Clinical profile of hospitalized COVID-19 patients in first & second wave of the pandemic: Insights from an Indian registry based observational study

Abstract

Background & objectives: India witnessed a massive second surge of COVID-19 cases since March 2021 after a period of decline from September 2020. Data collected under the National Clinical Registry for COVID-19 (NCRC) were analysed to describe the differences in demographic and clinical features of COVID-19 patients recruited during these two successive waves.

Methods: The NCRC, launched in September 2020, is an ongoing multicentre observational initiative, which provided the platform for the current investigation. Demographic, clinical, treatment and outcome data of hospitalized, confirmed COVID-19 patients were captured in an electronic data portal from 41 hospitals across India. Patients enrolled during September 1, 2020 to January 31, 2021 and February 1 to May 11, 2021 constituted participants of the two successive waves, respectively.

Results: As on May 11, 2021, 18961 individuals were recruited in the registry, 12059 and 6903 reflecting in-patients from the first and second waves, respectively. Mean age of the patients was significantly lower in the second wave [48.7 (18.1) yr vs. 50.7 (18.0) yr, P<0.001] with higher proportion of patients in the younger age group intervals of <20, and 20-39 yr. Approximately 70 per cent of the admitted patients were ≥ 40 yr of age in both waves of the pandemic. The proportion of males were slightly lower in second wave as compared to the first [4400 (63.7%) vs. 7886 (65.4%), P=0.02]. Commonest presenting symptom was fever in both waves. In the second wave, a significantly higher proportion [2625 (48.6%) vs. 4420 (42.8%), P<0.003] complained of shortness of breath, developed ARDS [422(13%) vs. 880 (7.9%), P<0.001], required supplemental oxygen [1637 (50.3%) vs. 4771 (42.7%), P<0.001], and mechanical ventilation [260 (15.9%) vs. 530 (11.1%), P<0.001]. Mortality also significantly increased in the second wave [OR: 1.35 (95% CI: 1.19, 1.52)] in all age groups except in <20 yr.

Interpretation & conclusions: The second wave of COVID-19 in India was slightly different in presentation than the first wave, with a younger demography, lesser comorbidities, and presentation with breathlessness in greater frequency.

Keywords: Complication; National Clinical Registry for COVID-19; outcome; pandemic waves; symptom.

Fig. 1

Spot map of India indicating the hospitals participating in the National Clinical Registry for COVID-19. Institutes Participating in the National Clinical Registry for COVID-19: (i) North: Postgraduate Institute of Medical Education & Research, Chandigarh; Medanta Institute of Education and Research, Gurugram; Christian Medical College, Ludhiana; Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak. (ii)West: All India Institute of Medical Sciences, Jodhpur; Rajasthan University of Medical Sciences, Mahatma Gandhi Medical College and Hospital, Jaipur; Sardar Patel Medical College, Bikaner; Smt. NHL Muncipal Medical College, CIMS Hospital, Ahmedabad; Sumandeep Vidyapeeth and Institution, Deemed to be University & Dhiraj Hospital, Vadodara; GMERS Medical College and Hospital, Himmatnagar. (iii) East: All India Institute of Medical Sciences, IMS & SUM hospital, Hitech Medical college, Bhubaneswar; Patliputra Medical College & Hospital, Dhanbad; Government Medical college, Jagdalpur; Institute of Post-Graduate Medical Education and Research, The Medical College, Infectious Diseases & Beliaghata General Hospital, College of Medicine and Sagore Dutta Hospital, Kamarhati, Tata Medical Centre, Kolkata; All India Institute of Medical Sciences, ESI hospital, Raipur. (iv) Central: Aligarh Muslim University, Aligarh; All India Institute of Medical Sciences, Gandhi Medical College, Bhopal; King George's Medical University, Lucknow; Government Institute of Medical Sciences, Greater Noida; R.D. Gardi Medical College, Ujjain; J.N. Medical College, Banaras Hindu University, Varanasi. (v) North-East: North-Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong; Naga Hospital Authority, Kohima, Nagaland. (vi) South: National Institute of Mental Health and Neuro-sciences, Bowring and Lady Curzon Medical college and Research Institute, St. John's Medical College Hospital, Bengaluru; Nizam's Institute of Medical Sciences, ESIC Medical College, Hyderabad; Gulbarga Institute of Medical Sciences, Kalburgi; Gandhi Medical College, Secunderabad; Kakatiya Medical College/MGM Hospital, Warangal.

Fig. 2

The two waves of COVID-19 pandemic in India.

Fig. 3

Comparison of the common presenting complaints in symptomatic patients during the 1^st (n=10338) and 2^nd wave (n=5404) of the pandemic.