Mumbai: Even though Mumbai has reported an increase in Covid-19 cases, doctors said the current surge and level of infection is far from the first two waves. After a shortage of antivirals and steroids during the first and second waves, paracetamol is dominating medical prescriptions in the current wave.
Calling the current surge, driven by the Omicron variant and its sub-variants, a blip, Dr Vasant Nagvekar, an infectious disease expert and member of the state’s Covid-19 task force, said he was the mildest form of Covid-19 since the pandemic began. “Most patients are only prescribed paracetamol for fever that sets in within 48 hours. We only admit patients with multiple comorbidities for observation,” he said.
Observing the three waves, Dr Nagvekar said the first wave was moderate where they initially struggled with medication and treated patients symptomatically.
“At first, we had no antiviral drugs. Remdesivir, a broad-spectrum antiviral drug, was not available until early June 2020, but was not widely available. The second wave was the most severe where we saw lung damage as the virus evaded the immune system. Mortality and hospitalizations were high and we also saw fungal infections. Antiviral drugs like remdesivir, favipiravir, tocilizumab and steroids have been used. It was from the third wave that we saw fewer hospitalizations and the disease is self-limiting but highly transmissible,” he said.
Dr Rajesh Sharma, a specialist in respiratory medicine at Saifee Hospital, said patients who test positive take 2-3 days to recover. “They are either asymptomatic or mildly symptomatic, in which they have a sore throat, malaise – a general feeling of being unwell, cough and fever, which lasts for 2 days,” he said.
Dr Sharma said regular paracetamol is what is prescribed for fever unless the patient has high-risk factors like multiple comorbidities and the fever persists beyond three days. “In a few patients we see discomfort lasting a little longer as well as post-viral bronchitis in which the person may deal with a persistent cough for two weeks. But no other post-Covid complications like we’ve seen in other waves,” he said.
Dr Pradip Awate, epidemiologist and state surveillance officer, said that while it was up to the ICMR or the national task force to decide whether to call it endemic, the current trend seems to indicate that we enter an endemic state.
“In the second and third wave, the doubling time for cases was the second and third day, which is not the case now. The number of cases remains the same for almost a week and then increases. The uptrend is different. It doesn’t look like a wave and within a few weeks it should calm down,” he said.
Dr Awate said the admission rate in Maharashtra is 4.5% and 95% of cases are asymptomatic or mild. “We are in regular contact with clinicians and we have not received any significant input from them regarding new cases of Covid-19,” he said.
Maharashtra’s public health department said the June surge can be attributed to the Omicron sub-variants – BA.2 and BA.2.38 – which have been seen in recent whole genome sequencing reports.
“The virus will continue to mutate. We will have more variants and sub-variants. We must be alert to new variants to verify virulence. This can be done through testing and genomic monitoring. Current Omicron subvariants are highly transmissible but milder,” said Dr Subhash Salunkhe, epidemiologist and member of the national task force.