NEW DELHI — Cases of Covid-19 during India’s recent outbreak have been more severe, with people under the age of 50 falling sicker, compared to a previous wave last fall, according to doctors from badly affected areas.
While a number of factors may have contributed, including delays in treatment and inadequate access to hospital beds or oxygen, doctors surveyed by the Wall Street Journal in India said they saw so many patients. suffer from severe symptoms so quickly that they think the disease is getting more virulent there.
A number of Indian doctors have said people hospitalized in the flare-up needed more oxygen than Covid-19 patients before. They described faster spreading lung damage and faster decreasing oxygen levels in relatively young patients, as well as longer recovery times. Covid-19 patients of all ages have had increased oxygen requirements, doctors said, but were particularly surprised to see this in younger patients.
Epidemiologists have warned that what Indian doctors are describing is anecdotal evidence and more studies are needed to determine whether mutations in the virus in India have led to more serious illness. Other factors could explain what doctors are seeing, particularly longer waits for hospital care, they said. The recent outbreak of Covid-19 has overwhelmed India’s healthcare system, leading to shortages of beds, oxygen and medicine in hospitals.
Studies are underway in a number of countries to understand whether the Covid-19 variants are more virulent, instead of simply being more easily spread, said Giridhara R. Babu, professor of epidemiology at the Indian Institute. of Bangalore Public Health.
New or changed symptoms described by doctors should be part of those studies, Dr Babu said. “We cannot ignore these observations. These are very important observations, ”he said.
A few doctors said the age range of patients with Covid-19 was similar to the last wave, and the more contagious variants now prevalent were increasing the number of symptomatic patients of all ages. They also noted that those under 45 were additionally at risk as vaccinations were not available to them until May 1.
India began recording global highs of more than 400,000 new daily cases of Covid-19 at the end of April, four times the peak of the first major wave of the disease in the country at the end of April. last fall. The number of new cases has declined this month, as has the percentage of positive tests, although there are concerns that tests may not be sufficient in rural areas to get a good reading.
Highly infectious viral variants circulated in India during the outbreak, four of which were classified as variants of concern by the World Health Organization. The variant first identified in India months ago is labeled B.1.617.
It is sometimes referred to as the Indian variant, but the government opposes the term, saying it is misinformation. India’s Ministry of Electronics and Information Technology said it suggested that social media companies operating in the country last week not allow the posting of content using the term on their platforms.
Indian scientists say one of the main factors behind the Covid-19 surge appears to be a particular version of the variant, called B.1.617.2.
It appears to be more contagious, British scientists who have studied it said in a recent report. And genomic sequencing data shows that India’s surge in some areas has coincided with an increase in the prevalence of B.1.617.2.
“So far, it seems that wherever B.1.617.2 goes, it surpasses the other variants,” said Saumitra Das, director of the National Institute of Biomedical Genomics, based near Kolkata in eastern ‘India, which handles the sequencing work. nationally.
B.1.617.2 has been detected in 50 countries, according to an online database maintained by researchers at four universities. Its presence in the United States remains low, according to the Centers for Disease Control and Prevention.
Preliminary studies suggest that vaccines are effective against it. The risk of developing symptomatic Covid-19 from B.1.617.2 was reduced by 88% after two doses of the vaccine from Pfizer Inc. and BioNTech SE and by 60% after two doses of the University of Oxford / AstraZeneca vaccine PLC, researchers at the UK’s public health agency said in an article just published but not yet peer reviewed.
Scientists are studying whether B.1.617.2 is more virulent or harmful. William Haseltine, a pioneering scientist on projects against cancer, HIV drugs and the human genome, noted that during pandemic influenza a century ago, the first wave of the disease hit the elderly, but a second wave, even worse, has arrived for young people.
” No matter where [the coronavirus] appears, there are many variations, and they are all different. They share some common properties, including increased transmissibility, increased age range and increased disease in young people, ”said Dr Haseltine.
In New Delhi, genomic sequencing data showed the presence of B.1.617.2 in 84% of virus samples on April 28, an increase of just 25% on March 3. Cases of Covid-19 in the city exploded in April.
Anisha Saigal, 29, had been battling symptoms for about a week when on the morning of April 16, she found herself short of breath. His blood oxygen saturation was 88%, compared to a healthy level of 95% or more.
Ms Saigal stood in line for 3.5 hours at Holy Family Hospital in New Delhi for a consultation. An x-ray showed she had pneumonia in both lungs. A doctor advised hospitalization, but the hospital did not have beds available.
Five hours later, he gave her a bed in the pediatric ward, its walls adorned with hand-painted cartoons of Tom and Jerry and Mickey and Minnie Mouse.
“It was dystopian to see adults struggling to breathe while trying to fit into these children’s beds,” Saigal said.
After almost two weeks, Ms Saigal, able to breathe without the oxygen provided by the hospital, returned home, just in time for her mother’s birthday. She continues to struggle and is on medication for scarring in the lungs and heart palpitations.
“What bothers me is that I’m not even 30 and taking lung and heart medication,” Saigal said.
While younger patients in India remain much more likely than older ones to survive, doctors say they are seeing a greater proportion of young patients with Covid-19 dying than when the disease was at its peak in India. last fall. At Medanta Hospital near New Delhi, several patients in their 20s with severe lung infections did not survive.
“This is an indication that this is a virulent strain much more virulent than in the first wave,” said Naresh Trehan, cardiac surgeon and chairman of the Medanta hospital chain, adding that his assessment was based on observations rather than clinical data.
At Guru Teg Bahadur Hospital in New Delhi, a 26-year-old resident doctor complained of a fever in early May. The doctor, who was not vaccinated, took a Covid-19 test and was admitted to the emergency room. He was diagnosed that evening and died of an intracranial hemorrhage overnight, said BL Sherwal, director of the hospital.
India does not have updated national data on hospitalizations by age during the outbreak, but some local mortality data suggests a greater impact on young people. In Mumbai, around 40% of Covid-19-related deaths in the first 26 days of May occurred in patients under the age of 60, up from 29% in the previous smallest increase last September.
“Young patients need high flow oxygen and intensive care,” said Suranjit Chatterjee, internal medicine specialist and Covid-19 service coordinator at Indraprastha Apollo Hospital in New Delhi..
In the state of Punjab, the severity of Covid-19 cases also appears to have changed, with patients aged 35 to 50 in greater respiratory distress than in last fall’s wave, Madhu Gupta said. , professor of community medicine and public health at The Post. University institute for medical training and research in Chandigarh, the capital of Punjab.
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“It’s pretty scary to see this in this age group,” said Dr. Gupta. The presence of the type B.1.617.2 virus is increasing in Punjab.
One evening in late April, Priyanka Kumari, 25, arrived at her parents’ home in the small town of Munger, Bihar, in a very weak state. “She couldn’t walk. She couldn’t speak, ”said Chanda Kumari, her 21-year-old sister.
The next morning, the family offered Priyanka a bed at a local government hospital, who found her blood oxygen saturation very low. There was no ventilator or medication, her sister said.
They found a hospital with a ventilator in a nearby town and arranged an ambulance to take Priyanka there. She died on the way.
“We haven’t been able to recover from the shock,” said Chanda Kumari.
—Jason Douglas and Newley Purnell contributed to this article.
Write to Suryatapa Bhattacharya à [email protected]
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