Covid-19 virulent, unpredictable, highly contagious now: Doctors

Nagpur: Along with being highly contagious, Covid-19 is virulent and unpredictable in the second wave, as per doctors who are diagnosing and treating positive patients. The district is reportedly witnessing 3-5 times rise in number of moderate and severe patients in the second wave as compared to the first one.
Radiologist Dr Rajkumar Khandelwal told TOI, “In the first wave, around 5% patients used to have chest CT score of 9-15 (moderate). This time it has increased to 15%. About 15% patients used to have zero CT score in the first wave. Now, it has dropped to below 5%,” he said.
Intensivist Dr Nikhil Balankhe said, “The number of moderate and severe patients has increased 4-5 times in second wave. Condition of around 50% patients starts deteriorating within a week. This time many young patients are requiring ventilators and few are succumbing to the disease. Infection in young patients was very less in first wave,” he said.
According to pulmonologist Dr Rajesh Swarnakar, there is steep rise in patients with CT score of 10 or more. “Disease has become virulent. We are seeing patients getting infected rapidly. The condition is deteriorating very fast and recovery period is longer even after oxygen and other support. Virus has certainly mutated and become more dangerous,” he said.
Dr Swarnakar, also national secretary of Indian Chest Society, emphasizes that in absence of any definitive cure for Covid, the job of doctors is to give supportive care but it’s the patient’s appropriate immune response that has to win this battle in second wave. “Most of them win it but some with comorbidities like diabetes, and alcoholics fail to survive,” he said.
Senior critical care specialist Dr Rajan Barokar said that the disease progressed in a predictable manner, though medicines were limited, in the first wave. “Now, the disease is very unpredictable. Condition of stable patients is worsening in no time. CT scores don’t match with low oxygenation. There are some patients with higher (>15/25) CT score and are absolutely stable with normal oxygenation. At the same time, we have seen patients with CT score < 5 but having lower saturation,” he said.
Dr Barokar also said that this time C-reactive protein (CRP) as a marker of severity is also not very dependable. “I have seen many patients whose CRP on presentation or in first 3-5 days was sky high, which doesn't went hand in hand with clinical signs,” he said.
He further said that some patients in urban as well as rural areas are being treated at home by local doctors following people’s reluctance to get admitted due to lack of human resource or relatives’ support and finance. “It is leading to misjudgment of the regime in this second wave. Those who do not need Remdesivir are being given it. Condition of those who were wrongly given steroids (without low oxygen) in first 5-7 days, flared up leading to higher mortality in second wave,” he said.
In 25 days of April, the district has registered 1,838 deaths which is 2.4 times of March (763) and 1.25 times of September last year (1,465).
The second wave is also highly contagious. Positive cases were 48,457 in September last year which was peak of first wave. There were 76,250 cases in March which is 1.6 times of September.
In just 25 days of April, the district has registered 1,48,150 cases, which is three times of September last year and almost two times of March.