and there was no chance of missing the detection of a Covid-19 mutant through the test.

“I would like to emphasise that the RT-PCR test that we are utilising, they measure two or more genes and they never miss a test… We have always used two or more genes for testing and therefore missing is absolutely impossible… It can find any kind of mutant because it measures two or more genes at different sites,” he said.

A common aspect in both waves has been the age group that has been infected, he pointed out and said, “In both the waves, 70% of infected patients are above 40 years.”

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 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, the director of the All India Institute of Medical Sciences, Delhi, 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.

Meanwhile, the prime minister Narendra Modi held meetings with senior doctors on the prevailing Covid situation as the total number of cases across the world has reached above 141 million and the death has increased to more than 3 million.

Delhi, the national capital of India, was brought under one-week “total curfew” to be effective from 10 PM on Monday till 6 AM next Monday after the Covid-19 positivity rate touched 30% in Delhi. It is reporting a spurt in cases as the daily number of infection has been hovering above 25,000. Until now, the curfew was limited to nights only. Meanwhile, the nationwide tally breached 15-million mark after adding 273,810 fresh cases to its tally.

The worldwide situation was also similar as the outbreak of coronavirus disease (Covid-19) continued to gain speed. The week ending on April 18 recorded the highest number of people infected globally. According to the John Hopkins’ tally, more than 5.2 million people across the world contracted the infection in the last seven days. It was a 12 per cent increase in cases from a week earlier, throwing doubt on hopes that the end of the pandemic is in sight.

In the United States, authorities have administered half of Americans 18 years or older with at least one dose of vaccine, the Centers for Disease Control and Prevention reported Sunday. President Joe Biden’s chief medical adviser, Anthony Fauci said, decision on how to resume the Johnson & Johnson shot will probably come by Friday.

The Union Health Ministry on Monday said Maharashtra, Uttar Pradesh, Delhi and Rajasthan are among the 10 states that account for 78.58 per cent of the new cases reported in a day. The other states in the list of 10 are Tamil Nadu, Karnataka, Gujarat, Kerala, Madhya Pradesh and Chhattisgarh.

The state governments have been asked to take strict action against anyone found indulged in black marketing or hoarding of antiviral drug remdesivir, Chemicals and Fertilisers Minister D V Sadananda Gowda said. The minister said he had also taken a meeting with the pharma secretary to review the availability of the antiviral drug which is used in the treatment of COVID-19. “Took a meeting with the Secretary (Pharma) to review availability of #Remdesivir. Government is in regular touch with manufacturers regarding this. Weekly production plans have been prepared in consultation with the manufacturers,” Gowda tweeted. Black marketing, hoarding of remdesivir is being strictly monitored and state governments have been advised to take strict action against those indulging in such malpractices, he added. In another tweet, the minister said: “Manufacturers have agreed to ramp up production of #Remdesivir. Additional sites for production have been approved. Production to be doubled in the coming weeks,” he added.