Changing Pattern of Mortality in First and Second COVID-۱۹ Waves: A Comparative Study From Kerala, India

Background and aims: India has seen a two-wave pattern of coronavirus disease ۲۰۱۹ (COVID-۱۹) infections. The comparative characteristics of these two waves remain largely unknown. Changing trends in the demographic and clinical characteristics of the deceased COVID-۱۹ patients in these two waves helped to identify the vulnerable population and guide public health interventions to decrease mortality. Methods: We obtained COVID-۱۹ death summaries from the medical records of a large tertiary healthcare centre in North Kerala, India. Two groups of COVID-۱۹ deaths were selected: the first group included patients who died in the first wave between ۱ July ۲۰۲۰ and ۳۱ December ۲۰۲۰ (n = ۳۱۱), and the second group included those who died in the second wave between ۱ March ۲۰۲۱ and ۳۰ June ۲۰۲۱ (n = ۴۳۱). Results: The mortality in the second wave in young patients (≤۵۰ years) was ۲.۲% higher (۱۱.۸% vs. ۹.۶%, P = ۰.۳۴۶) and that in elderly patients (≥۸۰ years) was ۷.۷% higher (۱۹.۹۵% vs. ۱۲.۲%, P = ۰.۰۰۵) compared to the first wave. The average duration from symptom onset to death also significantly decreased in the second wave. Further, there was an increased proportion of COVID-۱۹-related deaths in patients with diabetes in the second wave (۵۹.۳% vs. ۵۱.۷%, P = ۰.۰۲۵). The main cause of death was respiratory failure due to COVID-۱۹ pneumonia in both waves. Conclusion: The second COVID-۱۹ wave was different from the first wave with more deaths in the young and elderly, a shorter duration from symptom onset to death, and an increase in the proportion of deaths with diabetes, maternal deaths, and deaths in those without any pre-existing comorbidities.

Keywords:

COVID-۱۹ , SARS-CoV-۲ , Pandemic , Mortality