Hospitalization of covid patients was influenced by govt policies: WHO

Citing a study by researchers at the Eternal Hospital and LBS College of Pharmacy in Jaipur, WHO said people were encouraged to seek hospital care in the March-December 2020 period, while home isolation was promoted after the emergence of the delta variant and the surge in covid cases, primarily due to the lack of hospital beds and the pressure on India’s healthcare system.

The study, Greater Covid-19 Severity and Mortality in Hospitalized Patients in Second (Delta) Wave Compared to the First: Single Centre Prospective Study in India, was published in the medRxiv journal on 7 September. It has, however, not been peer reviewed yet.

According to the study, during the second wave, patients reported more severe disease compared to those who were infected during the first wave. At its peak in April-May 2021, patients required in-hospital oxygen support, invasive and non-invasive ventilatory support, and longer stays in intensive care units (ICUs), with far higher mortality rate compared to the first wave, it added.

The study said the median length of stay during pre-delta versus delta circulation period was higher at eight days compared to seven days, and ICU period was at nine days versus six days during the fist wave. In-hospital deaths were also 1.84 times higher during the period of delta circulation. “However, the study should be interpreted carefully as these are preliminary results. Note, hospitalization rates pre- and post-emergence of (d)elta variant were influenced by government policies,” WHO said.

On 2 July 2020, the Union health ministry had said that patients with mild, moderate and severe symptoms must be admitted in covid care centres, dedicated covid health centres and dedicated covid hospitals, respectively. On 28 April, the ministry revised its guidelines advising home isolation for mild and asymptomatic patients, when India was reporting 450,000 daily cases that led to a shortage of medical oxygen, hospital beds and ICU set-ups.

“Emergence of (d)elta variant threw the Indian health system in unchartered terrain. While prior to (d)elta emergence, hospital-based isolation of covid-19 patients was a feasible and most appropriate solution to contain spread, the sudden surge caused by the (d)elta variant made that strategy redundant,” said Himanshu Sikka, lead—health, nutrition and, water, sanitation and hygiene, IPE Global, a development consultancy.

“Government thus had no choice but to educate and push people towards home isolation in mild cases, so that critical cases could get hospital care. While home isolation helped reduced pressure on health facilities, it was not successful in containing the spread in the second wave due to the nature of the virus, which spread to all family members once entering the house,” Sikka added.