Directions of change in intrinsic case severity across successive SARS-CoV-2 variant waves have been inconsistent

David J. Pascall; Elen Vink; Rachel Blacow; Naomi Bulteel; Alasdair Campbell; Robyn Campbell; Sarah Clifford; Chris Davis; Ana da Silva Filipe; Noha El Sakka; Ludmila Fjodorova; Ruth Forrest; Emily Goldstein; Rory Gunson; John Haughney; Matthew T.G. Holden; Patrick Honour; Joseph Hughes; Edward James; Tim Lewis; Oscar MacLean; Martin McHugh; Guy Mollett; Tommy Nyberg; Yusuke Onishi; Ben Parcell; Surajit Ray; David L. Robertson; Shaun R. Seaman; Sharif Shabaan; James G. Shepherd; Katherine Smollett; Kate Templeton; Elizabeth Wastnedge; Craig Wilkie; Thomas Williams; The COVID-19 Genomics UK (COG-UK) Consortium; Emma C. Thomson

doi:10.1016/j.jinf.2023.05.019

Directions of change in intrinsic case severity across successive SARS-CoV-2 variant waves have been inconsistent

David J. Pascall, Elen Vink, Rachel Blacow, Naomi Bulteel, Alasdair Campbell, Robyn Campbell, Sarah Clifford, Chris Davis, Ana da Silva Filipe, Noha El Sakka, Ludmila Fjodorova, Ruth Forrest, Emily Goldstein, Rory Gunson, John Haughney, Matthew T.G. Holden, Patrick Honour, Joseph Hughes, Edward James, Tim LewisOscar MacLean, Martin McHugh, Guy Mollett, Tommy Nyberg, Yusuke Onishi, Ben Parcell, Surajit Ray, David L. Robertson, Shaun R. Seaman, Sharif Shabaan, James G. Shepherd, Katherine Smollett, Kate Templeton, Elizabeth Wastnedge, Craig Wilkie, Thomas Williams, The COVID-19 Genomics UK (COG-UK) Consortium, Emma C. Thomson^*

^*Corresponding author for this work

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

Abstract

Objectives
To determine how the intrinsic severity of successively dominant SARS-CoV-2 variants changed over the course of the pandemic.

Methods A retrospective cohort analysis in the NHS Greater Glasgow and Clyde (NHS GGC) Health Board. All sequenced non-nosocomial adult COVID-19 cases in NHS GGC with relevant SARS-CoV-2 lineages (B.1.177/Alpha, Alpha/Delta, AY.4.2 Delta/non-AY.4.2 Delta, non-AY.4.2 Delta/Omicron, and BA.1 Omicron/BA.2 Omicron) during analysis periods were included. Outcome measures were hospital admission, ICU admission, or death within 28 days of positive COVID-19 test. We report the cumulative odds ratio; the ratio of the odds that an individual experiences a severity event of a given level vs all lower severity levels for the resident and the replacement variant after adjustment.

Results
After adjustment for covariates, the cumulative odds ratio was 1.51 (95% CI: 1.08-2.11) for Alpha versus B.1.177, 2.09 (95% CI: 1.42-3.08) for Delta versus Alpha, 0.99 (95% CI: 0.76-1.27) for AY.4.2 Delta versus non-AY.4.2 Delta, 0.49 (95% CI: 0.22-1.06) for Omicron versus non-AY.4.2 Delta, and 0.86 (95% CI: 0.68-1.09) for BA.2 Omicron versus BA.1 Omicron.

Conclusions
The direction of change in intrinsic severity between successively emerging SARS-CoV-2 variants was inconsistent, reminding us that the intrinsic severity of future SARS-CoV-2 variants remains uncertain.

Original language	English
Pages (from-to)	128-135
Number of pages	8
Journal	Journal of Infection
Volume	87
Issue number	2
Early online date	10 Jul 2023
DOIs	https://doi.org/10.1016/j.jinf.2023.05.019
Publication status	Published - 1 Aug 2023

Keywords

Intrinsic severity
COVID-19
SARS-CoV-2
Alpha variant
Delta variant
Omicron variant

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10.1016/j.jinf.2023.05.019

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Copyright © 2023 Published by Elsevier Ltd on behalf of The British Infection Association. This work has been made available online in accordance with publisher policies or with permission. Permission for further reuse of this content should be sought from the publisher or the rights holder. This is the author created accepted manuscript following peer review and may differ slightly from the final published version. The final published version of this work is available at https://doi.org/10.1016/j.jinf.2023.05.019.
Accepted author manuscript, 186 KBLicence: CC BY-NC-ND

Cite this

Pascall, D. J., Vink, E., Blacow, R., Bulteel, N., Campbell, A., Campbell, R., Clifford, S., Davis, C., da Silva Filipe, A., El Sakka, N., Fjodorova, L., Forrest, R., Goldstein, E., Gunson, R., Haughney, J., Holden, M. T. G., Honour, P., Hughes, J., James, E., ... Thomson, E. C. (2023). Directions of change in intrinsic case severity across successive SARS-CoV-2 variant waves have been inconsistent. Journal of Infection, 87(2), 128-135. https://doi.org/10.1016/j.jinf.2023.05.019

@article{d348840a7a534c0c93e844c901b37bbf,

title = "Directions of change in intrinsic case severity across successive SARS-CoV-2 variant waves have been inconsistent",

abstract = "Objectives To determine how the intrinsic severity of successively dominant SARS-CoV-2 variants changed over the course of the pandemic.Methods A retrospective cohort analysis in the NHS Greater Glasgow and Clyde (NHS GGC) Health Board. All sequenced non-nosocomial adult COVID-19 cases in NHS GGC with relevant SARS-CoV-2 lineages (B.1.177/Alpha, Alpha/Delta, AY.4.2 Delta/non-AY.4.2 Delta, non-AY.4.2 Delta/Omicron, and BA.1 Omicron/BA.2 Omicron) during analysis periods were included. Outcome measures were hospital admission, ICU admission, or death within 28 days of positive COVID-19 test. We report the cumulative odds ratio; the ratio of the odds that an individual experiences a severity event of a given level vs all lower severity levels for the resident and the replacement variant after adjustment. Results After adjustment for covariates, the cumulative odds ratio was 1.51 (95% CI: 1.08-2.11) for Alpha versus B.1.177, 2.09 (95% CI: 1.42-3.08) for Delta versus Alpha, 0.99 (95% CI: 0.76-1.27) for AY.4.2 Delta versus non-AY.4.2 Delta, 0.49 (95% CI: 0.22-1.06) for Omicron versus non-AY.4.2 Delta, and 0.86 (95% CI: 0.68-1.09) for BA.2 Omicron versus BA.1 Omicron. Conclusions The direction of change in intrinsic severity between successively emerging SARS-CoV-2 variants was inconsistent, reminding us that the intrinsic severity of future SARS-CoV-2 variants remains uncertain.",

keywords = "Intrinsic severity, COVID-19, SARS-CoV-2, Alpha variant, Delta variant, Omicron variant",

author = "Pascall, {David J.} and Elen Vink and Rachel Blacow and Naomi Bulteel and Alasdair Campbell and Robyn Campbell and Sarah Clifford and Chris Davis and {da Silva Filipe}, Ana and {El Sakka}, Noha and Ludmila Fjodorova and Ruth Forrest and Emily Goldstein and Rory Gunson and John Haughney and Holden, {Matthew T.G.} and Patrick Honour and Joseph Hughes and Edward James and Tim Lewis and Oscar MacLean and Martin McHugh and Guy Mollett and Tommy Nyberg and Yusuke Onishi and Ben Parcell and Surajit Ray and Robertson, {David L.} and Seaman, {Shaun R.} and Sharif Shabaan and Shepherd, {James G.} and Katherine Smollett and Kate Templeton and Elizabeth Wastnedge and Craig Wilkie and Thomas Williams and {The COVID-19 Genomics UK (COG-UK) Consortium} and Thomson, {Emma C.}",

note = "Funding: This work was supported by UKRI through the JUNIPER consortium (grant number MR/V038613/1, https://maths.org/juniper/); the Medical Research Council (MRC) (grant number MC UU 12014/12, grant number MC UU 00002/11, https://www.ukri.org/councils/mrc/); the G2P-UK National Virology Consortium (grant number MR/W005611/1, https://www.ukri.org).",

year = "2023",

month = aug,

day = "1",

doi = "10.1016/j.jinf.2023.05.019",

language = "English",

volume = "87",

pages = "128--135",

journal = "Journal of Infection",

issn = "0163-4453",

publisher = "W.B. Saunders Ltd",

number = "2",

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Pascall, DJ, Vink, E, Blacow, R, Bulteel, N, Campbell, A, Campbell, R, Clifford, S, Davis, C, da Silva Filipe, A, El Sakka, N, Fjodorova, L, Forrest, R, Goldstein, E, Gunson, R, Haughney, J, Holden, MTG, Honour, P, Hughes, J, James, E, Lewis, T, MacLean, O, McHugh, M, Mollett, G, Nyberg, T, Onishi, Y, Parcell, B, Ray, S, Robertson, DL, Seaman, SR, Shabaan, S, Shepherd, JG, Smollett, K, Templeton, K, Wastnedge, E, Wilkie, C, Williams, T, The COVID-19 Genomics UK (COG-UK) Consortium & Thomson, EC 2023, 'Directions of change in intrinsic case severity across successive SARS-CoV-2 variant waves have been inconsistent', Journal of Infection, vol. 87, no. 2, pp. 128-135. https://doi.org/10.1016/j.jinf.2023.05.019

TY - JOUR

T1 - Directions of change in intrinsic case severity across successive SARS-CoV-2 variant waves have been inconsistent

AU - Pascall, David J.

AU - Vink, Elen

AU - Blacow, Rachel

AU - Bulteel, Naomi

AU - Campbell, Alasdair

AU - Campbell, Robyn

AU - Clifford, Sarah

AU - Davis, Chris

AU - da Silva Filipe, Ana

AU - El Sakka, Noha

AU - Fjodorova, Ludmila

AU - Forrest, Ruth

AU - Goldstein, Emily

AU - Gunson, Rory

AU - Haughney, John

AU - Holden, Matthew T.G.

AU - Honour, Patrick

AU - Hughes, Joseph

AU - James, Edward

AU - Lewis, Tim

AU - MacLean, Oscar

AU - McHugh, Martin

AU - Mollett, Guy

AU - Nyberg, Tommy

AU - Onishi, Yusuke

AU - Parcell, Ben

AU - Ray, Surajit

AU - Robertson, David L.

AU - Seaman, Shaun R.

AU - Shabaan, Sharif

AU - Shepherd, James G.

AU - Smollett, Katherine

AU - Templeton, Kate

AU - Wastnedge, Elizabeth

AU - Wilkie, Craig

AU - Williams, Thomas

AU - The COVID-19 Genomics UK (COG-UK) Consortium

AU - Thomson, Emma C.

N1 - Funding: This work was supported by UKRI through the JUNIPER consortium (grant number MR/V038613/1, https://maths.org/juniper/); the Medical Research Council (MRC) (grant number MC UU 12014/12, grant number MC UU 00002/11, https://www.ukri.org/councils/mrc/); the G2P-UK National Virology Consortium (grant number MR/W005611/1, https://www.ukri.org).

PY - 2023/8/1

Y1 - 2023/8/1

N2 - Objectives To determine how the intrinsic severity of successively dominant SARS-CoV-2 variants changed over the course of the pandemic.Methods A retrospective cohort analysis in the NHS Greater Glasgow and Clyde (NHS GGC) Health Board. All sequenced non-nosocomial adult COVID-19 cases in NHS GGC with relevant SARS-CoV-2 lineages (B.1.177/Alpha, Alpha/Delta, AY.4.2 Delta/non-AY.4.2 Delta, non-AY.4.2 Delta/Omicron, and BA.1 Omicron/BA.2 Omicron) during analysis periods were included. Outcome measures were hospital admission, ICU admission, or death within 28 days of positive COVID-19 test. We report the cumulative odds ratio; the ratio of the odds that an individual experiences a severity event of a given level vs all lower severity levels for the resident and the replacement variant after adjustment. Results After adjustment for covariates, the cumulative odds ratio was 1.51 (95% CI: 1.08-2.11) for Alpha versus B.1.177, 2.09 (95% CI: 1.42-3.08) for Delta versus Alpha, 0.99 (95% CI: 0.76-1.27) for AY.4.2 Delta versus non-AY.4.2 Delta, 0.49 (95% CI: 0.22-1.06) for Omicron versus non-AY.4.2 Delta, and 0.86 (95% CI: 0.68-1.09) for BA.2 Omicron versus BA.1 Omicron. Conclusions The direction of change in intrinsic severity between successively emerging SARS-CoV-2 variants was inconsistent, reminding us that the intrinsic severity of future SARS-CoV-2 variants remains uncertain.

AB - Objectives To determine how the intrinsic severity of successively dominant SARS-CoV-2 variants changed over the course of the pandemic.Methods A retrospective cohort analysis in the NHS Greater Glasgow and Clyde (NHS GGC) Health Board. All sequenced non-nosocomial adult COVID-19 cases in NHS GGC with relevant SARS-CoV-2 lineages (B.1.177/Alpha, Alpha/Delta, AY.4.2 Delta/non-AY.4.2 Delta, non-AY.4.2 Delta/Omicron, and BA.1 Omicron/BA.2 Omicron) during analysis periods were included. Outcome measures were hospital admission, ICU admission, or death within 28 days of positive COVID-19 test. We report the cumulative odds ratio; the ratio of the odds that an individual experiences a severity event of a given level vs all lower severity levels for the resident and the replacement variant after adjustment. Results After adjustment for covariates, the cumulative odds ratio was 1.51 (95% CI: 1.08-2.11) for Alpha versus B.1.177, 2.09 (95% CI: 1.42-3.08) for Delta versus Alpha, 0.99 (95% CI: 0.76-1.27) for AY.4.2 Delta versus non-AY.4.2 Delta, 0.49 (95% CI: 0.22-1.06) for Omicron versus non-AY.4.2 Delta, and 0.86 (95% CI: 0.68-1.09) for BA.2 Omicron versus BA.1 Omicron. Conclusions The direction of change in intrinsic severity between successively emerging SARS-CoV-2 variants was inconsistent, reminding us that the intrinsic severity of future SARS-CoV-2 variants remains uncertain.

KW - Intrinsic severity

KW - COVID-19

KW - SARS-CoV-2

KW - Alpha variant

KW - Delta variant

KW - Omicron variant

U2 - 10.1016/j.jinf.2023.05.019

DO - 10.1016/j.jinf.2023.05.019

M3 - Article

SN - 0163-4453

VL - 87

SP - 128

EP - 135

JO - Journal of Infection

JF - Journal of Infection

IS - 2

ER -

Directions of change in intrinsic case severity across successive SARS-CoV-2 variant waves have been inconsistent

Abstract

Keywords

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