delta london mask
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's also more severe.

Hearing impairment, severe gastric upsets and blood clots leading to gangrene, symptoms not typically seen in COVID-19 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 also now dominant there — carries a higher risk of hospitalization.

Delta, also known 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 U.S. A spike in infections, fueled by the delta variant, has forced the U.K. to reconsider its plans for reopening later this month, with a local report saying it may be pushed back by two weeks. Higher rates of transmission and a reduction in the effectiveness of vaccines have made understanding the strain's effects especially critical.

Comment: Without more data it's unclear what effect the experimental mass vaccination campaign has had on these variants, because in the UK outbreaks are correlated with an increase in vaccinations: Death rate in England is lowest since records began 20 years ago

"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-19 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."

Comment: Again, is this because of the new variant, and possibly the vaccines, or is something else causing these new symptoms?

Stomach pain, nausea, vomiting, loss of appetite, hearing loss and joint pain are among the ailments COVID-19 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.

Comment: It's notable that Black Fungus disease that was first suspected to be correlated to coronavirus and its treatments in India, and that has now been also reported in South America, is also the place where these unusual clinical symptoms are being detected. Although Black Fungus was reported to be on the rise prior to vaccinations, with cases rising 2.5 times between September & December last year.

Some patients develop micro thrombi, 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-19 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 U.K., according to a recent study by an Indian government panel.

Comment: The surge in coronavirus cases is notable. As with everywhere else, India began its vaccination campaign this year, although whether that's the cause is unclear: 200 villagers in India flee homes to avoid Covid vaccination - some jump into nearby river

The surge in cases may have driven an increase in the frequency with which rare COVID-19 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.

Comment: Clotting issues are reported by AstraZeneca vaccine recipients, with Pfizer and Moderna vaccine recipients reporting heart problems.

"We suspect it could be because of the new virus variant," he said. Manudhane is collecting data to study why some people 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-19 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.

'Atypical presentations'

The unusual presentations for delta and a closely related variant known as kappa, whose spread led to a fourth lockdown in the Australian city of Melbourne, are still being confirmed, said Raina MacIntyre, a professor of global biosecurity at the University of New South Wales in Sydney. "In the meanwhile, it is important to take note of this and be aware of possible atypical presentations," she said.

The most alarming aspect of the current outbreak in India is the rapidity with which the virus is spreading, including to children, said Chetan Mundada, a pediatrician with the Yashoda group of hospitals in Hyderabad.

Comment: It's 'spread to children', but are they showing symptoms? Or are they simply healthy children that test positive?

Entire families

Apollo's Ghafur said he was also seeing entire families with Covid symptoms, unlike last year when individuals dominated, reflecting an increase in household transmission caused by the delta variant.

Cases of Mucormycosis — a rare opportunistic fungal infection — have also been surging in India. It had infected more than 8,800 COVID-19 patients and survivors as of May 22, forcing local health care authorities to call it an epidemic.

Even as India's outbreak begins to ease — daily infections have slipped to less than a quarter of the May 7 peak — the delta variant is sparking outbreaks elsewhere, including hitherto virus havens such as Taiwan, Singapore and Vietnam, bolstering calls for mass immunization.

Comment: Again, these 'outbreaks' have been correlated with vaccine uptake.

German politician and scientist Karl Lauterbach said Tuesday the variant will probably become more prevalent in Germany too in the coming months. "To avoid it completely seems unrealistic to me," he said on Twitter in German. "The decisive factor is a very high vaccination rate, which reduces mortality."

But with emerging evidence delta and at least one other variant may be adept at evading vaccine-induced antibodies, pharmaceutical companies are under pressure to tweak existing shots or develop new ones.

Comment: If the variant is thought to be 'adept at evading the vaccine', can one assume that they know this because it's being reported in people and regions where the vaccines have been administered?

"New vaccines have to prepared with new variants in mind," said Ghafur. "We can't get ahead of the virus, but at least we can least keep up with it."