India's Second COVID Wave: How is it different from the First Wave?

PURPOSE: India is witnessing the resurgence of the COVID-19 pandemic in the form of a hard-hitting second wave. We wanted to compare the clinical profile of the first wave (April-June 2020) with the second wave (March-May 2021) of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), to help prioritize the target population group and management strategies. This will further help in the management of any upcoming third COVID wave. METHODS & MATERIALS: We conducted a retrospective observational study and examined the demographic profile, symptoms, illness severity, baseline investigations, treatment given, comorbidities, and outcomes of the COVID-19 patients belonging to the first (W1) and the second (W2) waves of the Indian COVID pandemic. RESULTS: W2 had most people affected in the age group 50.5 (17.7) years compared with 37•1 (16•9) for W1. Baseline oxygen saturation was lower for W2 [84•0 (13•4) % versus(v/s) 91•9 (7•4) %] than W1. 70.2 % of the cases belonged to the severe category in W2 compared to 37.5% in W1. The level of hepatic transaminases was higher for W2 [AST, 108.3 (99.3) v/s 54.6 (69.3); ALT, 97.6 (82.3) v/s 58.7 (69.7) IU/L] than W1. CT severity score in W2 [29.5 (6.7)] was greater than W1 [23•2 (11•5)] [All P<0.05]. The standardized mortality ratio for W2 was 3.5 times that of W1. Higher proportion of patients require oxygen (81.8% v/s 11.2%), high flow nasal cannula (11.4% v/s 5.6%), non-invasive ventilation (41.2% v/s 1.5%), invasive ventilation (24.5% v/s 0.9%), and ICU admissions (56.4% v/s 12.0%) in W2 as compared with W1. We found the second wave to be stronger in terms of oxygen requirement, organ dysfunction, and mortality CONCLUSION: Higher age, oxygen and ventilator requirement, ICU admissions, and organ failure are more prevalent in the second COVID wave that has hit India compared to the first wave and is associated with more deaths. India swiftly needs to scale up the prevalent ICU set up and oxygen production capacity to help accommodate the higher load.