COVID-19 patients age, comorbidity profiles and clinical presentation related to the SARS-CoV-2 UK-variant spread in the Southeast of France

Abstract

The variant 20I/501Y.V1, associated to a higher risk of transmissibility, emerged in Nice city (Southeast of France, French Riviera) during January 2021. The pandemic has resumed late December 2020 in this area. A high incidence rate together with a fast turn-over of the main circulating variants, provided us the opportunity to analyze modifications in clinical profile and outcome traits. We performed an observational study in the University hospital of Nice from December 2020 to February 2021. We analyzed data of sequencing of SARS-CoV-2 from the sewage collector and PCR screening from all positive samples at the hospital. Then, we described the characteristics of all COVID-19 patients admitted in the emergency department (ED) (n = 1247) and those hospitalized in the infectious diseases ward or ICU (n = 232). The UK-variant was absent in this area in December, then increasingly spread in January representing 59% of the PCR screening performed mid-February. The rate of patients over 65 years admitted to the ED decreased from 63 to 50% (p = 0.001). The mean age of hospitalized patients in the infectious diseases ward decreased from 70.7 to 59.2 (p < 0.001) while the proportion of patients without comorbidity increased from 16 to 42% (p = 0.007). Spread of the UK-variant in the Southeast of France affects younger and healthier patients.

Health system impacts of SARS-CoV − 2 variants of concern: a rapid review

“…COVID-19 patients admitted during the Alpha wave were more likely to be younger with intermediate levels of frailty (Cusinato et al, UK, January 2020-March 2021, high quality)[ 55 ] • In patients hospitalized with COVID-19, Alpha was associated with a 33% higher risk of severe COVID-19 than wild-type (aOR 1.33 95% CI 1.03-1.72) (Martin-Blondel, France, Jan-Feb 2021, medium quality)[ 34 ] • Individuals infected with VOC, primarily Alpha, were more likely to require hospitalization (aOR 1.57 [95% CI 1.47-1.69] in Ontario and aOR 1.88 [95% CI 1.74-2.02] in Alberta) than those without VOC (McAlister et al, Canada, March 2020-March 2021, medium quality)[ 35 ] • Risk of hospital admission within 14 days after a positive test was higher for patients with Alpha than wild-type (HR 1.52 (95% CI 1.47 to 1.57). The absolute risk of hospital admission after 14 days was 4.7% (95% CI 4.6 to 4.7%) for patients with Alpha and 3.5% (95% CI 3.4 to 3.5%) for those wild-type (Nyberg et al, England, Nov 2020-Jan 2021, high quality)[ 61 ] • Alpha was associated with more severe disease than those from other lineages (median cumulative odds ratio: 1.40, 95% CI 1.02-1.93) (Pascall et al, Scotland, Nov 2020-Jan 2021, high quality)[ 67 ] • Alpha was associated with a 1·9-fold increased risk of hospitalization compared to non-VOC (aRR 95%CI 1.6-2.3) (Veneti et al, Norway, Dec 2020-Jun 2021, high quality)[ 71 ] • After correcting for mean age, sex, ambient temperature, and humidity, there was no association between Alpha and the number of symptoms reported over a 4-week period after a positive test or the number of hospitalizations (Graham et al, Scotland, Wales and England, Sep-Dec 2020, high quality )[ 65 ] • While risk of hospitalization within 14 days of a test and time to hospital admission from symptom onset were similar, Alpha patients were younger, had fewer comorbidities, and more likely to be from an ethnic minority compared to non-Alpha patients (Frampton et al, UK, Nov-Dec 2020, high quality)[ 57 ] • Pairing 29 Alpha cases to 58 controls (non-Alpha) on age and gender, there was no significant difference in time from first symptoms to emergency department admission or severity (Courjon et al, France, Dec 2020-Feb 2021, medium quality)[ 47 ] • Alpha did not lead to more severe disease in children and young people in the UK, with children admitted during the Alpha wave having lower Paediatric Early Warning Scores (PEWS) at presentation, lower antibiotic use, and less respiratory and cardiovascular support (Swann et al, UK, Jan 2020-Jan 2021, medium quality)[ 37 ] • There was no statistically significant difference between time from symptom onset to hospitalization or length of stay between Alpha patients and non-VOC patients (Whittaker et al, Norway, Dec 2020-Apr 2021, high quality)[ 73 ] Beta • Compared to Alpha, the odds of progressing to severe disease were 1.24-fold (95% CI 1.11-1.39) higher for Beta (Abu-Raddad, Qatar, Jan-May 2021, medium quality)[ 75 ] • Hospital admission rates were significantly h...…”

“…• Pairing 29 Alpha cases to 58 controls (non-Alpha) on age and gender, there was no significant difference in time from first symptoms to emergency department admission or severity (Courjon et al, France, Dec 2020-Feb 2021, medium quality)[ 47 ]…”

“…There was no significant interaction between Alpha and sex, ethnic group, or age group (Patone et al, England, Nov 2020-Jan 2021, high quality)[ 68 ] • In the Alpha wave, almost half of total ICU patients were admitted (803 out of the total 1680 patients), suggesting greater ICU admission than pre-VOC (Area et al, Spain, March-April 2021, high quality)[ 62 ] • The probability of ICU admission was twice as high among patients with Alpha compared to wild-type (OR 2.11, 95 CI% 1.55 − 2.87) (Martinez-Garcia, Spain, Jan-April 2021, medium quality)[ 50 ] • ICU admission was higher with Alpha (6.3%) compared to non-Alpha (3.4%) (Pascall et al, Scotland, Nov 2020-Jan 2021, high quality)[ 67 ] • Significantly more hospitalized Alpha patients were transferred to ICU (27.7%) compared to 8.6% of non-Alpha patients (Vassallo et al, France, Oct 2020-Apr 2021, medium quality)[ 38 ] • Alpha was associated with a 1.8-fold increased risk of ICU admission compared to non-VOC (aRR 95% CI 1.2-2.8) (Veneti et al, Norway, Dec 2020-Jun 2021, high quality)[ 71 ] • There was no significant difference between those admitted to the ICU before Alpha was dominant (23%) compared to after (26 and 35%), p = 0.374. For ICU patients, neither the severity score at admission (SAPSII) nor the depth of the respiratory distress seemed to increase with Alpha (Courjon et al, France, Dec 2020-Feb 2021, medium quality)[ 47 ] • No difference was found for progressing to critical disease between wild-type and Alpha (Abu-Raddad, Qatar, Jan-May 2021, medium quality)[ 75 ] • There was no difference in ICU admission between pre-Alpha and Alpha wave (Cusinato et al, UK, January 2020-March 2021, high quality)[ 55 ] • No overall increase in ICU admission was associated Alpha (HR 1.01, (95% CI 0.75-1.37, p = 0.94); however, women with Alpha may be at an increased risk of admission to ICU (HR 1.82, 95% CI 1.15-2.90, p = 0.011) (Stirrup et al, UK, Nov 2020-Jan 2021, high quality )[ 69 ] • There was no change in the proportion of children and young people admitted to critical care between the pre-Alpha (12.9%) and Alpha wave (12.7%) (Swann et al, UK, Jan 2020-Jan 2021, medium quality)[ 37 ] • There was no difference between Alpha patients (16%) and non-VOC patients (18%) admitted to the ICU (Whittaker et al, Norway, Dec 2020-Apr 2021, high quality)[ 73 ] Beta • Compared to Alpha, the odds of progressing to critical disease were 1.49-fold (95% CI 1.13-1.97) higher for Beta (Abu-Raddad, Qatar, Jan-May 2021, medium quality)[ 75 ] • Beta was associated with a 2.7-fold increased risk of ICU admission compared to non-VOC (aRR 95% CI 1.2-6.5) (Veneti et al, Norway, Dec 2020-Jun 2021, high quality)[ 71 ] • The proportion of patients admitted to the ICU was lower in the Beta wave (35.0%...…”

“…• There was no significant difference between those admitted to the ICU before Alpha was dominant (23%) compared to after (26 and 35%), p = 0.374. For ICU patients, neither the severity score at admission (SAPSII) nor the depth of the respiratory distress seemed to increase with Alpha (Courjon et al, France, Dec 2020-Feb 2021, medium quality)[ 47 ]…”

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“…Algunos autores reportaron aumento en la severidad del desenlace clínico y fatalidad, con mayor riesgo en mujeres, mayor posibilidad de hospitalización en cuidados intensivos, requerimiento de oxígeno y apoyo mecánico ventilatorio, con ligeras diferencias respecto a lo reportado por la variante Beta. [9][10][11] Variantes de sars-CoV-2: surgimiento y presentación clínica sars-CoV-2 Variants: Emergence and Clinical Presentation Indira R. Mendiola-Pastrana, * Geovani López-Ortiz. * En octubre de 2020 fue identificada la variante Delta, la cual se convirtió rápidamente en la variante más común en todo el mundo.…”