Abstract
BackgroundThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) alpha variant (B.1.1.7) is associated with higher transmissibility than wild-type virus, becoming the dominant variant in England by January 2021. We aimed to describe the severity of the alpha variant in terms of the pathway of disease from testing positive to hospital admission and death.MethodsWith the approval of NHS England, we linked individual-level data from primary care with SARS-CoV-2 community testing, hospital admission, and Office for National Statistics all-cause death data. We used testing data with S-gene target failure as a proxy for distinguishing alpha and wild-type cases, and stratified Cox proportional hazards regression to compare the relative severity of alpha cases with wild-type diagnosed from 16 November 2020 to 11 January 2021.ResultsUsing data from 185 234 people who tested positive for SARS-CoV-2 in the community (alpha = 93 153; wild-type = 92 081), in fully adjusted analysis accounting for individual-level demographics and comorbidities as well as regional variation in infection incidence, we found alpha associated with 73% higher hazards of all-cause death (adjusted hazard ratio [aHR]: 1.73; 95% confidence interval [CI]: 1.41–2.13; P < .0001) and 62% higher hazards of hospital admission (1.62; 1.48–1.78; P < .0001) compared with wild-type virus. Among patients already admitted to the intensive care unit, the association between alpha and increased all-cause mortality was smaller and the CI included the null (aHR: 1.20; 95% CI: .74–1.95; P = .45).ConclusionsThe SARS-CoV-2 alpha variant is associated with an increased risk of both hospitalization and mortality than wild-type virus.
Highlights
The SARS-CoV-2 (COVID-19) variant of concern B.1.1.7, called the alpha variant, was first identified in Kent, UK in autumn 2020.1 Early analysis estimated that alpha is more transmissible than the original lineage and it became the dominant strain throughout the UK in early 2021.2 Only a small number of alpha cases were originally identified by whole-genome sequencing
T For analysis of hospital admission, follow-up began at the date of testing positive for SARS-CoV-2 and was censored at 21 April 2021, the date of deregistration from general practitioner (GP) practice, or 7 days prior to receipt ip of a vaccination against SARS-CoV-2. r For analysis of all-cause mortality among those admitted to hospital, follow-up began at the date of c hospital admission and was censored at 21 April 2021 or 7 days prior to receipt of a vaccination s against SARS-CoV-2
Fewer people infected with the alpha variant had underlying comorbidities (1 s comorbidity (10.4% vs. 11.6%); 2+ comorbidities (2.9% vs. 3.8%)), compared to those infected with wild type virus
Summary
The SARS-CoV-2 (COVID-19) variant of concern B.1.1.7, called the alpha variant, was first identified in Kent, UK in autumn 2020.1 Early analysis estimated that alpha is more transmissible than the original lineage and it became the dominant strain throughout the UK in early 2021.2 Only a small number of alpha cases were originally identified by whole-genome sequencing. C This study aims to bring these elements together in a consolidated analysis, following the pathway of s disease from infection to hospital admission and death, in order to fully illuminate the association of u the alpha variant with altered healthcare need and mortality. Primary care data include individual-level coded diagnoses, medications, vaccinations, and p physiological parameters. These data were linked to key datasets to obtain: 1) SARS-CoV-2 community testing data through the Second Generation Surveillance System; 2) hospital admission e data; 3) COVID-19 related intensive care unit (ICU) admission data; 4) all-cause registered deaths c from the Office for National Statistics (ONS). The SARS-CoV-2 alpha variant (B.1.1.7) is associated with higher transmissibility than wild type virus, becoming the dominant variant in England by January 2021. We aimed to describe the severity of the alpha variant in terms of the pathway of disease from testing positive to hospital admission and death
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