|
 
 |
| REVIEW ARTICLE |
|
| Year : 2022 | Volume
: 9
| Issue : 4 | Page : 219-222 |
|
COVID 19 second wave – What has changed since the first wave
Madiha Abdul Nazer, Latha Ragunathan, P Bharathi, I Deepika
Department of Microbiology, Aarupadai Veedu Medical College, Puducherry, India
| Date of Submission | 25-Feb-2022 |
| Date of Decision | 25-Apr-2022 |
| Date of Acceptance | 01-Jun-2022 |
| Date of Web Publication | 17-Mar-2023 |
Correspondence Address:
Latha Ragunathan
Department of Microbiology, Aarupadai Veedu Medical College, Kirumampakkam, Puducherry - 607 402
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/cjhr.cjhr_21_22
A pandemic named SARS-COV2 COVID 19 affected many people's life in different ways globally. The normal life is still far away, lockdown rules have been relaxed in many countries. Morbidity and mortality increased a lot after the first wave. COVID-19 has affected medical education in a significant way. Most of the patients were asymptomatic during the second wave and some had symptoms such as myalgia, fever, and cough, which complicated to pneumonia, respiratory distress, and thromboembolic complications. There have been the development of many vaccines such as Covaxin, Pfizer–BioNTech, Covishield, Sputnik V, and Moderna, and these vaccinations have been given to frontline medical workers, people with comorbidities, aged people, etc., with high priority and then the general population. Many pregnant and peripartum women were put on Extracorporeal Membrane Oxygenation (ECMO) in severe to critical cases. A new black fungus was found in post-COVID 19 infections. It was named mucormycosis which usually affected immunocompromised people. There is a high importance in the examination of all the different epidemiological variables of all the places in all the regions across the world, to understand the mutations, and severity of the disease and also to be prepared. Many studies done on COVID-19 in first and the second wave was reviewed in detail and were compared for this review.
Keywords: Black fungus, COVID 19, desaturation, pregnancy, second wave
How to cite this article:
Nazer MA, Ragunathan L, Bharathi P, Deepika I. COVID 19 second wave – What has changed since the first wave. CHRISMED J Health Res 2022;9:219-22 |
How to cite this URL:
Nazer MA, Ragunathan L, Bharathi P, Deepika I. COVID 19 second wave – What has changed since the first wave. CHRISMED J Health Res [serial online] 2022 [cited 2023 Mar 31];9:219-22. Available from: https://www.cjhr.org/text.asp?2022/9/4/219/371935 |
| Introduction | |  |
The SARS-COV2 virus has disturbed many people's life across the world and it was declared as a pandemic on March 11, 2020, by the WHO called COVID-19.[1] Till now, the production and supply of these vaccines are also a difficult challenge. The trio that includes hand hygiene, social distancing, and wearing masks has become a part of people's life.[1] Many mutations happened to the SARS-COV2 virus and a second wave started by September 2020.[2] The mutant strains that were identified were SARS-COV2 lineage B.1.1.7 (UK), Brazil (P. 1), South Africa (B.1.351), and India (B.1.617).[3]
| Materials and Methods | | |
For this recent review on COVID-19s wave, our aim was to compare the first and the second wave of the pandemic. What all changes happened during the second wave. Patient count, effect in pregnancy, black fungus, etc., during the second wave, was taken into account for review. Many original articles, website articles, news articles, and WHO websites were reviewed for this current review.
| Second Wave in India | | |
Even though India has taken drastic steps to control COVID-19 pandemic along with high-level political support, there was a worsened second wave with an interval of 5 months from the first wave.[1],[4] There was a sudden rise in cases by the middle of February. The first wave was controlled with effective methods of the medical workers, governmental officials, and other frontline workers.[1] The highest patient count of 2 lakhs was observed in April 2021 in India.[1] In the first wave, only a few people in a family were affected, but in the second wave, almost 90% of the family members were affected.[4] First, testing capacity in India was also a huge burden, but now, there are more than 992 testing laboratories with all the equipment and also appropriate arrangements (CBNAAT, RTPCR, and TrueNat).[4] More than 0.2 million deaths were recorded in India.[5] Many states were badly affected and this was mostly due to community transmission. The main reason for community transmission were, careless behavior of people, large rallies and gatherings like Kumbh Mela, easing restrictions, etc.[5] There was a severe shortage in masks, personal protective equipment, ventilators, testing kits, lack of medical professionals and also hospital beds.[5] India started the vaccination drive in January 2021 with a reliable vaccine Covishield (Oxford–Astra Zeneca). Due to the difficulty in traveling, many patients start developing severe symptoms even before they can reach the hospital. Due to the double mutant SARS-COV2 virus, the relaxations given by the government, etc., also have caused a significant rise in the number of cases. These people were mostly belonging to rural villages. The number of reinfections among the people also came up.
| Sudden Desaturation | | |
Lungs are considered the most affected organ during COVID-19. The patients come with complaints like of body ache, fever, severe headache, fatigue, diarrhea, loss of taste sensation, sore throat, dyspnea, vomiting, and loss of smelling sensation.[6] Mild–moderate COVID-19 infections approximated to be 80% and severe to critical cases approximated to be 20%. According to how the disease is presenting to an individual, the complications of COVID-19 remain vague and long term.[7] Whatever management and treatment protocol is being followed has proven to be very much effective and supportive.[5] During the pandemic, many researches were done based on interleukin 6 pathway inhibitors, hydroxychloroquine, etc., such as remdesivir, tocilizumab, dexamethasone, and convalescent plasma. Dexamethasone and remdesivir were the researched drugs, which were shown to be of much importance compared to the other drugs investigated, as it decreased the hospital stay of the patients and also reduced the complications of the infection. After plenty of research conducted worldwide, it has come to a conclusion that dexamethasone should be given to patients who are categorized as moderate and severe cases.[2],[7] After the patient became asymptomatic, some started developing second-time breathlessness after an interval of some days, even if they were managed well with treatment protocol for pneumonia associated with COVID-19. Many theories have been proposed for this second phase of breathlessness. However, mainly two theories were taken into account for lung fibrotic changes after the COVID-19 infections and also subclinical infectious symptoms. Lung fibrosis and lung abnormalities were clearly seen in the patients who developed pneumonia during COVID-19 infection, mainly after their discharge.[5] Because of the dysregulation of the healing process, pulmonary fibrosis may have occurred.[6] It can be also caused due to inflammation which is chronic. Post-COVID 19 infection and inflammation, lung tissue changes were observed both molecular-wise and cellularly too. These changes lead to damage to the tissue, which then leads to growth factor-β1 transformation, over expression of interleukin-1, inflammatory cytokines, tumor necrosis factor-α, and interleukin-6. It also leads to rise in fibroblast recruitment and also type 2 alveolar cells proliferation and stimulation. As a final result, there will be gas exchange impairment, extracellular matrix will be excessively produced and deposited, and finally leading to hypoxemia.[7]
| The Impact on Education | | |
There were many objectives that were badly affected during COVID-19 pandemic. However, the most badly affected was the medical education and also its related evaluations. In different countries globally, many courses of actions were done, in order to bring back the quality of education. Moreover, this was done by getting different viewpoints and opinions from different places and also assessing their experiences.[8] Everything became online platform, that included, theory classes, clinical positioning and also teaching sessions. Since the last many months, simulations for medical classes, virtual reality, and conferences both audio and video transformed the medical education to a great extent. These teaching policies are considered good, but these policies should have excellent conclusions and should be regularly evaluated.[9] For the continuation of medical education and to finish the curriculum according to the syllabus and on time, these teaching policies have helped a lot, but there is a problem. There is no proof that it has helped with the health management of the patient. It has been proposed that proper evaluation methods have to be implemented without disturbing the structure, design, or assessment methods.[10] In countries, were they are resource-limited, online teaching sessions such as viva, objective structured clinical examination, and webinars have shown to be helpful tools of assessment. The educational planning programs and all the future strategies are mainly affected due to economic loss in many countries during this pandemic. Due to this economic downpour, there is a large burden on medical education as it is an expensive system.[8]
| Pregnancy and Second Wave | | |
There was a significant rise in the peripartum and pregnant women with moderate, severe, and critical cases of COVID-19 infection. The morbidity and mortality raised at a significant rate. Many were admitted to the intensive care units and also were transferred to noninvasive ventilation and ECMO.[11] ECMO patients who were pregnant and during their peripartum period were more in the second wave than seen in the first wave, suggesting that the highly infective mutant strains of SARS-COV2 might have caused the significant rise in the infections among pregnant women.[12] However, some studies suggest that the mutant variant B.1.1.7 which was first seen in the UK, has not been responsible for the rise of cases among affected pregnant females during the second wave and does not cause more severe.[13] This trend was mostly seen in the second wave and many pregnant females were affected in a bad way with a remarkedly high percentage of cases. There are studies suggestive of severe consequences with pregnancy, where there is a significant increase in the LSCS births and iatrogenic preterm babies which can be due to fetus compromise or maternal compromise or both.[14] There are still talks and debates on the relationship between stillbirth and COVID-19 infection, but this relationship with neonatal deaths has not been proved yet. Other than that, related studies suggest that, neonates who get infected with COVID-19 is suggested to be mainly due to vertical transmission from the COVID-positive mother.[9] Various studies and hypotheses have been suggested regarding all these changes, but finally, the result is unclear. Many researches have to be conducted regarding these new mutant variants and its relation with the new shift and for the protection of pregnant women, whether health policies and regulations regarding COVID-19 in public should be modified or not.
| Black Fungus | | |
There was a significantly sharp rise in cases of invasive rhino-cerebral-ocular mucormycosis infection with COVID-19 (coronavirus infection disease 2019) patients in India during the second wave.[10] Most of the COVID-19 patients and Post-COVID patients suffering from this complication of mucormycosis had some of the underlying comorbidity mainly diabetes mellitus, but infections are also seen in immunocompetent persons.[11] The related complications of vision loss, brain abscess, and stroke are observed. Both morbidity and mortality during this second wave of this pandemic are on an increase post this fungal infection. Mainly in India during the second wave, too many cases of this fungal infection were reported, were hospital system handled the tough situation by prescribing steroids early and given for a longer time in the hope of avoiding the need for oxygen and hospital admission.[15] India is the deemed diabetes capital of the world. Severe COVID -19 causes enablement of the immune system which increases ferritin. COVID-19 is often linked with lymphopenia.[16]
Therefore, a combination of steroids, diabetes, high ferritin, and lymphopenia could be contributing to the present sudden and steep rise of mucormycosis cases.[11] With such a swift rise in cases, there is an urgent need to identify the patients at risk of this fungal infection and start sudden treatment to save lives and avoid worsening complications. Mucormycosis in Post-COVID-19 patients in India has reached epidemic percentage.[17],[18]
| Conclusion | | |
The current pandemic second wave has led to escalated morbidity and mortality rates, especially in developing countries like India. There is a high probability of experiencing a third wave of COVID-19 in many countries due to numerous factors. Factors such as weather patterns, politics, economics, population density, and comorbidities have led to the uninterrupted transmission and spread of the SARS-CoV-2. Lack of vaccines, treatment modalities, and COVID-19 test kits are among other contributing components to the aggravating and continuous transmission, spread, and increased morbidity rates related to COVID-19.[19] It has been suggested that there is an urgent need to continuously encourage and create awareness of COVID-19 vaccination programs worldwide to increase the acceptability and uptake of the vaccines. Therefore, confinement of the COVID-19 pandemic requires a multisectoral approach.[20] Strategies and plans should be made to get rid of the vaccine hesitancy among the general population so that the majority of the people are vaccinated, and herd immunity will be reached.[21]
Acknowledgment
We are grateful to the Institute to provide a suitable environment for helping in the publication of this review article.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Asad A, Srivastava S, Verma MK. Evolution of COVID-19 pandemic in India. Trans Indian Natl Acad Eng 2020;5:1-8.  |
| 2. | Ranjan R, Sharma A, Verma MK. Characterization of the second wave of COVID-19 in India. Curr Sci 2021;121:85-93. |
| 3. | |
| 4. | Thiagarajan K. Why is India having a COVID-19 surge? BMJ 2021;373:n1124. |
| 5. | |
| 6. | Alghizzawi MI, Ata F, Yousaf Z, Alhiyari MA, Bint I Bilal A, Elhiday A, et al. The second wave of desaturation in coronavirus disease 2019. New Microbes New Infect 2021;41:100866. |
| 7. | |
| 8. | Jodheea-Jutton A. Reflection on the effect of COVID-19 on medical education as we hit a second wave. MedEdPublish 2021;10:7. |
| 9. | Ahmed H, Allaf M, Elghazaly H. COVID-19 and medical education. Lancet Infect Dis 2020;20:777-8. |
| 10. | Pedro SA, Ndjomatchoua FT, Jentsch P, Tchuenche JM, Anand M, Bauch CT. Conditions for a second wave of COVID-19 due to interactions between disease dynamics and social processes. Front Physics 2020;8:514. |
| 11. | Upasana K, Rastogi N, Thakkar D, Yadav A, Arora S, Yadav S. Mucormycosis surge with the second wave of COVID-19 in India. Authorea 2021. DOI:10.22541/au.162187153.39497488/v1. |
| 12. | Cacciapaglia G, Cot C, Sannino F. Second wave COVID-19 pandemics in Europe: A temporal playbook. Sci Rep 2020;10:15514. |
| 13. | Asghar M, Din M. The expected second wave of COVID-19. Int J Clin Virol 2020;4:109-10. |
| 14. | Siston AM, Rasmussen SA, Honein MA, Fry AM, Seib K, Callaghan WM, et al. Pandemic 2009 influenza A (H1N1) virus illness among pregnant women in the United States. JAMA 2010;303:1517-25. |
| 15. | Iftimie S, López-Azcona AF, Vallverdú I, Hernández-Flix S, de Febrer G, Parra S, et al. First and second waves of coronavirus disease-19: A comparative study in hospitalized patients in Reus, Spain. PLoS One 2021;16:e0248029. |
| 16. | Petrikkos G, Tsioutis C. Recent advances in the pathogenesis of mucormycoses. Clin Ther 2018;40:894-902. |
| 17. | Garg D, Muthu V, Sehgal IS, Ramachandran R, Kaur H, Bhalla A, et al. Coronavirus disease (COVID-19) associated mucormycosis (CAM): Case report and systematic review of literature. Mycopathologia 2021;186:289-98. |
| 18. | Sen M, Lahane S, Lahane TP, Parekh R, Honavar SG. Mucor in a viral land: A tale of two pathogens. Indian J Ophthalmol 2021;69:244-52. [ PUBMED] [Full text] |
| 19. | Martini M, Gazzaniga V, Bragazzi NL, Barberis I. The Spanish Influenza Pandemic: A lesson from history 100 years after 1918. J Prev Med Hyg 2019;60:E64-7. |
| 20. | Kashyape R, Jain R. The utility of HRCT in the initial diagnosis of COVID-19 pneumonia – An Indian perspective. Indian J Radiol Imaging 2021;31:S178-81. |
| 21. | Kadiwar S, Smith JJ, Ledot S, Johnson M, Bianchi P, Singh N, et al. Were pregnant women more affected by COVID-19 in the second wave of the pandemic? Lancet 2021;397:1539-40. |
|
Search Pubmed for