Differentials in the characteristics of COVID-19 cases in Wave-1 and Wave-2 admitted to a network of hospitals in North India

  1. Sandeep Budhiraja
  2. Abhaya Indrayan
  3. Mona Aggarwal
  4. Vinita Jha
  5. Dinesh Jain
  6. Bansidhar Tarai
  7. Poonam Das
  8. Bharat Aggarwal
  9. RS Mishra
  10. Supriya Bali
  11. Monica Mahajan
  12. Vivek Nangia
  13. Ajay Lall
  14. Nevin Kishore
  15. Ashish Jain
  16. Omender Singh
  17. Namrita Singh
  18. Ashok Kumar
  19. Prashant Saxena
  20. Arun Dewan
  21. Ritesh Aggarwal
  22. Shailesh Sahay
  23. Rajiv Dang
  24. Neelima Mishra
  25. Mohit Mathur
  26. I. M. Chugh
  27. Pankaj Aneja
  28. Sanjay Dhall
  29. Vandana Boobna
  30. Vinit Arora
  31. Ajay Gupta
  32. Vijay Arora
  33. Mukesh Mehra
  34. Meenakshi Jain
  35. Vimal Nakra
  36. BD Sharma
  37. Praveen Pandey
  38. YP Singh
  39. Anil Vardani
  40. RK Singal
  41. Deepak Gargi Pandey
  42. Atul Bhasin
  43. Sandeep Nayyar
  44. Rajesh Pande
  45. Pankaj Chaudhary
  46. Ajay Kr Gupta
  47. Ashish Gupta
  48. Nitesh Tayal
  49. Puneet Gupta
  50. Manish Gupta
  51. Sumit Khetrapal
  52. Sachin Pandove
  53. Deepak Bhasin
  54. Devender Midha
  55. Harpal Singh
  56. Ambrish Dixit
  57. Vinay Sagar
  58. Vaibhav Chachra
  59. Bhupesh Uniyal
  60. Sanjay Saxena
  61. Amarjit Singh
  62. Shalini Sharma

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Abstract

Second wave of COVID-19 pandemic in India came with unexpected quick speed and intensity, creating an acute shortage of beds, ventilators, and oxygen at the peak of occurrence. This may have been partly caused by emergence of new variant delta. Clinical experience with the cases admitted to hospitals suggested that it is not merely a steep rise in cases but also possibly the case-profile is different. This study was taken up to investigate the differentials in the characteristics of the cases admitted in the second wave versus those admitted in the first wave.

Records of a total of 14398 cases admitted in the first wave (2020) to our network of hospitals in north India and 5454 cases admitted in the second wave (2021) were retrieved, making it the largest study of this kind in India. Their demographic profile, clinical features, management, and outcome was studied.

Age-sex distribution of the cases in the second wave was not much different from those admitted in the first wave but the patients with comorbidities and those with greater severity had larger share. Level of inflammatory markers was more adverse. More patients needed oxygen and invasive ventilation. ICU admission rate remained nearly the same. On the positive side, readmissions were lower, and the duration of hospitalization was slightly less. Usage of drugs like remdesivir and IVIG was higher while that of favipiravir and tocilizumab was lower. Steroid and anticoagulant use remained high and almost same during the two waves. More patients had secondary bacterial and fungal infections in Wave-2. Mortality increased by almost 40% in Wave-2, particularly in the younger patients of age less than 45 years. Higher mortality was observed in those admitted in wards, ICU, with or without ventilator support and those who received convalescent plasma.

No significant demographic differences in the cases in these two waves, indicates the role of other factors such as delta variant and late admissions in higher severity and more deaths. Comorbidity and higher secondary bacterial and fungal infections may have contributed to increased mortality.

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    SciScore for 10.1101/2021.06.24.21259438: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: All the admitted patients gave a prior consent for their anonymised data to be used for research purpose.
    IRB: Ethics Committee Approval: This study was approved by the Institutional Ethics Committee, Max Super Speciality Hospital (A unit of Devki Devi Foundation), address : Service Floor, Office of Ethics Committee, East Block, next to Conference Room, Max Super Speciality Hospital,
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    Results from scite Reference Check: We found no unreliable references.

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  2. Version published to 10.1101/2021.06.24.21259438 on medRxiv