Three fold increase in mortality among younger Covid-19 patients: Max study

There was a 40% increase in mortality among hospitalised coronavirus disease (Covid-19) patients during the second wave of the pandemic as compared to the previous one, according to a pre-print study of hospitalisations with the viral infection across Max Healthcare hospitals that clinicians are attributing to patients reaching hospital late, when their condition already turned serious.

The study is based on clinical data from over 14,000 Covid-19 patients admitted during the first wave and over 5,400 during the second wave to Max hospitals in Delhi-NCR, Mohali, Dehradun, and Bhatinda.

While the mortality was higher across age groups during the second wave, the sharpest three-fold increase was seen among the young patients below the age of 45 years. The mortality – proportion of admitted patients who died – increased from 1.3% last year to 4.1% this year.

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“Although the age profile of the hospitalised patients remained the same during the first and the second wave of Covid-19, our data shows that the mortality among the young people increased three times which is what most clinicians have been saying. The higher mortality could be because people were reaching hospitals late – most hospitals were running full at the peak, more secondary infections, or higher mortality due to delta variant that led to the second wave,” said Dr Sandeep Budhiraja, group medical director, Max Healthcare.

The study showed that the average duration from the symptom to hospital admission among those below the age of 45 years increased by a day from 6.3 to 7.3 during the second wave. The severity of the disease at admission also increased during the second wave – 39.4% of the patients admitted were in the severe category in the second wave as compared to 32% previously. This could be because all Covid-19 patients had to be admitted, regardless of severity of disease, at the beginning of the pandemic, Dr Budhiraja explained.

There was also a statistically significant increase in the proportion of the patients who needed oxygen support during the second wave – 74% as compared to 63.4% during the first wave, the study shows.

However, despite the increase in the severity of the disease, the duration of hospitalisation went down from nine days to eight days. “This is the average; duration of hospitalisation was much longer for severe cases. This is likely the result of another policy change by the government. Initially, patients were required to get two consecutive RT-PCR negative report before discharge; now it is no longer needed or encouraged,” said Dr Budhiraja.

The proportion of Covid-19 patients who developed secondary infections was also more than double during the second wave. It increased from 11.9% during the first wave to 27.8% during the second wave.

As for the cases of mucormycosis of black fungus, there were only 10 cases and 2 deaths reported during the first wave across the Max Healthcare chain in comparison to 169 cases and 17 deaths reported this year. The study also found that the use of steroids and anticoagulants (medicine to prevent blood clots) remained high and consistent between the two waves.

“This is one of the largest studies from India on clinical profile of hospitalised Covid-19 patients. And, we have looked at various parameters such duration of hospitalisation, need for oxygen, treatments given, and laboratory markers,” said Dr Budhiraja.