India’s Covid Surge Hit Young Patients Hard and Fast
Covid-19 cases during India’s recent surge have been more severe, with people younger than 50 getting sicker, compared with a previous wave last fall, according to doctors in hard-hit areas.
While a number of factors might have contributed, including treatment delays and inadequate access to hospital beds or oxygen, physicians interviewed by The Wall Street Journal in India said they have seen so many patients suffer serious symptoms so quickly that they believe the disease there is becoming more virulent.
“The dreaded cytokine storm, which would appear after a week in the last wave, is striking within the initial three to five days,” said Kunal Sarkar at Medica Superspecialty Hospital in Kolkata, referring to the immune-system overreaction that can be fatal.
A number of Indian doctors said those hospitalized in the surge have required more oxygen than Covid-19 patients previously needed. They described seeing faster-spreading lung damage and faster-dropping oxygen levels among relatively young patients, and longer recovery times. Covid-19 patients at all age levels have had increased oxygen needs, doctors said, but they were especially surprised to see this in younger patients.
Epidemiologists cautioned that what Indian doctors are describing is anecdotal evidence, and that more study is needed to determine whether mutations in the virus in India have led to more-severe disease. Other factors could explain what the doctors are seeing, particularly longer waits for hospital care, they said. The recent Covid-19 surge overwhelmed India’s healthcare system, leading to shortages of beds, oxygen and medication at hospitals.
Studies are under way in a number of countries to understand whether the Covid-19 variants are more virulent, as opposed to merely being more easily spread, said Giridhara R. Babu, a professor of epidemiology at the Indian Institute of Public Health in Bangalore.
New or changed symptoms described by physicians should form a part of such studies, Dr. Babu said. “One cannot ignore these observations. These are very important observations,” he said.
A few doctors said that the age range of Covid-19 patients was similar to the last wave and that the more-contagious variants now prevalent increased the number of symptomatic patients of all ages. They also noted that those under 45 were additionally exposed because vaccinations weren’t open to them until May 1.
India began recording global highs of more than 400,000 new daily Covid-19 cases in late April, four times the peak in the country’s first big wave of the disease last fall. New-case numbers have declined this month and so has the percentage of tests that are positive, although there are concerns that not enough testing is done in rural areas to get a good read.
Highly infectious virus variants have been circulating in India during the surge, including four 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 called the Indian variant, but the government objects to the term, saying it amounts to misinformation. India’s Ministry of Electronics and Information Technology says it suggested to social media firms operating in the country last week that they not allow content using the term to be posted on their platforms.
Indian scientists say one of the biggest factors driving the Covid-19 surge appears to be a particular version of the variant, called B.1.617.2.
It appears more contagious, British scientists who have studied it said in a recent report. And genomic sequencing data show that India’s surge in some areas coincided with an increase in the prevalence of B.1.617.2.
“So far, it looks like wherever B.1.617.2 is going, it is outpacing the other variants,” said Saumitra Das, director of the National Institute of Biomedical Genomics, based near Kolkata in eastern India, who is managing 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 U.S. its presence remains small, according to the Centers for Disease Control and Prevention.
Preliminary studies suggest vaccines are effective against it. The risk of developing symptomatic Covid-19 from B.1.617.2 was cut 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 PLC vaccine, researchers at the U.K.’s public health agency said in a paper 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 of cancer, HIV drugs and human genome projects, noted that in the pandemic flu a century ago, the first wave of the disease hit the elderly but then a second and worse wave came for the young.
“No matter where [the coronavirus] appears, there are many variants, and they are all different. They share some common properties, which include increased transmissibility, an increased age range and an increased disease in the young,” 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, a surge from just 25% on March 3. Covid-19 cases 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 breathless. Her blood oxygen saturation was 88%, versus a healthy level of 95% or more.
Ms. Saigal stood in line for 3½ hours at Holy Family Hospital in New Delhi to get a consultation. An X-ray showed she had pneumonia in both lungs. A doctor advised hospitalization, but the hospital had no beds available.
Five hours later, it offered her a bed in the pediatric ward, its walls decorated with hand-painted cartoons of Tom and Jerry and of Mickey and Minnie Mouse.
“It was dystopian to see adults struggling to breathe while trying to fit in those beds meant for children,” Ms. Saigal said.
After nearly two weeks, Ms. Saigal, able to breathe without the oxygen the hospital provided, went home, just in time for her mother’s birthday. She continues to struggle and is on medication for lung scarring and heart palpitations.
“What’s bothering me is how I’m not even 30 and on medicines for lungs and heart,” said Ms. Saigal.
While younger patients in India remain much more likely than older ones to survive, doctors say they’re seeing a higher share of younger Covid-19 patients dying than they did when the disease was at its earlier peak last fall. At Medanta hospital near New Delhi, several patients in their 20s with severe lung infections didn’t survive.
“This is an indication that this is a much more virulent virus strain than in the first wave,” said Naresh Trehan, a cardiac surgeon and chairman of the Medanta hospital chain, adding that his assessment was based on observation rather than clinical data.
At Guru Teg Bahadur Hospital in New Delhi, a 26-year-old junior resident physician complained of a fever in early May. The doctor, who wasn’t vaccinated, took a Covid-19 test and was admitted to the emergency room. He was diagnosed that evening and died of intracranial bleeding in the night, said B.L. Sherwal, director of the hospital.
India doesn’t have updated national data on hospitalizations by age during the surge, but some local mortality data suggest a greater impact on younger people. In Mumbai, around 40% of Covid-19-related deaths in the first 26 days of May occurred in patients younger than 60, compared with 29% during the prior, smaller surge last September.
“Young patients are requiring high-flow oxygen and ICU care,” said Suranjit Chatterjee, an internal-medicine specialist and coordinator of the Covid-19 wards at New Delhi’s Indraprastha Apollo Hospital.
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, said Madhu Gupta, a professor of community medicine and public health at the Post Graduate Institute of Medical Education and Research in Chandigarh, Punjab’s capital city.
“It’s quite scary to see that in this age group,” Dr. Gupta said. The presence of the B.1.617.2 virus type is growing in Punjab.
One evening in late April, 25-year-old Priyanka Kumari reached her parents’ home in the small town of Munger, in Bihar, in a state of great weakness. “She could not walk. She could not speak,” said Chanda Kumari, her 21-year-old sister.
The next morning, the family got Priyanka a bed in a local government hospital, which found her blood oxygen saturation to be very low. It didn’t have a ventilator or medicines, said her sister.
They found a hospital with a ventilator in a neighboring town and arranged for an ambulance to take Priyanka there. She died on the way.
“We have not been able to recover from the shock,” Chanda Kumari said.