Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study

Twohig, K. A. et al. (2021) Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study. Lancet Infectious Diseases, (doi: 10.1016/S1473-3099(21)00475-8) (PMID:34461056) (PMCID:PMC8397301) (In Press)

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Abstract

Background: The SARS-CoV-2 delta (B.1.617.2) variant was first detected in England in March, 2021. It has since rapidly become the predominant lineage, owing to high transmissibility. It is suspected that the delta variant is associated with more severe disease than the previously dominant alpha (B.1.1.7) variant. We aimed to characterise the severity of the delta variant compared with the alpha variant by determining the relative risk of hospital attendance outcomes. Methods: This cohort study was done among all patients with COVID-19 in England between March 29 and May 23, 2021, who were identified as being infected with either the alpha or delta SARS-CoV-2 variant through whole-genome sequencing. Individual-level data on these patients were linked to routine health-care datasets on vaccination, emergency care attendance, hospital admission, and mortality (data from Public Health England's Second Generation Surveillance System and COVID-19-associated deaths dataset; the National Immunisation Management System; and NHS Digital Secondary Uses Services and Emergency Care Data Set). The risk for hospital admission and emergency care attendance were compared between patients with sequencing-confirmed delta and alpha variants for the whole cohort and by vaccination status subgroups. Stratified Cox regression was used to adjust for age, sex, ethnicity, deprivation, recent international travel, area of residence, calendar week, and vaccination status. Findings: Individual-level data on 43 338 COVID-19-positive patients (8682 with the delta variant, 34 656 with the alpha variant; median age 31 years [IQR 17–43]) were included in our analysis. 196 (2·3%) patients with the delta variant versus 764 (2·2%) patients with the alpha variant were admitted to hospital within 14 days after the specimen was taken (adjusted hazard ratio [HR] 2·26 [95% CI 1·32–3·89]). 498 (5·7%) patients with the delta variant versus 1448 (4·2%) patients with the alpha variant were admitted to hospital or attended emergency care within 14 days (adjusted HR 1·45 [1·08–1·95]). Most patients were unvaccinated (32 078 [74·0%] across both groups). The HRs for vaccinated patients with the delta variant versus the alpha variant (adjusted HR for hospital admission 1·94 [95% CI 0·47–8·05] and for hospital admission or emergency care attendance 1·58 [0·69–3·61]) were similar to the HRs for unvaccinated patients (2·32 [1·29–4·16] and 1·43 [1·04–1·97]; p=0·82 for both) but the precision for the vaccinated subgroup was low. Interpretation: This large national study found a higher hospital admission or emergency care attendance risk for patients with COVID-19 infected with the delta variant compared with the alpha variant. Results suggest that outbreaks of the delta variant in unvaccinated populations might lead to a greater burden on health-care services than the alpha variant. Funding: Medical Research Council; UK Research and Innovation; Department of Health and Social Care; and National Institute for Health Research.

Item Type:Articles
Status:In Press
Refereed:Yes
Glasgow Author(s) Enlighten ID:Li, Dr Kathy and Robertson, Professor David and Asamaphan, Dr Patawee and Mair, Mr Daniel and Tong, Dr Lily and Orton, Dr Richard and Gunson, Dr Rory and Blacow, Dr Rachel and Da Silva Filipe, Dr Ana and Hughes, Dr Joseph and Mollett, Mr Guy and Vattipally, Dr Sreenu and Thomson, Professor Emma and Johnson, Miss Natasha and Niebel, Mr Marc and Shah, Dr Rajiv and Aranday-Cortes, Dr Elihu and Singer, Dr Joshua and Jesudason, Dr Natasha and Shepherd, Dr James and Broos, Ms Alice and Carmichael, Dr Stephen and Nichols, Mrs Jenna and Nomikou, Dr Kyriaki and Illingworth, Dr Chris and Bradley-Stewart, Dr Amanda and MacLean, Dr Alasdair
Authors: Twohig, K. A., Nyberg, T., Zaidi, A., Thelwall, S., Sinnathamby, M. A., Aliabadi, S., Seaman, S. R., Harris, R. J., Hope, R., Lopez-Bernal, J., Gallagher, E., Charlett, A., De Angelis, D., Presanis, A. M., Dabrera, G., Koshy, C., Ash, A., Wise, E., Moore, N., Mori, M., Cortes, N., Lynch, J., Kidd, S., Fairley, D., Curran, T., McKenna, J., Adams, H., Fraser, C., Golubchik, T., Bonsall, D., Hassan-Ibrahim, M., Malone, C., Cogger, B., Wantoch, M., Reynolds, N., Warne, B., Maksimovic, J., Spellman, K., McCluggage, K., John, M., Beer, R., Afifi, S., Morgan, S., Marchbank, A., Price, A., Kitchen, C., Gulliver, H., Merrick, I., Southgate, J., Guest, M., Munn, R., Workman, T., Connor, T., Fuller, W., Bresner, C., Snell, L., Patel, A., Charalampous, T., Nebbia, G., Batra, R., Edgeworth, J., Robson, S., Beckett, A., Aanensen, D., Underwood, A., Yeats, C., Abudahab, K., Taylor, B., Menegazzo, M., Clark, G., Smith, W., Khakh, M., Fleming, V., Lister, M., Howson-Wells, H., Berry, L., Boswell, T., Joseph, A., Willingham, I., Jones, C., Holmes, C., Bird, P., Helmer, T., Fallon, K., Tang, J., Raviprakash, V., Campbell, S., Sheriff, N., Blakey, V., Williams, L.-A., Loose, M., Holmes, N., Moore, C., Carlile, M., Wright, V., Sang, F., Debebe, J., Coll, F., Signell, A., Betancor, G., Wilson, H., Eldirdiri, S., Kenyon, A., Davis, T., Pybus, O., du Plessis, L., Zarebski, A., Raghwani, J., Kraemer, M., Francois, S., Attwood, S., Vasylyeva, T., Escalera Zamudio, M., Gutierrez, B., Torok, M. E., Hamilton, W., Goodfellow, I., Hall, G., Jahun, A., Chaudhry, Y., Hosmillo, M., Pinckert, M., Georgana, I., Moses, S., Lowe, H., Bedford, L., Moore, J., Stonehouse, S., Fisher, C., Awan, A., BoYes, J., Breuer, J., Harris, K., Brown, J., Shah, D., Atkinson, L., Lee, J., Storey, N., Flaviani, F., Alcolea-Medina, A., Williams, R., Vernet, G., Chapman, M., Levett, L., Heaney, J., Chatterton, W., Pusok, M., Xu-McCrae, L., Smith, D., Bashton, M., Young, G., Holmes, A., Randell, P., Cox, A., Madona, P., Bolt, F., Price, J., Mookerjee, S., Ragonnet-Cronin, M., F. Nascimento, F., Jorgensen, D., Siveroni, I., Johnson, R., Boyd, O., Geidelberg, L., Volz, E., Rowan, A., Taylor, G., Smollett, K., Loman, N., Quick, J., McMurray, C., Stockton, J., Nicholls, S., Rowe, W., Poplawski, R., McNally, A., Martinez Nunez, R., Mason, J., Robinson, T., O'Toole, E., Watts, J., Breen, C., Cowell, A., Sluga, G., Machin, N., Ahmad, S., George, R., Halstead, F., Sivaprakasam, V., Hogsden, W., Illingworth, C., Jackson, C., Thomson, E., Shepherd, J., Asamaphan, P., Niebel, M., Li, K., Shah, R., Jesudason, N., Tong, L., Broos, A., Mair, D., Nichols, J., Carmichael, S., Nomikou, K., Aranday-Cortes, E., Johnson, N., Starinskij, I., da Silva Filipe, A., Robertson, D., Orton, R., Hughes, J., Vattipally, S., Singer, J., Nickbakhsh, S., Hale, A., Macfarlane-Smith, L., Harper, K., Carden, H., Taha, Y., Payne, B., Burton-Fanning, S., Waugh, S., Collins, J., Eltringham, G., Rushton, S., O'Brien, S., Bradley, A., Maclean, A., Mollett, G., Blacow, R., Templeton, K., McHugh, M., Dewar, R., Wastenge, E., Dervisevic, S., Stanley, R., Meader, E., Coupland, L., Smith, L., Graham, C., Barton, E., Padgett, D., Scott, G., Swindells, E., Greenaway, J., Nelson, A., McCann, C., Yew, W., Andersson, M., Peto, T., Justice, A., Eyre, D., Crook, D., Sloan, T., Duckworth, N., Walsh, S., Chauhan, A., Glaysher, S., Bicknell, K., Wyllie, S., Elliott, S., Lloyd, A., Impey, R., Levene, N., Monaghan, L., Bradley, D., Wyatt, T., Allara, E., Pearson, C., Osman, H., Bosworth, A., Robinson, E., Muir, P., Vipond, I., Hopes, R., Pymont, H., Hutchings, S., Curran, M., Parmar, S., Lackenby, A., Mbisa, T., Platt, S., Miah, S., Bibby, D., Manso, C., Hubb, J., Chand, M., Dabrera, G., Ramsay, M., Bradshaw, D., Thornton, A., Myers, R., Schaefer, U., Groves, N., Gallagher, E., Lee, D., Williams, D., Ellaby, N., Harrison, I., Hartman, H., Manesis, N., Patel, V., Bishop, C., Chalker, V., Ledesma, J., Twohig, K., Holden, M., Shaaban, S., Birchley, A., Adams, A., Davies, A., Gaskin, A., Plimmer, A., Gatica-Wilcox, B., McKerr, C., Moore, C., Williams, C., Heyburn, D., De Lacy, E., Hilvers, E., Downing, F., Shankar, G., Jones, H., Asad, H., Coombes, J., Watkins, J., Evans, J., Fina, L., Gifford, L., Gilbert, L., Graham, L., Perry, M., Morgan, M., Bull, M., Cronin, M., Pacchiarini, N., Craine, N., Jones, R., Howe, R., Corden, S., Rey, S., Kumziene-SummerhaYes, S., Taylor, S., Cottrell, S., Jones, S., Edwards, S., O'Grady, J., Page, A., Mather, A., Baker, D., Rudder, S., Aydin, A., Kay, G., Trotter, A., Alikhan, N.-F., de Oliveira Martins, L., Le-Viet, T., Meadows, L., Casey, A., Ratcliffe, L., Simpson, D., Molnar, Z., Thompson, T., Acheson, E., Masoli, J., Knight, B., Ellard, S., Auckland, C., Jones, C., Mahungu, T., Irish-Tavares, D., Haque, T., Hart, J., Witele, E., Fenton, M., Dadrah, A., Symmonds, A., Saluja, T., Bourgeois, Y., Scarlett, G., Loveson, K., Goudarzi, S., Fearn, C., Cook, K., Dent, H., Paul, H., Partridge, D., Raza, M., Evans, C., Johnson, K., Liggett, S., Baker, P., Bonner, S., Essex, S., Lyons, R., Saeed, K., Mahanama, A., Samaraweera, B., Silveira, S., Pelosi, E., Wilson-Davies, E., Williams, R., Kristiansen, M., Roy, S., Williams, C., Cotic, M., Bayzid, N., Westhorpe, A., Hartley, J., Jannoo, R., Lowe, H., Karamani, A., Ensell, L., Prieto, J., Jeremiah, S., Grammatopoulos, D., Pandey, S., Berry, L., Jones, K., Richter, A., Beggs, A., Best, A., Percival, B., Mirza, J., Megram, O., Mayhew, M., Crawford, L., Ashcroft, F., Moles-Garcia, E., Cumley, N., Smith, C., Bucca, G., Hesketh, A., Blane, B., Girgis, S., Leek, D., Sridhar, S., Forrest, S., Cormie, C., Gill, H., Dias, J., Higginson, E., Maes, M., Young, J., Kermack, L., Gupta, R., Ludden, C., Peacock, S., Palmer, S., Churcher, C., Hadjirin, N., Carabelli, A., Brooks, E., Smith, K., Galai, K., McManus, G., Ruis, C., Davidson, R., Rambaut, A., Williams, T., Balcazar, C., Gallagher, M., O'Toole, Á., Rooke, S., Hill, V., Williamson, K., Stanton, T., Michell, S., Bewshea, C., Temperton, B., Michelsen, M., Warwick-Dugdale, J., Manley, R., Farbos, A., Harrison, J., Sambles, C., Studholme, D., Jeffries, A., Jackson, L., Darby, A., Hiscox, J., Paterson, S., Iturriza-Gomara, M., Jackson, K., Lucaci, A., Vamos, E., Hughes, M., Rainbow, L., Eccles, R., Nelson, C., Whitehead, M., Turtle, L., Haldenby, S., Gregory, R., Gemmell, M., Wierzbicki, C., Webster, H., de Silva, T., Smith, N., Angyal, A., Lindsey, B., Groves, D., Green, L., Wang, D., Freeman, T., Parker, M., Keeley, A., Parsons, P., Tucker, R., Brown, R., Wyles, M., Whiteley, M., Zhang, P., Gallis, M., Louka, S., Constantinidou, C., Unnikrishnan, M., Ott, S., Cheng, J., Bridgewater, H., Frost, L., Taylor-Joyce, G., Stark, R., Baxter, L., Alam, M., Brown, P., Aggarwal, D., Cerda, A., Merrill, T., Wilson, R., McClure, P., Chappell, J., Tsoleridis, T., Ball, J., Buck, D., Todd, J., Green, A., Trebes, A., MacIntyre-Cockett, G., de Cesare, M., Alderton, A., Amato, R., Ariani, C., Beale, M., Beaver, C., Bellis, K., Betteridge, E., Bonfield, J., Danesh, J., Dorman, M., Drury, E., Farr, B., Foulser, L., Goncalves, S., Goodwin, S., Gourtovaia, M., Harrison, E., Jackson, D., Jamrozy, D., Johnston, I., Kane, L., Kay, S., Keatley, J.-P., Kwiatkowski, D., Langford, C., Lawniczak, M., Letchford, L., Livett, R., Lo, S., Martincorena, I., McGuigan, S., Nelson, R., Palmer, S., Park, N., Patel, M., Prestwood, L., Puethe, C., Quail, M., Rajatileka, S., Scott, C., Shirley, L., Sillitoe, J., Spencer Chapman, M., Thurston, S., Tonkin-Hill, G., Weldon, D., Rajan, D., Bronner, I., Aigrain, L., Redshaw, N., Lensing, S., Davies, R., Whitwham, A., Liddle, J., Lewis, K., Tovar-Corona, J., Leonard, S., Durham, J., Bassett, A., McCarthy, S., Moll, R., James, K., Oliver, K., Makunin, A., Barrett, J., and Gunson, R.
College/School:College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
Journal Name:Lancet Infectious Diseases
Publisher:Lancet Publishing Group
ISSN:1473-3099
ISSN (Online):1474-4457
Published Online:27 August 2021
Copyright Holders:Copyright © 2021 Crown Copyright
First Published:First published in Lancet Infectious Diseases 2021
Publisher Policy:Reproduced under a Creative Commons License

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