tetano
Editor, Senior Moderator
S Afr J Infect Dis
. 2023 Dec 18;38(1):550.
doi: 10.4102/sajid.v38i1.550. eCollection 2023. Changing character and waning impact of COVID-19 at a tertiary centre in Cape Town, South Africa
Lucas E Hermans[SUP] 1 [/SUP], Petro Booysen[SUP] 2 [/SUP], Linda Boloko[SUP] 2 [/SUP], Marguerite Adriaanse[SUP] 3 [/SUP], Timothy J de Wet[SUP] 4 [/SUP], Aimee R Lifson[SUP] 5 [/SUP], Naweed Wadee[SUP] 2 [/SUP], Nectarios Papavarnavas[SUP] 6 [/SUP], Gert Marais[SUP] 7 8 [/SUP], Nei-Yuan Hsiao[SUP] 7 [/SUP], Michael-Jon Rosslee[SUP] 9 [/SUP], Gregory Symons[SUP] 10 [/SUP], Gregory L Calligaro[SUP] 10 [/SUP], Arash Iranzadeh[SUP] 11 [/SUP], Robert J Wilkinson[SUP] 2 12 13 [/SUP], Ntobeko A B Ntusi[SUP] 1 14 [/SUP], Carolyn Williamson[SUP] 15 [/SUP], Mary-Ann Davies[SUP] 16 17 [/SUP], Graeme Meintjes[SUP] 1 2 [/SUP], Sean Wasserman[SUP] 2 18 [/SUP]
Affiliations
Background: The emergence of genetic variants of SARS-CoV-2 was associated with changing epidemiological characteristics throughout coronavirus disease 2019 (COVID-19) pandemic in population-based studies. Individual-level data on the clinical characteristics of infection with different SARS-CoV-2 variants in African countries is less well documented.
Objectives: To describe the evolving clinical differences observed with the various SARS-CoV-2 variants of concern and compare the Omicron-driven wave in infections to the previous Delta-driven wave.
Method: We performed a retrospective observational cohort study among patients admitted to a South African referral hospital with COVID-19 pneumonia. Patients were stratified by epidemiological wave period, and in a subset, the variants associated with each wave were confirmed by genomic sequencing. Outcomes were analysed by Cox proportional hazard models.
Results: We included 1689 patients were included, representing infection waves driven predominantly by ancestral, Beta, Delta and Omicron BA1/BA2 & BA4/BA5 variants. Crude 28-day mortality was 25.8% (34/133) in the Omicron wave period versus 37.1% (138/374) in the Delta wave period (hazard ratio
0.68 [95% CI 0.47-1.00] p = 0.049); this effect persisted after adjustment for age, gender, HIV status and presence of cardiovascular disease (adjusted HR [aHR] 0.43 [95% CI 0.28-0.67] p < 0.001). Hospital-wide SARS-CoV-2 admissions and deaths were highest during the Delta wave period, with a decoupling of SARS-CoV-2 deaths and overall deaths thereafter.
Conclusion: There was lower in-hospital mortality during Omicron-driven waves compared with the prior Delta wave, despite patients admitted during the Omicron wave being at higher risk.
Contribution: This study summarises clinical characteristics associated with SARS-CoV-2 variants during the COVID-19 pandemic at a South African tertiary hospital, demonstrating a waning impact of COVID-19 on healthcare services over time despite epidemic waves driven by new variants. Findings suggest the absence of increasing virulence from later variants and protection from population and individual-level immunity.
Keywords: COVID-19; Delta; Omicron; SARS-CoV-2; clinical characteristics; observational study.
. 2023 Dec 18;38(1):550.
doi: 10.4102/sajid.v38i1.550. eCollection 2023. Changing character and waning impact of COVID-19 at a tertiary centre in Cape Town, South Africa
Lucas E Hermans[SUP] 1 [/SUP], Petro Booysen[SUP] 2 [/SUP], Linda Boloko[SUP] 2 [/SUP], Marguerite Adriaanse[SUP] 3 [/SUP], Timothy J de Wet[SUP] 4 [/SUP], Aimee R Lifson[SUP] 5 [/SUP], Naweed Wadee[SUP] 2 [/SUP], Nectarios Papavarnavas[SUP] 6 [/SUP], Gert Marais[SUP] 7 8 [/SUP], Nei-Yuan Hsiao[SUP] 7 [/SUP], Michael-Jon Rosslee[SUP] 9 [/SUP], Gregory Symons[SUP] 10 [/SUP], Gregory L Calligaro[SUP] 10 [/SUP], Arash Iranzadeh[SUP] 11 [/SUP], Robert J Wilkinson[SUP] 2 12 13 [/SUP], Ntobeko A B Ntusi[SUP] 1 14 [/SUP], Carolyn Williamson[SUP] 15 [/SUP], Mary-Ann Davies[SUP] 16 17 [/SUP], Graeme Meintjes[SUP] 1 2 [/SUP], Sean Wasserman[SUP] 2 18 [/SUP]
Affiliations
- PMID: 38223432
- PMCID: PMC10784273
- DOI: 10.4102/sajid.v38i1.550
Background: The emergence of genetic variants of SARS-CoV-2 was associated with changing epidemiological characteristics throughout coronavirus disease 2019 (COVID-19) pandemic in population-based studies. Individual-level data on the clinical characteristics of infection with different SARS-CoV-2 variants in African countries is less well documented.
Objectives: To describe the evolving clinical differences observed with the various SARS-CoV-2 variants of concern and compare the Omicron-driven wave in infections to the previous Delta-driven wave.
Method: We performed a retrospective observational cohort study among patients admitted to a South African referral hospital with COVID-19 pneumonia. Patients were stratified by epidemiological wave period, and in a subset, the variants associated with each wave were confirmed by genomic sequencing. Outcomes were analysed by Cox proportional hazard models.
Results: We included 1689 patients were included, representing infection waves driven predominantly by ancestral, Beta, Delta and Omicron BA1/BA2 & BA4/BA5 variants. Crude 28-day mortality was 25.8% (34/133) in the Omicron wave period versus 37.1% (138/374) in the Delta wave period (hazard ratio
0.68 [95% CI 0.47-1.00] p = 0.049); this effect persisted after adjustment for age, gender, HIV status and presence of cardiovascular disease (adjusted HR [aHR] 0.43 [95% CI 0.28-0.67] p < 0.001). Hospital-wide SARS-CoV-2 admissions and deaths were highest during the Delta wave period, with a decoupling of SARS-CoV-2 deaths and overall deaths thereafter.
Conclusion: There was lower in-hospital mortality during Omicron-driven waves compared with the prior Delta wave, despite patients admitted during the Omicron wave being at higher risk.
Contribution: This study summarises clinical characteristics associated with SARS-CoV-2 variants during the COVID-19 pandemic at a South African tertiary hospital, demonstrating a waning impact of COVID-19 on healthcare services over time despite epidemic waves driven by new variants. Findings suggest the absence of increasing virulence from later variants and protection from population and individual-level immunity.
Keywords: COVID-19; Delta; Omicron; SARS-CoV-2; clinical characteristics; observational study.