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VOLUME 65 , ISSUE 2 ( April-June, 2023 ) > List of Articles


Comparative Analysis of First, Second, and Third Waves of COVID-19 Infection in Himachal Pradesh – North India: A Retrospective Study

Manisha Bhardwaj, Pratibha Himral, Rajesh Bhawani

Keywords : Coronavirus disease-2019, Differences, Mortality, Waves

Citation Information : Bhardwaj M, Himral P, Bhawani R. Comparative Analysis of First, Second, and Third Waves of COVID-19 Infection in Himachal Pradesh – North India: A Retrospective Study. Indian J Chest Dis Allied Sci 2023; 65 (2):85-91.

DOI: 10.5005/jp-journals-11007-0070

License: CC BY-NC 4.0

Published Online: 01-11-2023

Copyright Statement:  Copyright © 2023; The Author(s).


With the evolving coronavirus disease-2019 (COVID-19) pandemic, India witnessed multiple peaks with dissimilarities at various levels. We conducted a cross-sectional study on COVID-19 patients admitted at a tertiary care hospital in Himachal Pradesh, India, during the peak of the first wave (from 1 November 2020 to 20 November 2020), the second wave (from 20 April 2021 to 10 May 2021), and the third wave (from 15 January 2022 to 15 February 2022) to evaluate differences in the clinico-demographic profile and treatment outcomes. A total of 300 confirmed cases of COVID-19 were included in the analysis, 100 from each wave. The mean age (in years) of study participants during the first, second, and third waves was [mean ± standard deviation (SD)] 56.94 ± 14.80, 54.92 ± 14.98, and 61.29 ± 18.69, respectively; p = 0.16. Males outnumbered females in all three waves. The hospital stay was maximum during the second wave (mean ± SD; 12.22 ± 8.81 days) when compared to the first (5.21 ± 3.43 days) and third waves (3.71 ± 2.74 days); p = 0.008. Fever and cough were primarily reported in the first wave (with p < 0.001 and p = 0.001, respectively). Gastrointestinal symptoms were more common in the second and third waves (p < 0.001). Diabetes, hypertension, and cardiovascular diseases were common underlying diseases among admitted patients in three waves. Total leukocyte count, neutrophil-to-lymphocyte ratio, and erythrocyte sedimentation rate were higher in the second wave (p = 0.004; p < 0.001; and p < 0.001, respectively). The incidence of liver dysfunction was more common in the second wave. The second wave was deadly both in terms of severity and mortality as compared to the first and third waves. The younger age-group (18–40 years) was largely affected during the second wave while the elderly age-group was primarily affected during the third wave.

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  1. Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382(18):1708–1720. PMID: 32109013.
  2. World Health Organization. Timeline of WHO's response to COVID-19. Available at: Accessed on: August 1, 2021.
  3. Coronavirus outbreak in India. Available at: Accessed on: August 1, 2021.
  4. Iftimie S, Ló Pez–Azcona AF, Vallverdú I, et al. First and second waves of coronavirus disease-19: A comparative study in hospitalized patients in Reus, Spain. PLoS One 2021;1–13. DOI: 10.1371/journal.pone.0248029.
  5. Soriano V, Ganado–Pinilla P, Sanchez–Santos M, et al. Main differences between the first and second waves of COVID-19 in Madrid, Spain. Int J Infect Dis 2021;105:374–376. PMID: 33684560.
  6. Cossio Y, Aller MB, Abadias MJ, et al. Comparing the first and second waves of COVID-19 in a tertiary university hospital in Barcelona. F1000Res 2021;10:1197. DOI: 10.12688/f1000research.73988.1.
  7. Contou D, Fraisse M, Pajot O, et al. Comparison between frst and second wave among critically ill COVID-19 patients admitted to a French ICU: No prognostic improvement during the second wave? Crit Care 2021;25(1):3. DOI: 10.1186/s13054-020-03449-6.
  8. Reddy MM, Zaman K, Mishra SK, et al. Differences in age distribution in first and second waves of COVID-19 in eastern Uttar Pradesh, India. Diabetes Metab Syndr Clin Res Rev 2021;15(6):1–2. PMID: 34731821.
  9. Mitra S, Muley A, Bavishi A, et al. Characteristics and outcomes of COVID-19 during the third wave of COVID pandemic: A single-center descriptive study. J Assoc Physicians India 2023;71(2):37–40. PMID: 37354469.
  10. Clinical Management Protocol for COVID-19 (In Adults) Version 3 Updated 13.06.2020; Government of India, Ministry of Health and Family Welfare. Directorate General of Health Services (EMR Division). 2020.
  11. Clinical Management Protocol for COVID-19 (In Adults) Version 6 Updated 24.05.2021 Government of India Ministry of Health and Family Welfare. Directorate General of Health Services (EMR Division). 2021.
  12. Sarkar A, Chakrabarti AK, Dutta S. COVID-19 infection in India: A comparative analysis of the second wave with the first wave. Pathogens 2021;10(9):1222. PMID: 34578254.
  13. COVID-19 in Himachal Pradesh. Available at: Accessed on: April 18, 2023.
  14. Sharma P, Rattan S, Katoch V, et al. COVID-19 pandemic: Probing the dynamics in the North Himalayan state. Indian J Community Fam Med 2022;8(1):44. DOI: 10.4103/IJCFM.IJCFM_59_21.
  15. Seong H, Hyun HJ, Yun JG, et al. Comparison of the second and third waves of the COVID-19 pandemic in South Korea: Importance of early public health intervention. Int J Infect Dis 2021;104:742–745. PMID: 33556610.
  16. Singh S, Sharma A, Gupta A, et al. Demographic comparison of the first, second and third waves of COVID-19 in a tertiary care hospital at Jaipur, India. Lung India 2022;39(6):525–531. PMID: 36629231.
  17. Jacobsen H, Klein SL. Sex differences in immunity to viral infections. Front Immunol 2021;12:720952. PMID: 36629231.
  18. World Health Organization. Living guidance for clinical management of COVID-19: Living guidance. World Health Organization; 2021. Available at: Accessed on: October 1, 2021.
  19. RECOVERY Collaborative group; Horby P, Lim WS, et al. Dexamethasone in Hospitalized Patients with COVID-19. N Engl J Med. 2021 Feb 25;384(8):693–704. PMID: 32678530.
  20. Kunno J, Supawattanabodee B, Sumanasrethakul C, et al. Comparison of different waves during the COVID-19 pandemic: Retrospective descriptive study in Thailand. Adv Prev Med 2021;2021:1–8. PMID: 34659835.
  21. Ghosh T, Biswas MK. A comparative study between the first and second waves of world threatening COVID-19 disease. Eur J Transl Clin Med 2020;7(11):8234–8256. ISSN: 2515-8260.
  22. Magray TA, Nazir U, Rather RH, et al. Demographic and mortality trends across three COVID-19 waves in Kashmir Division, India. Asian J Med Sci 2022;13(10):23–28. DOI: 10.3126/AJMS.V13I10.47234.
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