Morbidity leads to mortality

CHENNAI: With five deaths in the last two weeks due to COVID-19, doctors highlighted the need for patients with comorbidities to be extra cautious, as most COVID-related fatalities in 2023 were among them.

While the increase of testing could be one of the reasons for deaths being reported currently, doctors say that sick patients were not tested earlier for usual procedures but that has changed now.

“Patients under treatment for liver and kidney problems or other illnesses are being tested before they are taken for any other procedures to avoid any post-operative complications due to COVID. It’s because of increased testing that we’re able to find more positive cases as well. Plus, mortality is mainly because of pre-existing health conditions,” explains Dr Suresh Kumar, infectious diseases expert, Apollo Hospital.

It’s reported that the current surge has affected individuals with comorbidities leading to an increase in mortality rates. This is not only in Tamil Nadu, but across India in the last 2 weeks, mainly caused by the sub-variant JN.1.

Deaths, co-morbidities

Despite the high transmission rate of the virus, the sub-variant has not shown any signs of progressing to its severe form, especially among those who have been vaccinated.

“COVID-related deaths are restricted to the high-risk population vulnerable to the disease progressing to its severe form. It comprises of the elderly, and patients with uncontrolled diabetes, chronic kidney disease, chronic liver disease and malignancies, on immunosuppressants, undergoing treatments like chemotherapy, etc., Any form of COVID variant among this group will lead to increased mortality,” says Dr Kiran G Kulirankal, assistant professor, division of infectious diseases, Amrita Hospital.

Officials from the Directorate of Public Health and Preventive Medicine (DPH) say that the testing of samples has been leading to undiagnosed cases being diagnosed, whereas fatalities are caused because of various other serious illnesses.

“Out of the everyday mortalities recorded in the State, only 1 or 2 are COVID-related. People dying of natural causes and other illnesses can also be tested positive for COVID. There is no surge and hence, no need to panic over any strain of the virus, including JN.1,” states Dr TS Selvavinayagam, director of DPH.

Mild infections

Doctors warn that people with mild symptoms can be carriers, and they can spread the infection to those who are already ill, which adds to the mortality and morbidity.

“JN.1 is more of the upper tract infection, but people with hybrid immunity, or immunity from previous infections and vaccinations, are not developing complications. We see a rise in patients who have comorbidities and are unvaccinated. They can become sick and severity is high. Younger people who are symptomatic can pass on the illnesses to others, including the elderly and comorbid patients at home, which can worsen the illness,” elaborates Dr Vijayalaksmi Balakrishnan, senior consultant, infectious diseases, Kauvery Hospital.

Symptoms of the JN.1 variant are similar to those observed in other members of the Omicron family. These typically begin with a sore throat, followed by congestion and a dry cough. Additional symptoms can include a runny nose, fatigue, headache, muscle aches, fever, diarrhoea, and an altered sense of smell.

“Symptoms such as breathing difficulty may be severe in individuals over 75 years or those who are immunocompromised, especially if they are not vaccinated. The vaccines used during the Omicron wave have been effective, and similar efficacy is expected against JN.1, although more data is required to fully understand the vaccine’s protective efficacy against this specific variant,” opines Dr Spoorthi Arun, consultant, internal medicine, Promed Hospital.

Follow COVID protocol

Health experts recommend revisiting the COVID precautions, such as wearing masks, frequent hand-washing, and maintaining social distance.

These measures are crucial for curtailing the transmission of the JN.1 strain, along with other public health measures to monitor and control the spread of COVID-19.

Dr Sreenivasan V, interventional pulmonologist, Gleneagles Healthcity, points out that the JN.1 variant has a single mutation in the spike protein compared to Pirola.

“Most important feature of this variant is very high transmissibility from person to person. JN.1 is known to be one of the fastest-spreading viruses due to a mutation in its spike protein – the part that latches onto the human cells,” he states. “Since 2020, every year we’re seeing the emergence of new COVID variants demanding vigilant surveillance.”

In some cases, the JN.1 variant may also present with a loss of appetite and persistent nausea. “These patients need to be quarantined for five days according to the guidelines. Patients who fall sick are mostly having pre-existing health issues. So, it’s also important for them to check with a doctor on whether they require vaccination for both influenza and pneumococcal infections,” he adds.