Abstract
ObjectivesThe clinical outcomes of the Beta (B.1.351) variant of concern (VOC) of the SARS-CoV-2 virus remain poorly understood. In early 2021, northeastern France experienced an outbreak of Beta that was not observed elsewhere. This outbreak slightly preceded and then overlapped with a second outbreak of the better understood VOC Alpha (B.1.1.7) in the region. This situation allowed us to contemporaneously compare Alpha and Beta in terms of the characteristics, management, and outcomes of critically ill patients.MethodsA multicenter prospective cohort study was conducted on all consecutive adult patients who had laboratory confirmed SARS CoV-2 infection, underwent variant screening, and were admitted to one of four intensive care units (ICU) for acute respiratory failure between January 9th and May 15th, 2021. Primary outcome was 60-day mortality. Differences between Alpha and Beta in terms of other outcomes, patient variables, management, and vaccination characteristics were also explored by univariate analysis. The factors that associated with 60-day death in Alpha- and Beta-infected patients were examined with logistic regression analysis.ResultsIn total, 333 patients (median age, 63 years; 68% male) were enrolled. Of these, 174 and 159 had Alpha and Beta, respectively. The two groups did not differ significantly in terms of 60-day mortality (19 vs. 23%), 28-day mortality (17 vs. 20%), need for mechanical ventilation (60 vs. 61%), mechanical ventilation duration (14 vs. 15 days), other management variables, patient demographic variables, comorbidities, or clinical variables on ICU admission. The vast majority of patients were unvaccinated (94%). The remaining 18 patients had received a partial vaccine course and 2 were fully vaccinated. The vaccinated patients were equally likely to have Alpha and Beta.ConclusionsBeta did not differ from Alpha in terms of patient characteristics, management, or outcomes in critically ill patients.Trial RegistrationClinicalTrials.gov, identifier: NCT04906850.
Highlights
The SARS-CoV-2 virus causes coronavirus disease-2019 (COVID-19), which can result in acute hypoxic respiratory failure secondary to pneumonia among other serious outcomes
32 patients were excluded from the study because the virus strain was not a variant of concern (VOC) (n = 26), the virus strain could not be determined (n = 5), or the patient refused to participate in the study (n = 1)
These mortality rates are similar to the mortality rates that associate with the wild-type strain: for example, two multicenter cohort studies showed that the 28-day mortality of critically ill French patients infected with the wild-type strain during the first COVID-19 wave ranged from 18 to 31% [23, 24]
Summary
The SARS-CoV-2 virus causes coronavirus disease-2019 (COVID-19), which can result in acute hypoxic respiratory failure secondary to pneumonia among other serious outcomes It was first detected in Wuhan, China at the end of 2019 and has subsequently caused a quickly spreading and ongoing pandemic that has killed millions of people worldwide [1]. Like other RNA viruses, SARS-CoV-2 is highly prone to rapid genetic evolution It became clear by late 2020 that highly transmissible and potentially more virulent variants that might be able to evade natural and vaccine immunity were arising and spreading globally. All have multiple mutations in the spike glycoprotein that are thought to increase the transmissibility of the virus One of these is N501Y, which is present in Alpha, Beta, and Gamma [4]. Almost nothing is known about the mortality rates and other outcomes that associate with this VOC
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