The similarities and differences between the mortality patterns of the two waves in India remain largely unknown. This was a retrospective study of medical records conducted in the COVID data center of our hospital This study analyzed data of patients who died in the month of August, 2020 to October 2020 (one month before and after the peak of first wave i.e., 16th September, 2020) & April 2021 to June 2021 (one month before and after the peak of second wave i.e., 6th May, 2021), corresponding to an equal part of the pandemic during first (2020) and second (2021) wave. Out of 1893 patients in the study, 764 patients were admitted during the first wave and 1129 patients during the second wave of pandemic. In total, 420 patients died during the entire study period. Of those, 147 (35%) deaths occurred during the first wave and 273 (65%) during the second wave, reflecting a case fatality rate (CFR) of 19.2% during the first wave and a CFR of 24.18%. There were no significant differences in the Age Group, Gender, Presenting Complaints, Duration of Stay and Comorbidities. However, the deceased COVID-19 patients had an increase in Case Fatality Rate, average duration of symptoms from onset to Hospital Admission (DOSHA) and a major shift from MODS to ARDS being the Cause of Death during the second wave of Pandemic. This study demonstrates increased CFR, average DOSHA and a paradigm shift to ARDS as cause of mortality during the second peak of the Pandemic. It is necessary to remain vigilant of newer COVID-19 variants of concern, follow COVID-19 appropriate behaviors and keep emphasizing on care of high-risk groups including patients with comorbidities and elderly population to prevent mortality.

There are numerous publications describing the epidemiology and clinical outcome of patients infected with COVID-19. However, limited studies solely describing the fatalities, especially in India. In this retrospective, single-centre analysis of patients’ case records, we aim to describe and discuss the demographics, clinical, laboratory findings in 201 patients who expired as a result of SARS CoV-2 infection. Electronic medical files of all confirmed COVID-19 patients, admitted to the ICU between 1st February 2020 and 15th July 2020, were scanned retrospectively and data was collected from files of the fatalities only, without revealing patient identity at any point. The data, including demographics (age, sex, comorbidities), clinical presentation, baseline laboratory parameters, SOFA score and duration of illness was recorded and analyzed statistically. A total of 201 deceased patients were included in the study, out of which 58.2% were males. The median age was 59 years (IQR: 47.5 – 65 years) which appears to be less than a lot of studies conducted outside India. Majority of patients had classical influenza-like symptoms at presentation (74.1%), but a sizable number also had extra-pulmonary manifestations (24.9%). Eight patients had isolated neurological presentation. It was found that number of comorbidities increased, and duration of illness decreased with increasing age, and this was statistically significant (p 0.03 and 0.01, respectively). SOFA score was found to be an important marker of severity of illness in COVID patients. ARDS remained the primary cause of death in 87.1% patients, although septic shock was observed in 34.8%. Six patients expired due to a high suspicion of pulmonary thromboembolism.

The year 2020 saw the rise of an influenza-like illness from SARS-nCoV2 (Severe Acute Respiratory Illness by novel Coronavirus 2), which causes myriad of symptoms in patients, ranging from mild upper respiratory symptoms to severe ARDS (Acute Respiratory Distress Syndrome). It is, however, known to cause high morbidity and mortality in patients with underlying comorbidities like diabetes, hypertension, kidney disease, obesity and malignancies. Amongst these, the subset with haematological malignancies has an especially poor prognosis possibly as a result of immune suppression, due to underlying bone marrow depression as well as effects of chemotherapeutic agents. These patients need frequent visits and admissions to the hospital for treatment, thus exposing them to the risk of acquiring the infection. Also, a high index of suspicion, with low threshold for testing is needed in view of possible atypical presentation and symptoms. These patients may also warrant an early ICU admission, as they tend to develop severe disease with ARDS more frequently, with an overall poor prognosis and high mortality rate. We hereby present a series of six patients with underlying haematological malignancies who were admitted in our ICU with a serious COVID-19 illness and a grave outcome.