Comparing India's Second COVID Wave with the First Wave-A Single-Center Experience

  1. Mayank Kapoor
  2. Budha O Singh
  3. Prasan Kumar Panda
  4. Pathik Dhanger
  5. Anant Kataria

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Abstract

The COVID-19 pandemic has resurfaced in India as a hardhitting second wave. This study aims to compare the clinical profile of the first wave (April-June 2020) and the second wave (March-May 2021) of the severe acute respiratory syndrome coronavirus-2 pandemic (SARS-CoV-2) in a single tertiary care center in India.

Methods:

In this retrospective observational study, we examined the demographic profile, symptoms at presentation, severity of illness, baseline investigations, treatments received, underlying comorbidities, and outcomes of the COVID-19 patients belonging to the first (W1) and the second wave (W2) of the pandemic in India.

Results:

The age group affected most in the W2 is 50.5 (17.7) versus 37·1 (16·9) years for W1. The baseline oxygen saturation is lower in W2, being 84·0 (13·4) % compared with 91·9 (7·4) % in W1 [SpO2 <90% OR 14.3 (6.1-33), P<0.0001]. 70.2 % of the cases belonged to the severe category in W2 compared to 37.5% in W1. W2 has worse outcomes. Incidence of acute respiratory distress syndrome (ARDS) [48.7% v/s 6.45%; OR 15.4 (6.5-35.7), P<0.0001], Acute Kidney Injury (AKI) [18% v/s 2.4%; OR 6 (1.7- 22.2), P = 0.005], Acute Liver Injury (transaminitis) [12.8% v/s 6.4%, OR 7.3 (3.7- 14.3), P<0.0001], and deaths (29% v/s 9.6%, standardized mortality ratio 3.5) is higher in W2. Similarly, the CT severity score for W2 [29.5 (6.7)] was higher than W1 [23·2 (11·5), P<0.05]. The proportion of patients requiring oxygen [81.8% v/s 11.2%; OR 125 (40-333.3), P<0.0001], high flow nasal cannula (HFNC) (11.4% v/s 5.6%), Non- Invasive Ventilation (NIV) (41.2% v/s 1.5%), invasive ventilation [24.5% v/s 0.9%; OR 22.72 (2.94-166.6), P=0.003], as well as ICU/HDU admissions [56.4% v/s 12.0%; OR 10.5 (5.3-21.2), P<0.0001] was higher for W2 as compared with W1. Cough, invasive ventilation, inotrope requirement, and ARDS are significantly related to higher mortality in the W2 than W1.

Conclusion:

Higher age, oxygen requirement, ventilator requirement, ICU admission, and organ failure are more prevalent in the admitted COVID-19 cases during the second wave that hit India than in the first wave and are associated with more fatalities. Strategy for another wave should be planned accordingly.

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  1. Version published to 10.2174/2772434417666220628153110
  2. ScreenIT

    SciScore for 10.1101/2021.06.03.21258009: (What is this?)

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

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis was done using SPSS version 25.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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: We detected the following sentences addressing limitations in the study:
    Our study has limitations. We only analyzed the records of the hospitalized patients; hence, we could not take into account any non-hospitalized COVID-19 patient with mild disease. Moreover, because of hospital bias, the proportion of severe cases is higher in W2 than W1. The primary reason for this being a change in the admission criteria from W1 to W2. In W1, the hospital had the policy of admitting all COVD-19 positive patients. However, with the rising number of cases and decreasing bed availability in W2, the hospital admits a predominating number of moderate and severe cases. In addition, the use of experimental therapies has appeared midway after the first wave in India, which is why their proportion of use is more in W2. In conclusion, the second wave of COVID has hit India hard and can overwhelm India’s healthcare infrastructure. Hypoxia and organ dysfunctions are more frequently reported in the second wave population, leading to higher ICU admissions and deaths, further overburdening the situation. Our data could be used to inform India’s population about the severity of this second wave so that people understand the nature of the situation and follow all the COVID-19 appropriate behaviors more strictly. The lessons learned from this fight are essential to prevent a third wave from entering any country. We should be better prepared in terms of testing, vaccination, and boosting our critical care sector.

    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.
    • No protocol registration statement was detected.

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

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.06.03.21258009v1 on medRxiv