Omicron: Not so mild for the vulnerable

BMC had launched a door-to-door vaccination drive for people who were bedridden and immobile, but Singh, whose right leg was amputated, refused to get jabbed

Mumbai: In August, health workers from the civic body visited 58-year-old Brijesh Singh’s home in Malad to vaccinate him against Covid-19. The Brihanmumbai Municipal Corporation (BMC) had launched a door-to-door vaccination drive for people who were bedridden and immobile, but Singh, whose right leg was amputated, refused to get jabbed. “He told the health workers that there was no point in taking the vaccine as he hardly stepped out of the house,” said Singh’s wife Saroj.

The third wave of the pandemic, predominantly driven by the Omicron variant, is being called “mild” as the symptoms seem to range from fever to sore throats (Vijay Bate)

Fourteen years ago, Singh’s leg was amputated because of sepsis. He was diabetic but had not taken medication for years. He had suffered from tuberculosis in the past. Once a taxi driver, he stopped leaving his home after the surgery. His unvaccinated status added to his vulnerability in the pandemic.

On January 6, Singh’s family rushed him to the civic-run Shatabdi Hospital in Kandivli as he had stopped eating for two days. When they did a Covid-19 test on him, it was positive. The next day, Singh was shifted to the jumbo facility in NESCO, Goregaon, where he was admitted to the Intensive Care Unit (ICU). He died two days later. His death certificate stated that he died of Covid-19 pneumonia that led to respiratory failure.

The third wave of the pandemic, predominantly driven by the Omicron variant, is being called “mild” as the symptoms seem to range from fever to sore throats and most persons affected seem to recover within five to seven days. However, the term is misleading, experts said.

For the vulnerable population — like Singh and others with co-morbidities — Covid-19, whether it is a Delta variant or Omicron, can still be fatal.

In the past 10 days alone, Mumbai’s oxygen bed occupancy has gone up from 11.5% to 23.6%; ICU bed occupancy has gone up from 19.6% to 29.3%: and the occupancy of ventilator beds has increased from 23.3% to 34.7%. As per the case curve in the earlier waves, oxygen, ICU and ventilator beds typically start filling up seven to 12-days from the onset of infection as the patient would start displaying serious symptoms — thus requiring ventilator or ICU support — only from the 7th day onwards. In other words, as cases rise, so will the need for critical care, irrespective of the variant as a section of the population will always remain vulnerable on account of weak immunity and/or co-morbidities.

“(Singh’s) infection was widespread into the lungs, and the X-ray showed ground-glass opacities,” said Dr Neelam Andrade, dean of the NESCO facility where Singh was admitted. Ground glass opacities are hazy grey areas in the lungs suggesting pulmonary fibrosis. Singh was put on a range of medications including Remdesivir, but he did not respond to them.

In Singh’s case, his treating doctors were unaware of the variant he was infected with. “Knowing the variant won’t change anything,” said Andrade, who has been closely monitoring the progress of ICU patients. “Omicron, despite being known to cause mild infection, can cause severe disease in patients like Singh who have co-morbidities and are unvaccinated,” she said. Being unvaccinated during a pandemic increases the chances of severe disease and mortality by multifold, experts said.

“Besides co-morbidities, a lot of factors play a role in how a patient copes with the infection,” Andrade said. “Whether the patient has been on proper medications for his/her co-morbidities, are they following a healthy lifestyle, do they have good nutritional intake etc. matters immensely. We have seen patients with multiple co-morbidities turning around, and otherwise seemingly healthy patients failing to cope with the infection because of these factors,” she said.

DON’T CALL IT A MILD WAVE

Mumbai has recorded 969,989 cases and 16426 deaths due to Covid-19 since the pandemic began. At present, nearly 900 people are admitted in ICUs across the city — up from 507 on January 4. In the same time period, those hospitalized rose from 4,491 patients to 6,946, the number of cases rose from 816,965 to 969,989.

The number of infections is so widespread that it has already overwhelmed the healthcare systems. On one hand, ICUs in the private sector are full up, and on the other hand, there is an acute staff crunch with many healthcare workers down with Covid-19.

Vile Parle resident E Valsalam Yunus (63) was unable to find an ICU in the civic-run Seven Hills hospital and the private Nanavati Hospital, following which his family rushed him to the NESCO facility on January 3. Yunus remained in the ICU for five days and was discharged upon recovery. He had a history of heart disease, diabetes and hypertension, but and was unvaccinated. “He has a pacemaker and multiple stents and his heart is functioning sub-optimally with an ejection fraction (pumping ability of heart) of just 20%,” said Yunus’s daughter Angel (31). “I tried to convince him to take the vaccine multiple times, but he refused,” she said. At the start of the new year, Yunus, his wife and son developed symptoms like body ache, runny nose and cough. While his wife and son became better within two days, Yunus’s oxygen level dropped to 91.

“Calling this a mild wave sends a very wrong signal,” said Dr Anita Mathew, an internal medicine specialist at the Fortis Hospital in Mumbai. “When we have infections in such a large number, a considerable section of the population is going to need critical care,” she said.

“There is a lot of underlying Covid-19. Many patients coming with other ailments like heart attacks, accidents or any other interventions have active Covid infection. And this infection definitely plays role in the patients’ overall recovery,” she said adding that those landing up in the ICU are a mix of unvaccinated, partially vaccinated and fully vaccinated individuals. There are also some patients with re-infections requiring ICU admission, she said.

Dr Shashank Joshi, a member of the Covid-19 task force said that they have defined three broad groups as high risk: people with co-morbidities who don’t have the ability to mount their immunity despite vaccination, senior citizens and those who are unvaccinated or partially vaccinated. “We have to focus on getting people vaccinated, and those who are vaccinated should get their boosters to mount the immunity. Other than that, following strict Covid behaviour is the best weapon,” he said.