Wave Of COVID-19 Pandemic Research Articles

Clinical Characteristics and outcome analysis of SARS-CoV-2 patients admitted to different Critical Care Units in Nepal.

The clinical presentation, biochemical characteristics, and outcomes of patients infected with SARS-CoV-2 can vary in different populations. The purpose of the study is to assess the clinical presentation and identify predictors of mortality among patients with severe acute respiratory distress syndrome admitted to different critical care units in Nepal. An observational study was conducted among the confirmed SARS-CoV-2 patients admitted to different critical care units in seven provinces of Nepal. Retrospective data was collected for the period of three months (April 14, 2021 to July 15, 2021) in relation to the peak of the second wave of COVID-19 pandemic in Nepal. Clinical, biochemical and mortality data were collected from the admitted patients of different critical care units. Univariate logistic regression analysis was done among the selected variables at 5% significance. Final predictor variables were identified after multiple regression analysis. Out of total of 646 patients admitted to critical care units of different provinces of Nepal, there was a male predominance 420 (65%). A total of 232(35.91 %) patients were non-survivors with the majority of mortality occurring in patients > 50 years of age. Cough (72.3 %), shortness of breath (70.9%) and fever (56 %) were the most common presenting clinical features. Increasing age, presence of comorbidity, critical COVID-19 cases, respiratory rate, temperature, serum urea and alanine aminotransferase were identified as predictors of mortality after multiple regression analysis. Approximately 36 % of the confirmed SARS-CoV-2 patient admitted to critical care units did not survive. There was a male preponderance with most casualties occurring in patients more than 50 years of age. Cough, shortness of breath and fever were the most common presenting features. After multiple regression analysis of the identified clinical and biochemical factors, age, presence of comorbidity, respiratory rate, temperature, severity grade as per the World Health Organization classification, serum urea and alanine aminotransferase were identified as the predictors of mortality.

Psychological Status of Nepalese Young Adults During The End of First Wave of COVID-19 Pandemic.

Psychological problems increased during the period of COVID-19. Lockdown" is adopted in many countries of the world. It has also been seen that COVID-19 has led not only to an increase of infection and death but also vast change in the lifestyles of every individual especially in young adults causing various mental health issues. However, in Nepal, there are limited studies to address this issue. The main objective of this study is to generate evidence on the prevalence of symptoms of post-traumatic stress disorder, anxiety, and depression among young adults and the factors contributing to these outcomes in Nepal. Cross-sectional methods were employed using an online structured questionnaire in January 2021, among 1229 participants. Three logistic regression models were performed to examine the significant COVID-19 factors. The prevalence of Depression, Anxiety and post-traumatic stress disorder related symptoms in this study were 255(20.4%), 240(19.2%)and 162(13.2%) respectively relate.COVID-19 diagnosis, COVID-related stress and exposure was significantly related to depression. Similarly, COVID-19 diagnosis, change in income during COVID-19, being exposed to 4 or more exposure factors had high chances of getting anxiety. Also, income change during COVID-19 and stressors during COVID-19 were related to post-traumatic stress disorder. This research shows that various COVID-19 related factors have contributed to the high prevalence of these outcomes.

Isolating the net effect of multiple government interventions with an extended Susceptible-Exposed-Infectious-Recovered (SEIR) framework: empirical evidence from the second wave of COVID-19 pandemic in China

ObjectiveBy using a data-driven statistical approach, we isolated the net effect of multiple government interventions that were simultaneously implemented during the second wave of COVID-19 pandemic in China.Design, data sources...

Seroprevalence of antiSARS-CoV-2 IgG antibodies in children with household exposure to confirm cases of COVID-19 during the second wave of COVID-19 pandemic in Kota, Rajasthan

Background: Weather and the susceptibility of children to SARS-CoV-2 infection is still a debated question particularly in view of important decisions regarding opening schools. Therefore, we planned this cross-sectional analysis of antiSARS-CoV-2 Immunoglobulin-G (IgG) antibodies in children with known household exposure to SARS-CoV-2. This serosurveillance, to find the presence of IgG antibodies among children of probable household exposure of confirmed COVID-19 cases will help in the better understanding of the immune response after COVID-19 infection/exposure. Aims and Objectives: The aim of the study was to investigate the prevalence of anti-SARS-CoV-2 antibodies in children among the families who had confirm case/cases of COVID 19 during the second wave of the COVID-19 pandemic. This study is designed as a cross-sectional serosurveillance study in Kota, Rajasthan India. Materials and Methods: Population-based serosurveillance among children with probable household exposure to confirmed COVID-19 cases who was admitted in Govt. Medical College attached COVID 19 dedicated hospital was carried out during October 2021 to December 2021 using the COVID IgG Antibody Detection Enzyme-Linked Immunosorbent Assay kits. Seropositivity among children was measured and with various other factors to understand the immunity status among COVID-19 cases. Descriptive statistical analysis done. Results: 156/1285 eligible candidates (19.53%) having a total of 251 household contacts of <17 years age group agreed to participate in study while rest of them refused. Anti-SARS-CoV-2 IgG antibodies were present in 127/251 household contacts (50.59%). Among them maximum 28.68% of seropositive were from age group 11–17 years age, symptoms were observed in 29.13% IgG positive contacts, maximum seropositivity was seen when only one family member was hospitalized, 63% seropositivity was seen when primary relative of child was hospitalized as compared to secondary. Maximum seroreactivity (55.9%) was seen when the Chest CT score of index case was high, that is, 14–25. max reactivity was observed 76/127 (59.84%) when hospital duration of index case is <1 week. 118/127 (92.91%) of seroreactive children were found when the index case was unvaccinated or partially vaccinated. Conclusion: Seropositivity of 50.59% suggests that all the cases may not have IgG antibodies. Among the seronegative cases, the antibodies either not developed, or are undetectable, or have disappeared during the post COVID period. Seropositivity based on gender difference is statistically not significant. Proportion of positivity shows an increasing trend with increasing age among pediatric household contacts. Complete COVID-19 vaccination is an effective tool to minimize the disease frequency/severity. Severe disease patients with high CT score transmits the infection to household contacts more efficiently.

Experience and Reflection From Inpatient Staff at an Intellectual Disability Hospital During COVID-19

AimsThe COVID-19 pandemic and the associated impact on the NHS led to particular challenges for Intellectual Disability (ID) inpatient hospitals across the country. The aim of this Research Project is to gather the experience of Inpatient staff in our local ID Hospital following the first wave of COVID-19 pandemic in July 2020.MethodsWe gathered data by means of survey from inpatient staff including ‘staff nurses’ and ‘health care support workers’ from 2 cute assessment and treatment units and 1 rehabilitation unit over the preceding 3 months. We obtained 15 responses. We gathered quantitative data via a questionnaire on the views of staff regarding the service provision for patients and staff during COVID-19. We also gathered qualitative data on learning points and how things would have been done differently in hindsight.ResultsThe responses were anonymised, directly transcribed, coded and grouped into themes. 67% of staff stated appropriate type and quantity of Personal Protective Equipment was available. 60% of staff stated it was ‘easy’ to access a General Practitioner for patient reviews. 60% of staff stated, there was a change in arrangements for Do Not Resuscitate/Escalation plans during COVID-19. 47% of staff stated there was availability of virtual or face-to-face clinical training support. 67% of staff did not take sickness leave due to symptoms or contact with a COVID-19 patient. 67% of staff did not receive or found it difficult to access a COVID-19 test. 47% of staff reported a negative impact of the pandemic on their physical and mental health well being. 13% of staff found the Counselling/emotional Support helpful.Some of the key themes that emerged in the qualitative data analysis included the importance of being grateful for personal health and well being, move lives could be saved if earlier and more frequent testing was available during the first wave, delays in the arrival of PPE in the hospital and ideas to mitigate risk by designating members of staff to a fixed work area to reduce mixing.ConclusionA wide range of reflections, suggestions and feedback were obtained during the research project which will be helpful to plan and organise services moving forward should future waves of COVID-19 emerge.

The epidemiology of distress: prevalence and associated factors of symptoms of depression, anxiety, and loneliness at the end of the first wave of COVID-19 in Qatar

IntroductionThere is paucity of epidemiological studies from the Arab world and most of the focus of available international data is on the early months of the pandemic.ObjectivesWe conducted the first cross-sectional national phone survey of adults in Qatar during the end of the first wave of the pandemic (December 2020 -January 2021) to estimate the prevalence and determinants of depression and/or anxiety.MethodsWe used the Physician Health Questionnaire-9 and Generalized Anxiety Disorder-7 with cut-off scores of ≥10; the revised UCLA loneliness scale; and questions related to COVID-19 status, death of family or friend, quarantine, health and changes in living arrangements. Bivariate and logistic regression models estimated associations between thirteen variables and combined depression-anxiety (score of 20 or higher).Results The two-week prevalence of depression was 6.5% (95%CI: 5.1-8.4), of anxiety 5.1% (95%CI: 3.8-6.9), but only 2.5% sought mental health professional help since the pandemic started. When including loneliness (OR=1.57, p (<0.001) in the model, the following variables were statistically significantly associated with depression-anxiety: female gender (OR=1.90, p=0.037), Qatari nationality (OR=2.37, p=0.018), Arab ethnicity (OR=3.14, p=0.007), and COVID-19 death of family or friend (OR=3.06, p=0.003). Without adjusting for loneliness, younger age (18-29 versus 40+ years of age: OR=2.9, p=0.004) and chronic health conditions (OR=2.0, p=0.029) were significantly associated with depression-anxiety.ConclusionsPrevalence of depression and/or anxiety during the end of the first wave of COVID-19 pandemic in Qatar was similar to pre-pandemic estimates. Mental health service should focus on young adults, women, the bereaved, lonely and those with chronic health problems.DisclosureNo significant relationships.

Prevalence and Comparative Analyses of Mental Health Outcomes Among Medical and Non-Medical Practitioners During the Third Wave of Covid-19 Pandemic in Nigeria

Abstract This study assessed the mental health state of healthcare workers during the COVID-19 pandemic in Nigeria. A cross-sectional survey using the snowballing sampling technique was utilized to select 300 medical and non-medical healthcare practitioners in the study. An online questionnaire consisting of the Generalized Anxiety Disorder scale, Impact of Event Scale-Revised, Patient Health Questionnaire, and Insomnia Severity Index was used for data collection. Both the medical and the non-medical practitioners reported minimal to severe symptoms of insomnia, generalized anxiety, depression, and posttraumatic stress. However, a significant difference was found in symptoms of insomnia (χ2=16.98, df = 3, p<.01), such that non-medical practitioners exhibited clinical insomnia symptoms (13.8%) than the medical practitioners (11.5%). Further, a significant difference was found in symptoms of depression (χ2=9.93, df = 4, p<.05), such that medical practitioners exhibited more severe depressive symptoms (07.3%) than the non-medical practitioners (06.4%). A significant number of healthcare workers reported mental health challenges during the third wave of the COVID-19 pandemic emergence in Nigeria. Therefore, it is recommended that healthcare workers should be exposed to appropriate and regular psychosocial interventions to keep them healthy and functioning optimally.

Meaningful orientations and asthenia in pregnant women and young mothers during the first COVID-19 pandemic wave

IntroductionPregnancy and childcare are naturally stressful for women, often accompanied by the asthenic syndrome. In a pandemic situation, this type of stress may be potentiated by external conditions.ObjectivesThe study aimed to investigate the life-state orientations and asthenia levels of pregnant women and young mothers in the context of a pandemic. We also analyzed the correlations between the life-state orientations and the different types of asthenias.MethodsData collection was carried out in June 2020 using a Google form that we developed. Pregnant women and young mothers with children under seven years of age participated in the study with 47 respondents. We used the Purpose-in-Life Test to investigate the meaningful orientations and the MFI-20 to determine the level of asthenia. Both questionnaires were adapted for use in Russia.ResultsWe found that the mean overall MFI-20 score (M = 58.0±5.9) exceeded the mean values in our sample, indicating the presence of the asthenic syndrome. Physical asthenia (M = 12.9±1.4) and decreased activity (M = 12.0±1.7) were the strongest, with the lowest score on the general asthenia scale (M = 10.6±1.8). Correlation analysis showed that all components of meaningful orientations had multiple positive correlations with different types of asthenias, and the overall asthenia score was 100 % related to life meaningfulness (p < 0.01).ConclusionsPregnant women and young mothers are at risk for asthenia in the COVID-19 pandemic. This is obviously due to many responsibilities of mothers raising children.DisclosureNo significant relationships.

Comparative end-of-life communication and support in hospitalised decedents before and during the COVID-19 pandemic: a retrospective regional cohort study in Ottawa, Canada

ObjectiveTo compare end-of-life in-person family presence, patient–family communication and healthcare team–family communication encounters in hospitalised decedents before and during the COVID-19 pandemic.DesignIn a regional multicentre retrospective cohort study, electronic health...

The transiton of nutritional status at first year medical students during e-classes

The second wave of COVID-19 pandemic is resulting in second lockdown at Indonesia. This results in classes to only be allowed in online. It may lead to obesogenic situation. Obesity is the first comorbid factor for COVID-19 complications dan mortality. We aim to investigate the nutritional status and its related factor at medical students after a year of e-classes.

Online symptoms self-assessment during COVID-19 pandemic: an analysis of a COVID-19 portal responses from Canada

COVID-19 case was first identified in Canada on January 25, 2020, on a Toronto resident who had travelled to Wuhan China, and not long after, the WHO declared the viral infection a pandemic. Ontario health West created an online self-assessment portal that allowed individuals in the health region and adjourning areas to report any COVID related symptoms. The purpose of this study was to evaluate the utility and usefulness of the Ontario Heath West online COVID-19 self-assessment portal. Record level data obtained from the Ontario Health West self-assessment portal was analyzed. Descriptive statistics using charts and graphs were used to characterize the distribution of responses to the portal. In-depth analysis using correlation, lead-lag analysis, and trend comparison with actual Government of Ontario COVID-19 cases for the region were also conducted. A total of 34,144 distinct responses were recorded on the portal between April 10 and July 29, 2020, with 1,250 (3.7%) responding positively to one of the emergency symptoms questions. Trend analysis showed a peak portal response in May 2020 with a smaller rise subsequently in July 2020, coinciding with the actual COVID-19 peak in the region. The five most reported symptoms on the portal were sore throat (17.2%), headache (12.9%), fatigue (12.3%), digestive problems (12.2%) and cough (9.1%). For four sub-regions, the trend of self-report on the portal positively lagged actual Public Health Ontario reported COVID-19 cases, while for one sub-region, the trend positively led the actual Public Health Ontario reported COVID-19 cases for the area. We found correlation between online COVID-19 self- assessment data and the confirmed COVID-19 cases in the Southwestern region of Ontario. Trends in the COVID-19 associated emergency symptoms reported on the portal also tracked confirmed COVID-19 cases in the community. Peak response to the portal coincided with the peak volume of confirmed cases in Ontario during the first wave of COVID-19 pandemic in Canada, suggesting some consistency between the experiences of portal users and patterns of COVID-19 illness in the community. The portal was a useful tool at the person-level because it provided guidance to individuals about how to access appropriate health services according to the symptoms that they reported and connected them with primary care, reducing unnecessary visit to health facilities for COVID-19 related care.

Impact of lateral positioning on oxygenation in noninvasively ventilated COVID-19 patient

Background: Due to the sudden outbreak of covid 19, we lost almost 6230357 deaths till date. Covid 19 causes hypoxemia. As we know, body positions can improve oxygenation by various physiological changes. Many literatures showed prone position improved oxygenation in covid19 patients. So, we want to explore whether lateral position improves oxygenation status in covid19 infected noninvasively ventilated patients during first wave of covid19 pandemic. Objectives: Aim of this prospective observational study to evaluate the impact of lateral position on oxygenation in non-invasively ventilated covid 19 patients. Methods: we enrolled non-invasively ventilated covid 19 patients from 18 years to 70 years of age and hemodynamically stable patients who were in supine position but planned to give lateral position by ICU consultant. We noted hemodynamic, oxygenation status and ABGA parameter after one hour of lateral positioning. Results: Out of 100 patients, 67 were male and 33 were female. 31 patients had Diabetes as a comorbidity, 35 patients had hypertension. Out of 3 patients, 4 had IHD and 3 had hypothyroidism. SpO2 by pulse oximetry, SO2 and PO2 from ABGA showed statistically significant increase after one hour of lateral positioning. There were no significant changes in hemodynamic parameters after lateral positioning.

Impact of the COVID-19 pandemic on England’s national prescriptions of oral vitamin K antagonist (VKA) and direct-acting oral anticoagulants (DOACs): an interrupted time series analysis (January 2019–February 2021)

Background Direct-acting oral anticoagulants (DOACs) were developed as an alternative to warfarin to treat and prevent thromboembolism, including stroke prevention in non-valvular atrial fibrillation patients. The COVID-19 pandemic could increase the risk of stroke and/or the risk of bleeding in patients due to nonadherence or sub/supra-optimal dosing. Objective To investigate DOAC prescription trends in England’s community settings during the complete first wave of COVID-19 pandemic. Methods Descriptive and interrupted time series (ITS) analyses were conducted to examine the prescription patterns of DOACs (dabigatran, rivaroxaban, apixaban and edoxaban) and warfarin for primary care patients in the English Prescribing Dataset from January 2019 to February 2021, with March 2020 as the cut-off point. Results A 19% increase in mean DOAC’s accompanied with 20% warfarin prescriptions decline was observed. ITS modelling showed an increase in DOAC prescription volume in March 2020 (+7 million items, p = 0.008). The pre-existing upward trend in DOAC prescriptions slowed during the period (-427,000 items, p = 0.007). Apixaban was the most frequently used DOAC and had the largest step-change in March 2020 (+5 million items, p = 0.010). The mean monthly combined cost of DOACs and warfarin was higher during the period. DOAC prescription trends were consistent across England’s regions. Conclusion: The overall oral anticoagulants use in this period was lower than expected, indicating a medical needs gap, possibly due to adherence issues. The potential clinical and logistical consequences warrant further study to identify contributing factors and mitigate avoidable risks.

Student Satisfaction in Online Learning of Islamic Higher Education in Indonesia during the Second Wave of COVID-19 Pandemic

This study aims to determine student satisfaction with online learning at UIN Raden Mas Said Surakarta Indonesia. In this study, the researchers developed new variables related to student satisfaction in online learning, such as student commitment, student independence, parental support, main source of support for online learning, student readiness, creative and innovative learning and effectiveness and behavioral intentions. The methodology used is a quantitative research method, with measurement and analysis using the smart-PLS application. The population in this study was all students of the UIN RMS Surakarta education faculty. The results of this study show that there were 412 respondents who filled out the questionnaire. After being processed using Smart-PLS there were three variables that were accepted: first, effectiveness has a significant effect on student satisfaction in online learning, second, student commitment has a significant effect on student satisfaction in online learning and third, student satisfaction has a significant effect on the behavioral intentions of students in online learning.

Genomics of postvaccination SARS-CoV-2 infections during the Delta dominated second wave of COVID-19 pandemic, from Mumbai Metropolitan Region (MMR), India.

The present study was initiated to understand the proportion of predominant variants of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in postvaccination infections during the Delta dominated second wave of coronavirus disease 2019 (COVID‐19) in the Mumbai Metropolitan Region (MMR) in India and to understand any mutations selected in the postvaccination infections or showing association with any patient demographics. Samples were collected (n = 166) from severe/moderate/mild COVID‐19 patients who were either vaccinated (COVISHIELD/COVAXIN—partial/fully vaccinated) or unvaccinated, from a city hospital and from home isolation patients in MMR. A total of 150 viral genomes were sequenced by Oxford Nanopore sequencing and the data of 136 viral genomes were analyzed for clade/lineage and for identifying mutations. The sequences belonged to three clades (21A, 21I, and 21J) and their lineage was identified as either Delta (B.1.617.2) or Delta+ (B.1.617.2 + K417N) or sub‐lineages of Delta variant (AY.120/AY.38/AY.99). A total of 620 mutations were identified of which 10 mutations showed an increase in trend with time (May–October 2021). Associations of six mutations (two in spike, three in orf1a, and one in nucleocapsid) were shown with milder forms of the disease and one mutation (in orf1a) with partial vaccination status. The results indicate a trend toward reduction in disease severity as the wave progressed.

The Global Reading Room: Recovery of Breast Cancer Screening Services After the COVID-19 Pandemic First Wave.

The Global Reading Room: Recovery of Breast Cancer Screening Services After the COVID-19 Pandemic First Wave.

A multicentre Canadian survey of caregiver perspectives on COVID vaccine-related pain and stress for their family.

Caregiver hesitancy for their children to receive the COVID-19 vaccine remains due to concerns regarding safety and efficacy, but also due to fear of vaccine administration-related pain and distress. Study objectives were to determine caregivers' perceptions regarding both their personal and child's COVID-19 vaccine administration-related stress and fear and relate this to their likelihood to allow their child to receive COVID-19 vaccinations. This study was a secondary data analysis of a multicentre, cross-sectional survey of caregivers presenting to four Canadian pediatric emergency departments. Caregivers were surveyed between December 2020 and March 2021 and completed a digital survey on their own smartphones. 331 caregivers responded to the survey (mean age 39.9 years [SD 7.71]); 74.2% (245/331) were mothers. Children's mean age was 8.8 years [SD 5.4]; 49.8% (165/331) were female. 64.1% (209/326) of caregivers were willing to vaccinate their child against COVID-19, while 35.9% (117/326) were not. Greater perceived COVID-19 vaccine administration-related pain (0.88 [0.80; 0.95], p = .003) and stress (0.82 [0.76; 0.89], p = <.001) for their child as well as greater perceived personal stress with their own COVID-19 vaccine administration (0.81 [0.75; 0.88], p = <.001) were associated with caregivers being less likely to vaccinate their child. During the time period between COVID-19 pandemic waves 2 and 3, and after the vaccine had been federally approved for adults, one-third of Canadian caregivers surveyed reported being unwilling to vaccinate their child against COVID-19 in the future. Managing children's and caregivers' vaccine administration-related fear and stress may improve vaccine uptake for children.

Experiences of infected health care team during first wave of COVID-19 at Hilal-e-Ahmer Hospital, Faisalabad

BACKGROUND &amp; OBJECTIVE: COVID-19 has caused a very deep and intense effect on all persons irrespective of age and gender. It was especially a challenging fight for health professionals as they were dealing it from many aspects. All the infected health workers were facing many emotional and mental stresses, and at the same time, they were supposed to provide error free services at the hospital. To explore the experiences of infected Health Care Providers during COVID-19 pandemic.&#x0D; METHODOLOGY: The interview based qualitative descriptive research was conducted at Hilal-e Ahmar hospital Faisalabad, Pakistan. To get an in-depth idea about different experiences of the professionals, 15 Semi structured interviews were conducted during the first wave of COVID-19 pandemic in Pakistan. Convenient sampling was done by inviting all the infected members for the interviews. Purposive sampling was done, and a total of 15 interviews were conducted till the data was saturated. Participants gave their convenient time keeping in mind their easy duty days for the study, and they were interviewed in their offices. Interviews were transcribed, rechecked, and analyzed. Thematic analysis was done with narrations.&#x0D; RESULTS:5 broader themes were generated with sub-themes. The themes were 1) Diagnosis of disease, 2) Disease impacts, 3) Social reaction, 4) Combating techniques for isolation period and, 5) Dilemmas during the quarantine period. The participants were diagnosed by PCR technique, and the diagnosis was associated with extreme feelings of denial, depression, anxiety, fear of the future and uncertainty. Most of the participants faced negative responses from society and experienced a social boycott.&#x0D; CONCLUSION: The first wave of COVID-19 was a period of extreme stress and anxiety, especially for the health care providers working as the first line of defense against the disease. They not only suffer from the physiological effects of the disease but faced mental trauma and social stigmatization. Electronic media had a negative effect on the thought process of people.

Characterization and Outcomes of SARS-CoV-2 Infection in Overweight and Obese Patients: A Dynamic Comparison of COVID-19 Pandemic Waves.

There are few data on the dynamics of SARS-CoV-2 viral manifestations in obese and overweight persons during each of the five waves that occurred in Romania during the last two years. As such, the purpose of this research was to characterize the variance in case severity, symptomatology, ICU hospitalizations, and mortality among overweight and obese individuals infected with the SARS-CoV-2 virus. We included 250 overweight and obese patients admitted to hospital with COVID-19, where 50 patients were selected from each of the five pandemic waves that existed in Romania until March 2022. A total of 113 patients with normal body mass index were included in the study. They were matched with overweight and obese patients by age, gender, and cardiovascular comorbidities to avoid the effect of confounding factors. Between the five waves of the COVID-19 pandemic in Romania, the present investigation found substantial changes in overweight and obese patient features. Obesity increases the risk of hospitalization, severe complications, and mortality from COVID-19. However, this unique demographic is disproportionately affected by obesity-related comorbidities, which contribute to these adverse outcomes. We advocate for the development of new guiding principles for the formulation of healthcare strategies aimed at high-prevalence special populations such as overweight and obese individuals, while also promoting pandemic containment and avoiding the recurrence of pandemic waves with the same guidelines that proved detrimental in terms of economic and human life loss.

Clinical severity of COVID-19 in patients admitted to hospital during the omicron wave in South Africa: a retrospective observational study

BackgroundUp to the end of January, 2022, South Africa has had four recognisable COVID-19 pandemic waves, each predominantly dominated by one variant of concern: the ancestral strain with an Asp614Gly mutation during the first wave, the beta variant (B.1.351) during the second wave, the delta variant (B.1.617.2) during the third wave, and lastly, the omicron variant (B.1.1.529) during the fourth wave. We aimed to assess the clinical disease severity of patients admitted to hospital with SARS-CoV-2 infection during the omicron wave and compare the findings with those of the preceding three pandemic waves in South Africa.MethodsWe defined the start and end of each pandemic wave as the crossing of the threshold of weekly incidence of 30 laboratory-confirmed SARS-CoV-2 cases per 100 000 population. Hospital admission data were collected through an active national COVID-19-specific surveillance programme. We compared disease severity across waves by post-imputation random effect multivariable logistic regression models. Severe disease was defined as one or more of the following: acute respiratory distress, receipt of supplemental oxygen or mechanical ventilation, admission to intensive care, or death.FindingsWe analysed 335 219 laboratory-confirmed SARS-CoV-2 hospital admissions with a known outcome, constituting 10·4% of 3 216 179 cases recorded during the four waves. During the omicron wave, 52 038 (8·3%) of 629 617 cases were admitted to hospital, compared with 71 411 (12·9%) of 553 530 in the Asp614Gly wave, 91 843 (12·6%) of 726 772 in the beta wave, and 131 083 (10·0%) of 1 306 260 in the delta wave (p<0·0001). During the omicron wave, 15 421 (33·6%) of 45 927 patients admitted to hospital had severe disease, compared with 36 837 (52·3%) of 70 424 in the Asp614Gly wave, 57 247 (63·4%) of 90 310 in the beta wave, and 81 040 (63·0%) of 128 558 in the delta wave (p<0·0001). The in-hospital case-fatality ratio during the omicron wave was 10·7%, compared with 21·5% during the Asp614Gly wave, 28·8% during the beta wave, and 26·4% during the delta wave (p<0·0001). Compared with those admitted to hospital during the omicron wave, patients admitted during the other three waves had more severe clinical presentations (adjusted odds ratio 2·07 [95% CI 2·01–2·13] in the Asp614Gly wave, 3·59 [3·49–3·70] in the beta wave, and 3·47 [3·38–3·57] in the delta wave).InterpretationThe trend of increasing cases and admissions across South Africa's first three waves shifted in the omicron wave, with a higher and quicker peak but fewer patients admitted to hospital, less clinically severe illness, and a lower case-fatality ratio compared with the preceding three waves. Omicron marked a change in the SARS-CoV-2 epidemic curve, clinical profile, and deaths in South Africa. Extrapolations to other populations should factor in differing vaccination and previous infection levels.FundingNational Institute for Communicable Diseases.