To delve into the lessons we can learn from the second COVID-19 wave, we brought together a panel of experts in our latest Practo Connect webinar. Get the highlights here
As India’s second wave recedes and the warning of an impending third wave grows, there will never be a better time to reflect on ways to prevent or minimize the devastating impact of COVID-19. Even as vaccinations slowly pick up, the pandemic remains disconcerting.
To learn more about this rapidly evolving situation, we had Dr Ajay Handa, Senior Consultant – Pulmonology and Critical Care at Sakra World Hospital, and Dr EV Raman, ENT Consultant at Manipal Hospitals, leading our latest Practo Connect webinar. Hosted exclusively for doctors, by doctors, it delved into the lessons we can learn from the second wave to inform the way forward.
“During the first wave, India was peaking at 1 lakh odd cases,” starts Dr Handa, adding, “This became 4.5 lakh cases in April and May this year, with the addition of more severe cases and COVID-associated deaths. Additionally, many of the clinical features exhibited during the second wave of Coronavirus in India were different.”
Not only was the transmission rate higher, but also the emergence of new variants and fatal fungal infections led to deeper concerns. At Sakra World Hospital, the population treated during this time were younger than 50 years, were unvaccinated, and included pregnant and lactating women.
“This is similar to what happened during the second wave of COVID-19 in Spain last year,” says Dr Handa. However, unlike India, the second wave in Spain involved fewer hospitalizations and lesser mortality than the first wave.
Fighting a multi-system disease
COVID-19 involves almost every organ in the body, potentially resulting in respiratory failure, renal collapse, cardiac breakdown, hyperglycemia, liver dysfunction, and Encephalopathy. Although clinical presentations were largely similar in both waves, shortage of essential medical resources and higher number of patients suffering from severe forms of COVID pneumonia and ARDS resulted in higher mortality despite standard therapy.
“Even if symptoms were more prominent during the second wave, diagnosis remained a challenge,” says Dr Handa. “False-negative rate of RT-PCR tests became common, given that several variables – including timing of the test, correctness of the sample collected and its processing in the lab – can affect the outcome of the test,” he adds.
As per patient data at Sakra, average mortality rate of COVID-19 cases handled during the second wave was 11% (compared to 6% in the first). But early treatment can greatly reduce mortality among COVID-19 patients.
“Self-monitoring of health status is critical,” says Dr Handa. “It is important to sound an alarm when experiencing Hemoptysis, chest pain, breathlessness and altered sensorium. Furthermore, patients must monitor saturation levels every six hours, and also remember to take the 6-minute walk test daily after the fifth day of diagnosis,” he adds.
Mucormycosis & COVID-19-associated fungal infections
Unfortunately, the end is elusive for some COVID-19 patients who are struck by potentially lethal fungal infections soon after recovery. For them, a seemingly innocuous nasal obstruction or facial pain can develop into an angioinvasive fungus that grows inexorably, invading tissues through the blood vessels.
“For fungal infections associated with COVID-19, there should first be a histological confirmation of the infection,” says Dr Raman. “Additionally, there should be positive evidence of RT-PCR for COVID-19, and the interval between the two infections should not be more than three months,” he adds.
There are different forms of post-COVID fungal infections, including Rhinocerebral mucormycosis, that enters through the nose, goes to the orbit and lands up in the brain.
“This enters the system through inhalation, injection or traumatic inoculation,” says Dr Raman, adding, “Spread of infection is from the nose, to the nasal cavity palate, to the orbit, and is augmented by the presence of predisposing factors in the sight of infection, including diabetes, steroids of any form, malnutrition, organ transplant cases, and more.”
Although these cases were not unheard of among renal transplant patients or among those with uncontrolled diabetes with ketoacidosis in the pre-COVID era, it has been growing at an alarming rate during the second wave of Coronavirus.
“A number of factors can cause this problem, with diabetic patients being more susceptible to black fungus. Given that India has a large population of diabetic patients and an even larger population of those who would become diabetic under certain conditions, cases of Mucormycosis in India have been widely reported,” says Dr Raman.
Mucor is everywhere, but it does not generally affect us. However, it is the lack of immunity of the nasal mucosa – especially in rhino orbital cerebral mycosis – which makes a person susceptible to black fungus.
“Once this organism enters the respiratory passage, it goes through the blood vessels, destroying tissues and making many of these areas avascular,” says Dr Raman. “Thus, this condition requires a multidisciplinary treatment approach, involving otolaryngologists, physicians, nephrologists, ophthalmologists, infectious disease specialists, plastic surgeons, orofacial maxillary surgeons and neurologists,” he adds.
In preparation of a third wave
As the first reports of COVID-19 began to sweep through last year, it took with it the world we knew. The second wave should stand as a warning of the detrimental impact this pandemic can create, prompting us to continue COVID-appropriate behavior.
Join us every month as we partner with leading industry and doctor associations for our educational webinar series, Practo Connect. Watch this, as well as previous webinars, here.