COVID-19 Outcomes and Genomic characterization of SARS-CoV-2 isolated from Veterans in New England States

Abstract

BackgroundClinical and virologic characteristics of COVID-19 infections in veterans in New England have not been described.ObjectivesTo evaluate clinical and virologic factors impacting COVID-19 outcomes.Study DesignWe reviewed charts and sequenced virus from nasopharyngeal specimens with confirmed SARS-CoV-2 from 426 veterans in six New England states between April and September, 2020. Peak disease severity, hospitalization, and mortality were correlated to clinical, demographic, and virologic factors.ResultsOf 426 veterans, 274 had complete and accessible charts. 92.7% were men, 83.2% White, with mean age 63 years. On multivariate regression, significant predictors of hospitalization were age (OR: 1.05) and non-white race (OR: 2.39). Mortality and peak disease severity varied by age (OR 1.06 and 1.07 respectively) and oxygen requirement on admission (OR6.74 and 45.7). Dementia (OR: 3.44) was also associated with mortality. Most (97.3%) of our samples were dominated by the spike protein D614G substitution, and were from SARS-CoV-2 B.1 lineage or one of 37 different B.1 sub-lineages, with none representing more than 8.7% of the cases.ConclusionsIn an older cohort of veterans from the six New England states with a high comorbidity burden, age was the largest predictor of hospitalization, peak disease severity, and mortality. Non-white veterans were more likely to be hospitalized, and patients who required oxygen on admission were more likely to have severe disease and higher rates of mortality. Multiple SARS-CoV-2 lineages were distributed in patients in New England early in the COVID-19 era, mostly related to viruses from New York with D614G mutation.

Clinical and virologic factors associated with outcomes of COVID‐19 before and after vaccination among Veterans: Retrospective analysis from six New England states

“…Of 3950 Veterans in six New England states with confirmed SARS‐CoV‐2+ test before full vaccination during the study period, the average age was 60 ± 18 years, with 8% female and 81% White. An early cohort of 274 Veterans from our pilot study was included in this analysis to ensure the completeness of our analysis 10 …”

“…US Veterans make a reasonably vulnerable population because of their average age of 58 years, which is higher than the average age of a US resident (38.5 years), and because Veterans are largely male (89%) 9 . At the beginning of the COVID‐19 era, we conducted a small pilot study on Veterans with COVID‐19 between April 2020 and September 2020 from the same region of New England and found age, dementia, and low BMI to be associated with mortality 10 . Here, we present the analysis of outcomes throughout the COVID‐19 era in these Veterans from the New England states.…”

Clinical and Virologic Factors associated with Outcomes of COVID-19 before and after Vaccination among Veterans: Retrospective Analysis from Six New England States

“…An early cohort of 274 Veterans from our pilot study were included in this analysis to ensure the completeness of our analysis. 25 The most common comorbidities were chronic heart disease (31%), diabetes (27%), and chronic lung disease (23%). Of the 2,399 Veterans who became fully vaccinated in our study, 53% received the Pfizer vaccine, 41% received Moderna, and 6% received Janssen (Table 1b).…”

“…From the WGS data, we found that New England Veterans (>97%) were infected with B.1 and its sub-lineages with the D614G mutation in the early (n = 282) and middle period (n = 349) of the study. 25 In the late period (n = 277), the delta (B.1.617.2, 71%) lineages predominated (Supplemental Table 2). The most common and prominent lineages and subsequent hospitalizations within those lineages are shown in Figure 2.…”

“…2,[22][23][24] In the beginning of the COVID-19 era, we conducted a small pilot study on Veterans with COVID-19 between April, 2020 and September, 2020 from the same region of New England, and found age, dementia and low BMI to be associated with mortality. 25 Here we present the analysis of outcomes throughout the COVID-19 era in these Veterans from the New England states.…”