Gangrene, Hearing Loss, Show Delta Variant May Be More Severe

• The coronavirus variant driving India's devastating COVID-19 second wave is the most infectious to emerge so far. Doctors now want to know if it is also more severe.
• Hearing impairment, severe gastric upsets and blood clots leading to gangrene, symptoms not typically seen in COVID patients, have been linked by doctors in India to the so-called Delta variant. In England and Scotland, early evidence suggests the strain - which is now also dominant there - carries a higher risk of hospitalization.
• Delta, also know as B.1.617.2, has spread to more than 60 countries over the past six months and triggered travel curbs from Australia to the USA. A spike in infections, fuelled by the variant, has forced the UK to reconsider its plans for reopening later this month, with a local report saying it may be pushed back by two weeks. Singapore found that the mutation accounted for 95% of the local COVID samples linked to variants of concern. Higher rates of transmission and a reduction in the effectiveness of vaccines have made understanding the strain's effects especially critical.
• 'We need more scientific research to analyze if these newer clinical presentations are linked to B.1.617 or not,' said Abdul Ghafur, an infectious disease physician at the Apollo Hospital in Chennai, southern India's largest city. Ghafur said he is seeing more COVID patients with diarrhea now than in the initial wave of the pandemic.

New Enemy

• 'Last year, we thought we had learned about our new enemy, but it changed,' Ghafur said. 'This virus has become so, so unpredictable.'
• Stomach pain, nausea, vomiting, loss of appetite, hearing loss and joint pain are among the ailments COVID patients are experiencing, according to six doctors treating patients across India. The beta and gamma variants - first detected in South Africa and Brazil respectively - have shown little or no evidence of triggering unusual clinical signs, according to a study by researchers from the University of New South Wales last month.
• Some patients develop micro thrombic, or small blood clots, so severe that they led affected tissue to die and develop gangrene, said Ganesh Manudhane, a Mumbai cardiologist, who has treated eight patients for thrombotic complications at the Seven Hills Hospital during the past two months. Two required amputations of fingers or a foot.
• 'I saw three-to-four cases the whole of last year, and now it's one patient a week,' Manudhane said.

Baffling Clots

• India has reported 18.6 million COVID cases thus far in 2021, compared with 10.3 million last year. The delta variant was the primary cause behind the country's deadlier second wave and is 50% more contagious than the alpha strain that was first spotted in the UK, according to a recent study by an Indian government panel.
• The surge in cases may have driven an increase in the frequency with which rare COVID complications are being observed. Even still, Manudhane said he is baffled by the blood clots he's seeing in patients across age groups with no past history of coagulation-related problems.
• 'We suspect it could be because of the new virus variant,' he said. Manudhane is collecting data to study why some develop the clots and others don't.
• Doctors are also finding instances of clots forming in blood vessels that supply the intestines, causing patients to experience stomach pain - their only symptom, local media have reported.
• Some COVID patients are also seeking medical care for hearing loss, swelling around the neck and severe tonsillitis, said Hetal Marfatia, an ear nose and throat surgeon at Mumbai's King Edward Memorial Hospital.
• 'Every person is showing different symptoms,' in the second wave, she said.