For the past two days, the Tamil Nadu Health Department’s COVID-19 bulletin has created a separate list of deaths of patients who have had no comorbidities.
On June 7, six individuals who tested positive for the SARS-CoV-2 virus that causes the disease COVID-19 passed away despite having no underlying health factors. A day later, Tamil Nadu reported three more deaths of patients who had no co-morbid factors. These were individuals who were reportedly healthy, with some having age on their side. So, what explains their deaths?
TNM analysed data from May 4, when the TN health bulletin first began publishing detailed case-wise reports, until June 8. Out of 252 deaths that were recorded during this period, at least 47 COVID-19 patients or over 18.65% died despite having no medical condition. An age-wise breakup sheds more light on the numbers.
There were six patients or 2.38% between the age of 30-39 who succumbed to COVID-19 without having any co-morbidities. The fatalities increase with each decade. Eight persons or 3.17% who were aged between 40 and 49 died due to COVID-19. None of them had any reported medical conditions at the time of admission. There were 12 deaths in the age bracket of 50-59, with eight being men and four women. In all, 10.31% below the age of 60 died despite being healthy. At least 21 senior citizens (60+) who did not report any co-morbid factors also died of the disease.
Such deaths are not limited to TN and other states also have a small percentage of people without co-morbidities dying due to COVID-19.
Dr Narayana Babu, the Director of Medical Education (DME) and the Dean of Omandurar Government Multi Superspeciality Hospital in Chennai asserted that a majority of deaths in Tamil Nadu were of patients with co-morbidities. “More than 90-95% are persons who have comorbidities. Only 5% of such deaths are of those who don’t have any co-morbid factors,” says Dr Narayana.
TNM spoke to three doctors to understand the deaths of individuals who were relatively young and healthy.
Dr V Ramasubramanian, Infectious Disease Specialist, Apollo Hospitals in Chennai, points out that COVID-19 is like any other infectious disease and can be fatal to even those who are fit and healthy. Like Dr Narayana, however, Dr Ramasubramanian also notes that young and healthy dying is a small percentage.
“Age increases the risk of death but that doesn’t mean that if you are fit and healthy you can’t die. You can die. The ratio of death in young people should be about .3% So three out of 1000 people can die. Why can’t we accept that? People die of typhoid, people die of chickenpox, people can die of hepatitis A. So people can die of COVID also. You don’t need to be over 60 and with uncontrolled diabetes to die,” says Dr Ramasubramanian.
Dr K Kolandaswamy, who recently retired as Director of Public Health (DPH), however, flags undiagnosed medical conditions in COVID-19 patients as a reason for deaths. “It is very unlikely that the virus will cause mortality among the healthy. For those below 60 years, there is more probability of undiagnosed co-morbid conditions,” says Kolandaswamy. He adds that besides the mandatory CT chest scan, a number of hospitals are now doing abdominal examinations to rule out any hidden medical factors. “The new school of thought is that all cases should have a complete investigation. Even at the time of admission, each patient should be diagnosed for any hidden undiagnosed condition,” he says.
All three doctors emphasise seeking out medical care at the earliest.
“Those who are symptomatic should report earlier, and get treatment. They will be ok,” says the DME, who notes, “No fever should be taken lightly, nor any throat infection. At this juncture, any fever, any throat infection and contact history should be given importance. If anyone has a cough and respiratory distress, they should immediately seek medical attention,” says Dr Narayana.
Physical distancing and wearing a mask are essential to prevent getting infected, says Dr Ramasubramanian. However, he warns, “If someone is young and ignores his symptoms and stays at home, and comes at the time when he is very very ill, he may die. So, what people need to understand is that irrespective of the age, people who are young are less likely to die. But you still need to access medical care to ensure everything is alright. Most people recover without issues, but if you are feeling breathless and you ignore it, then you can end up reaching the hospital too late for anybody to help you.”
Data from the Tamil Nadu Health Department shows that out of the six individuals in the age bracket of 30-39 who died of COVID-19, five died within three days of hospitalisation. Take the case of a 30-year-old man from Chennai, who was admitted on June 4 at 3.40 pm in the Rajiv Gandhi Government General Hospital. He had given his samples for COVID-19 testing a day earlier at a private lab. However, even before his test result came out, he had to be admitted to the government hospital. But he died within ten minutes of admission at 3.50pm. Registered as Death Case No. 236 as per the TN health bulletin, the 30-year-old died, who had no other medical conditions, died due to “cardiopulmonary arrest, acute abdomen, perforation peritonitis, and septic shock”.
Dr Ramasubramanian says COVID-19 can in some rare occasions cause cytokine storm in young patients. Cytokine storm is an overreaction by a patient’s immune system to fight off an infection. It can cause high fevers, respiratory distress and lung damage in some individuals and can even be fatal. “COVID can cause multi organ dysfunction, resembling sepsis probably because of the cytokine storm. So this is uncommon in the young, I don't mean to say that it can’t happen. I mean to say that it is less likely to happen,” says the Apollo Hospitals doctor.
Cases of cytokine storms have been reported in Chennai hospitals, says Dr Narayana and that there is a protocol in place for treatment.
As per the TN Health Department’s data, some of the leading causes of death among a majority of COVID-19 patients who had no pre-existing conditions, is respiratory failure, and pneumonia.
Dr Narayana Babu says, “The coronavirus has an affinity for the lungs. So, viral load has a direct impact on the lungs so those who are affected get lung infection. That is the main culprit. The young should be aware of any respiratory distress, cough, and immediately take an X ray and CT and check oxygen saturation.”
The former DPH Kolandaswamy says that chain smokers in particular are susceptible to COVID-19. He points to cases where young patients have died of hypoxia - low levels of oxygen in the blood.
TNM had earlier reported how monitoring oxygen levels using a finger pulse oximeter is essential in COVID-19 cases.
Cases of young and healthy dying due to COVID-19 have been reported from the United States as well. In April, Washington Post reported at least 759 deaths of individuals under the age of 50 in the US.
Scientists are researching whether a person’s genes could make them more vulnerable to COVID-19. Some others suggest that young people are dying due to low levels of surfactant, a bodily substance that helps the lungs expand, reported CNN .
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