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Covid complications and deaths among youth in Maharashtra spike this year

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(This story originally appeared in on May 20, 2021)

MUMBAI: Covid-19’s second wave in Maharashtra appears to be more brutal to the young, affecting more people below 30 years of age than the first wave did in 2020.

State government’s statistics show that 651 people in the under-30 age group died between January and May 9 this year. In comparison, 1,117 below 30 died in the state in 10 months between March and December last year.

So far in 2021, 12.9 lakh people in the 20 to 40 age group have been affected, compared to 7.3 lakh in 2020, show state government statistics.

“As the number of affected youngsters is higher this time around, we are seeing more complications, longer ICU stays and deaths in this age group,” said Dr Avinash Supe, who heads the state government’s Covid death audit team.

A meeting of the death committee on Friday will analyze the reasons for mortality among the younger age group, but the morbidity patterns among them has doctors worried.

Firstly, in the second wave, there are more youngsters in ICUs. The average age of ICU admissions was 50-plus in the first wave, but now, doctors say, it is not uncommon to find people less than half that age in ICU. Dr Vasant Nagvekar, an infectious disease expert and member of the state task force, said young women, who were not so severely affected in the first wave, have needed ventilator support. “The youngest patient on ventilator at this point in Bandra’s Lilavati Hospital is a 21-year-old man,” said Nagvekar, who consults there.

Secondly, the length of stay is longer and the damage more extensive. Dr Rahul Pandit, who heads the ICU in Fortis Hospital, Mulund, and is a member of the state Covid-19 task force, said the average stay in ICU has risen to 14 to 15 days as against eight days in the first wave. “Patients, including younger ones, are coming in time, but are more hypoxic (low on oxygen),” he said.

Even after discharge, Supe said, youngsters require oxygen support for a few weeks. “Without support, their oxygen concentration levels drops to 90,” he added.

Thirdly, complications in the 20-40 group are severe. “People are in hospital for longer, and they get severe complications such as microthrombi (clumps of blood components) or pneumothorax (collapse of lungs). Not surprisingly, recovery is slower,” said a doctor from a BMC-run hospital.

Doctors feel mutations in Covid are the likely cause for the severity among 20-40s. “Mutations may have a role to play,” said Nagvekar, but pointed at two other factors: patients coming late as well as the rapid progression of the disease.

Dr Sushant Meshram, professor and head of pulmonary critical care at Government Medical College, Nagpur, said they have had patients coming with a HRCT score of 2 and 3, which rapidly jumped to 9 and 10 in a span of days. “Such rapid progression of the lung disease was certainly not seen last year,” he said.

He, too, believes mutations have had a role to play. “Besides the rise in absolute number of patients, the rapid course of the disease also probably explains why the need for medical oxygen was so high this time,” he added.

At the rural level, delay is more the reason. “Young people still don’t think they can get serious Covid. They come to hospital after an average of 8-10 days with an HRCT score of 20 and above,” said a district official from Amravati. Nagvekar said a red flag should be persistent high fever of 100-101 for five days. “One should get hospitalised immediately,” he said.

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