Rapid lung involvement attributed to mutations, high infectivity

Delay in getting test reports and patients seeking healthcare are additional factors

The demand for medical oxygen seems to be comparatively higher during the second wave of COVID-19. Doctors, who are seeing an increasing number of patients with rapid lung involvement, attributed the trend to mutations, high infectivity, apart from delayed reporting.

While there is no data to compare the usage of medical oxygen during the first outbreak with the current wave, doctors said the overall volume of infected persons and rapidity of the surge has made oxygen scarce.

Although patients develop pneumonia in the second week after getting infected, doctors said this is happening much earlier in some patients.

Consultant pulmonologist at Apollo Hospitals Ravindra Mehta, who is part of the State’s COVID-19 expert committee, said the possibility of the virus behaving differently during the second wave cannot be ruled out.

“The possibility of highly infectious mutants also having a more accelerated clinical course cannot be ruled out. The humongous number of people affected in a record short period of time, which shows that the virus is highly infectious, has led to a large population with moderate to severe disease requiring oxygen. This has put a tremendous load on the system,” he said.

The demand for oxygen is high also because the requirement of this life-saving commodity is not short-term. Most patients, who require oxygen, are in need of it for a long period, even after discharge, he explained.

Besides, delay in seeking healthcare, getting tested coupled with the delay in test results because of the pandemic overload are also reasons for many patients developing complications within days. “By the time a person consults a doctor, gets tested and gets his reports it is six-seven days by when pneumonia would have set in,” he said.

V. Ravi, member of the State’s COVID-19 Technical Advisory Committee (TAC) and nodal officer for genomic confirmation of SARS-CoV-2 in Karnataka, said most patients who report at hospitals with low oxygen saturation are those who would have been asymptomatic initially. This indicates that there is no proper monitoring of home-isolated patients, he said.

“Patients are deteriorating between five and 12 days as that is when their immune system becomes weak. Once a patient develops breathing problems, oxygen saturation drops rapidly in hours,” he said.

“During the first wave, the number of cases was less, and there was tremendous tracking, tracing, testing and monitoring of people in home isolation. This time, with the numbers going out of control, it has become difficult for the health system to monitor the situation,” he asserted.

Anoop Amarnath, member of Karnataka’s COVID critical care support unit (CCSU), who heads the department of Geriatric Medicine at Manipal Hospitals, said there is not much evidence yet that the disease characteristics are vastly different in the two waves. “The acute surge in cases explains the increased need for oxygen. Patients are developing complications due to delayed reporting, which was happening during the first wave too,” he added.

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