Severity of Severe Acute Respiratory System Coronavirus 2 (SARS-CoV-2) Alpha Variant (B.1.1.7) in England

Daniel J Grint; Kevin Wing; Catherine Houlihan; Hamish P Gibbs; Stephen J W Evans; Elizabeth Williamson; Helen I McDonald; Krishnan Bhaskaran; David Evans; Alex J Walker; George Hickman; Emily Nightingale; Anna Schultze; Christopher T Rentsch; Chris Bates; Jonathan Cockburn; Helen J Curtis; Caroline E Morton; Sebastian Bacon; Simon Davy; Angel Y S Wong; Amir Mehrkar; Laurie Tomlinson; Ian J Douglas; Rohini Mathur; Brian MacKenna; Peter Ingelsby; Richard Croker; John Parry; Frank Hester; Sam Harper; Nicholas J DeVito; Will Hulme; John Tazare; Liam Smeeth; Ben Goldacre; Rosalind M Eggo

doi:10.1093/cid/ciab754

Severity of Severe Acute Respiratory System Coronavirus 2 (SARS-CoV-2) Alpha Variant (B.1.1.7) in England

Daniel J Grint, Kevin Wing, Catherine Houlihan, Hamish P Gibbs, Stephen J W Evans, Elizabeth Williamson, Helen I McDonald, Krishnan Bhaskaran, David Evans, Alex J Walker, George Hickman, Emily Nightingale, Anna Schultze, Christopher T Rentsch, Chris Bates, Jonathan Cockburn, Helen J Curtis, Caroline E Morton, Sebastian Bacon, Simon DavyAngel Y S Wong, Amir Mehrkar, Laurie Tomlinson, Ian J Douglas, Rohini Mathur, Brian MacKenna, Peter Ingelsby, Richard Croker, John Parry, Frank Hester, Sam Harper, Nicholas J DeVito, Will Hulme, John Tazare, Liam Smeeth, Ben Goldacre, Rosalind M Eggo

Research output: Contribution to journal › Article › peer-review

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Abstract

BACKGROUND: The 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.

METHODS: With 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.

RESULTS: Using 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).

CONCLUSIONS: The SARS-CoV-2 alpha variant is associated with an increased risk of both hospitalization and mortality than wild-type virus.

Original language	English
Pages (from-to)	e1120-e1127
Journal	Clinical Infectious Diseases
Volume	75
Issue number	1
DOIs	https://doi.org/10.1093/cid/ciab754
Publication status	Published - 6 Sept 2022
Externally published	Yes

Bibliographical note

Keywords

COVID-19/epidemiology
Hospitalization
Humans
Respiratory System
SARS-CoV-2/genetics

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/cid/ciab754Licence: CC BY

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Grint, D. J., Wing, K., Houlihan, C., Gibbs, H. P., Evans, S. J. W., Williamson, E., McDonald, H. I., Bhaskaran, K., Evans, D., Walker, A. J., Hickman, G., Nightingale, E., Schultze, A., Rentsch, C. T., Bates, C., Cockburn, J., Curtis, H. J., Morton, C. E., Bacon, S., ... Eggo, R. M. (2022). Severity of Severe Acute Respiratory System Coronavirus 2 (SARS-CoV-2) Alpha Variant (B.1.1.7) in England. Clinical Infectious Diseases, 75(1), e1120-e1127. https://doi.org/10.1093/cid/ciab754

Grint, DJ, Wing, K, Houlihan, C, Gibbs, HP, Evans, SJW, Williamson, E, McDonald, HI, Bhaskaran, K, Evans, D, Walker, AJ, Hickman, G, Nightingale, E, Schultze, A, Rentsch, CT, Bates, C, Cockburn, J, Curtis, HJ, Morton, CE, Bacon, S, Davy, S, Wong, AYS, Mehrkar, A, Tomlinson, L, Douglas, IJ, Mathur, R, MacKenna, B, Ingelsby, P, Croker, R, Parry, J, Hester, F, Harper, S, DeVito, NJ, Hulme, W, Tazare, J, Smeeth, L, Goldacre, B & Eggo, RM 2022, 'Severity of Severe Acute Respiratory System Coronavirus 2 (SARS-CoV-2) Alpha Variant (B.1.1.7) in England', Clinical Infectious Diseases, vol. 75, no. 1, pp. e1120-e1127. https://doi.org/10.1093/cid/ciab754

@article{9743dd0091d1409c84ee1c847f9dc022,

title = "Severity of Severe Acute Respiratory System Coronavirus 2 (SARS-CoV-2) Alpha Variant (B.1.1.7) in England",

abstract = "BACKGROUND: The 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.METHODS: With 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.RESULTS: Using 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).CONCLUSIONS: The SARS-CoV-2 alpha variant is associated with an increased risk of both hospitalization and mortality than wild-type virus.",

keywords = "COVID-19/epidemiology, Hospitalization, Humans, Respiratory System, SARS-CoV-2/genetics",

author = "Grint, {Daniel J} and Kevin Wing and Catherine Houlihan and Gibbs, {Hamish P} and Evans, {Stephen J W} and Elizabeth Williamson and McDonald, {Helen I} and Krishnan Bhaskaran and David Evans and Walker, {Alex J} and George Hickman and Emily Nightingale and Anna Schultze and Rentsch, {Christopher T} and Chris Bates and Jonathan Cockburn and Curtis, {Helen J} and Morton, {Caroline E} and Sebastian Bacon and Simon Davy and Wong, {Angel Y S} and Amir Mehrkar and Laurie Tomlinson and Douglas, {Ian J} and Rohini Mathur and Brian MacKenna and Peter Ingelsby and Richard Croker and John Parry and Frank Hester and Sam Harper and DeVito, {Nicholas J} and Will Hulme and John Tazare and Liam Smeeth and Ben Goldacre and Eggo, {Rosalind M}",

note = "{\textcopyright} The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.",

year = "2022",

month = sep,

day = "6",

doi = "10.1093/cid/ciab754",

language = "English",

volume = "75",

pages = "e1120--e1127",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "1",

}

TY - JOUR

T1 - Severity of Severe Acute Respiratory System Coronavirus 2 (SARS-CoV-2) Alpha Variant (B.1.1.7) in England

AU - Grint, Daniel J

AU - Wing, Kevin

AU - Houlihan, Catherine

AU - Gibbs, Hamish P

AU - Evans, Stephen J W

AU - Williamson, Elizabeth

AU - McDonald, Helen I

AU - Bhaskaran, Krishnan

AU - Evans, David

AU - Walker, Alex J

AU - Hickman, George

AU - Nightingale, Emily

AU - Schultze, Anna

AU - Rentsch, Christopher T

AU - Bates, Chris

AU - Cockburn, Jonathan

AU - Curtis, Helen J

AU - Morton, Caroline E

AU - Bacon, Sebastian

AU - Davy, Simon

AU - Wong, Angel Y S

AU - Mehrkar, Amir

AU - Tomlinson, Laurie

AU - Douglas, Ian J

AU - Mathur, Rohini

AU - MacKenna, Brian

AU - Ingelsby, Peter

AU - Croker, Richard

AU - Parry, John

AU - Hester, Frank

AU - Harper, Sam

AU - DeVito, Nicholas J

AU - Hulme, Will

AU - Tazare, John

AU - Smeeth, Liam

AU - Goldacre, Ben

AU - Eggo, Rosalind M

PY - 2022/9/6

Y1 - 2022/9/6

N2 - BACKGROUND: The 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.METHODS: With 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.RESULTS: Using 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).CONCLUSIONS: The SARS-CoV-2 alpha variant is associated with an increased risk of both hospitalization and mortality than wild-type virus.

AB - BACKGROUND: The 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.METHODS: With 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.RESULTS: Using 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).CONCLUSIONS: The SARS-CoV-2 alpha variant is associated with an increased risk of both hospitalization and mortality than wild-type virus.

KW - COVID-19/epidemiology

KW - Hospitalization

KW - Humans

KW - Respiratory System

KW - SARS-CoV-2/genetics

U2 - 10.1093/cid/ciab754

DO - 10.1093/cid/ciab754

M3 - Article

C2 - 34487522

SN - 1058-4838

VL - 75

SP - e1120-e1127

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 1

ER -

Severity of Severe Acute Respiratory System Coronavirus 2 (SARS-CoV-2) Alpha Variant (B.1.1.7) in England

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

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Cite this