Mortality among adult hospitalized patients during the first wave and second wave of COVID-19 pandemic at a tertiary care center in India

Abstract

The similarities and differences between the mortality patterns of the two waves in India remain largely unknown. This was a retrospective study of medical records conducted in the COVID data center of our hospital This study analyzed data of patients who died in the month of August, 2020 to October 2020 (one month before and after the peak of first wave i.e., 16th September, 2020) & April 2021 to June 2021 (one month before and after the peak of second wave i.e., 6th May, 2021), corresponding to an equal part of the pandemic during first (2020) and second (2021) wave. Out of 1893 patients in the study, 764 patients were admitted during the first wave and 1129 patients during the second wave of pandemic. In total, 420 patients died during the entire study period. Of those, 147 (35%) deaths occurred during the first wave and 273 (65%) during the second wave, reflecting a case fatality rate (CFR) of 19.2% during the first wave and a CFR of 24.18%. There were no significant differences in the Age Group, Gender, Presenting Complaints, Duration of Stay and Comorbidities. However, the deceased COVID-19 patients had an increase in Case Fatality Rate, average duration of symptoms from onset to Hospital Admission (DOSHA) and a major shift from MODS to ARDS being the Cause of Death during the second wave of Pandemic. This study demonstrates increased CFR, average DOSHA and a paradigm shift to ARDS as cause of mortality during the second peak of the Pandemic. It is necessary to remain vigilant of newer COVID-19 variants of concern, follow COVID-19 appropriate behaviors and keep emphasizing on care of high-risk groups including patients with comorbidities and elderly population to prevent mortality.

Assessing the impact of the Gamma variant on COVID-19 Patient admissions in a Southern Brazilian tertiary hospital - A comparison of dual pandemic phases

“…The two waves had no statistically significant difference in disease severity or outcome, and the survival curves were similar. [11,24–26] Several factors might explain these findings, including an increase in the number of beds, the use of high-flow nasal cannulas, and the learning curve in disease management, which was associated with a standardized care protocol, enabling an optimized clinical management throughout the pandemic, resulting in fatality rates lower than previously reported in the country.…”

The role of ROX index–based intubation in COVID-19 pneumonia: a cross-sectional comparison and retrospective survival analysis

“…The mortality rate (79.3%) in our study population of severe COVID-19 with IMV was high, and bleak outcomes have been reported in ventilated COVID-19 patients worldwide [ 24 ]. This study was performed during the second wave of the pandemic in Kerala, India, which had a higher case fatality rate [ 25 ] with more frequent severe ARDS than in the first wave. Early intubation based on ROX index improved survival in our study population as evidenced by Kaplan-Meier survival analysis ( Figure 2 ), and this was not influenced by demographics or comorbidities of the patients.…”

The Association of Seasonal Variations and COVID-19 Clinical Features: A Comparative Study on the Fourth and Fifth Waves

“…In a cohort study conducted in South Africa, the second wave was associated with higher hospital admissions and increased mortality than the first wave [ 31 ]. In studies performed in India, the patients in the second wave had more comorbidities [ 32 ] and experienced a greater severity of disease [ 33 ], and their mortality was significantly higher than their first-wave counterparts [ 32 , 34 ]. A comparative study on the first and second COVID-19 waves in southern Germany showed improved survival outcomes in the second wave.…”