Characteristics and Outcomes of Hospitalized Patients in ...

This study describes the characteristics and clinical outcomes of patients hospitalized in South Africa during the Omicron wave compared ... CharacteristicsandOutcomesofHospitalizedPatientsinSouthAfricaDuringtheCOVID-19OmicronWaveComparedWithPreviousWaves|GlobalHealth|JAMA|JAMANetwork Ourwebsiteusescookiestoenhanceyourexperience.Bycontinuingtouseoursite,orclicking"Continue,"youareagreeingtoourCookiePolicy | Continue [SkiptoNavigation] fulltexticon FullText contentsicon Contents figureicon Figures/Tables multimediaicon Multimedia attachicon SupplementalContent referencesicon References relatedicon Related commentsicon Comments DownloadPDF Comment TopofArticle Methods Results Discussion ArticleInformation References Table1. CharacteristicsofPatientsAdmittedWithaPositiveCOVID-19Resultinthe4WavesaViewLargeDownloadTable2. OutcomesofPatientsAdmittedWithaPositiveCOVID-19Resultinthe4WavesaViewLargeDownload 1.NewCOVID-19variantdetectedinSouthAfrica.NationalInstituteforCommunicableDiseases(NICD).AccessedDecember20,2021.https://www.nicd.ac.za/new-covid-19-variant-detected-in-south-africa/2.ClassificationofOmicron(B.1.1.529)SARS-CoV-2variantofconcern.AccessedDecember20,2021.https://www.who.int/news/item/26-11-2021-classification-of-omicron-(b.1.1.529)-sars-cov-2-variant-of-concern3.UpdateonOmicron.AccessedDecember20,2021.https://www.who.int/news/item/28-11-2021-update-on-omicron4.NetworkforGenomicSurveillanceinSouthAfrica(NGS-SA).SARS-CoV-2sequencingupdate.December17,2021.AccessedDecember20,2021.https://www.nicd.ac.za/wp-content/uploads/2021/12/Update-of-SA-sequencing-data-from-GISAID-17-Dec-21_Final.pdf5.Latestvaccinestatistics.DepartmentofHealth,RepublicofSouthAfrica.AccessedDecember20,2021.https://sacoronavirus.co.za/latest-vaccine-statistics/6.Kleynhans  J,Tempia  S,Wolter  N,  etal;PHIRST-CGroup. SARS-CoV-2seroprevalenceinaruralandurbanhouseholdcohortduringfirstandsecondwavesofinfections,SouthAfrica,July2020-March2021.  EmergInfectDis.2021;27(12):3020-3029.doi:10.3201/eid2712.211465PubMedGoogleScholarCrossref DeltaVariantLinkedWithSpikeinYouthHospitalizations NewsFromtheCentersforDiseaseControlandPrevention October12,2021 BridgetM. Kuehn, MSJ WinterofOmicron—TheEvolvingCOVID-19Pandemic Viewpoint December22,2021 ThisViewpointdiscussestheOmicronvariantofSARS-CoV-2,includingitslikelyorigin,theimportanceofvaccination,theothertoolsavailabletocombatasurgeinCOVID-19cases,andthepossibilityofa“twindemic”withinfluenza. Carlos delRio, MD;SaadB. Omer, MBBS,MPH,PhD;PreetiN. Malani, MD,MSJ SeverityofIllnessinPersonsInfectedWiththeSARS-CoV-2DeltaVariantvsBetaVariantinQatar OriginalInvestigation December22,2021 ThiscohortstudyassessestheseverityofclinicaloutcomesinpersonsinfectedwiththeSARS-CoV-2DeltavariantvstheBetavariantinQatar. AdeelA. Butt, MBBS,MS;SohaR. Dargham, MPH;Hiam Chemaitelly, MS;Abdullatif AlKhal, MD;Patrick Tang, MD,PhD;MohammadR. Hasan, PhD;PeterV. Coyle, MD;AnilG. Thomas, MHA,BSN;AbdelsalamM. Borham, MQM;ElliG. Concepcion, BSN;AnvarH. Kaleeckal, MS;AliNizar Latif, MD;Roberto Bertollini, MD,MPH;Abdul-Badi Abou-Samra, MD,PhD;LaithJ. Abu-Raddad, PhD OmicronHasReachedtheUS—Here’sWhatInfectiousDiseaseExpertsKnowAbouttheVariant MedicalNews&Perspectives December28,2021 ThisMedicalNewsarticleonOmicron,thenewestSARS-CoV-2variantofconcern,isadaptedfromaJAMAvideointerviewrecordedonDecember1,2021. 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Conflictsofinterestcomprisefinancialinterests,activities,andrelationshipswithinthepast3yearsincludingbutnotlimitedtoemployment,affiliation,grantsorfunding,consultancies,honorariaorpayment,speaker'sbureaus,stockownershiporoptions,experttestimony,royalties,donationofmedicalequipment,orpatentsplanned,pending,orissued. Erronthesideoffulldisclosure. Ifyouhavenoconflictsofinterest,check"Nopotentialconflictsofinterest"intheboxbelow.Theinformationwillbepostedwithyourresponse. Notallsubmittedcommentsarepublished.Pleaseseeourcommentingpolicyfordetails. Yes,Ihavepotentialconflictsofinterest. No,Idonothavepotentialconflictsofinterest. Limit140characters Limit3600charactersorapproximately600words Submit Thefollowinginformationisrequiredandmustbecompletedinordertosubmitacomment: ThankYou. Yourcommentsubmissionwassuccessful. Pleaseallowupto2businessdaysforreview,approval,andposting. 1Commentforthisarticle EXPANDALL December31,2021 TheOmicronVariant:FriendorFoe? RaulGazmuri,MD,PhD |RosalindFranklinUniversityofMedicineandScienceandCaptainJamesA.LovellFederalHealthCareCenter Couldtheomicronvariantsignalatransitionfromapandemicwithhorribleconsequencestoanendemicwithwhichwecancoexistpeacefullywithoutasmuchdisruptionofourlives?ThesedatafromSouthAfricareportedinthislettersupportthatOmicronproducesamilddiseaseleadingtoasubstantiallylowerhospitalizationanddeathratecomparedtotheDeltavariant.TheexperienceinSouthAfricaalsoshowsashorterdurationofsymptomaticdisease. IamanintensivistwhohastakencareofCOVIDpatientssincethebeginningofthepandemic.WhatweareseeinginourICUisconsistentwith thisexplanation.Evenindividualswithmultiplecomorbiditiesandthosewhoareunvaccinatedareexperiencingmilderdiseasewithsomedegreeofhypoxemiabutaminorincreaseintheworkofbreathing.Thesepatientscanbemanagedwithsupplementaloxygen,sometimeshigh-flownasalcannula,butwithouttheprogressionobservedwithpreviousvariantsrequiringintubationformechanicalventilation. RespectedscientistshavesuggestedthatmostofuswillbeexposedtotheOmicronvariant,developamildandshort-liveddisease,andmostimportantlyfosternaturalimmunitywhichcouldprotectusfromothervariants. Verysoonwewilllearnwhethertheseobservationsareaccurateandcanbegeneralizedcausingadramaticincreaseincasesbutwithrelativelylittleimpactonhospitalizationsanddeaths. CONFLICTOFINTEREST: NoneReported READMORE NewOnline Views 83,760 Citations 0 Comments 1 ViewMetrics DownloadPDF Twitter Facebook More LinkedIn Cite This Citation MasloC,FriedlandR,ToubkinM,LaubscherA,AkalooT,KamaB.CharacteristicsandOutcomesofHospitalizedPatientsinSouthAfricaDuringtheCOVID-19OmicronWaveComparedWithPreviousWaves.JAMA.PublishedonlineDecember30,2021.doi:10.1001/jama.2021.24868 Downloadcitationfile: Ris(Zotero) EndNote BibTex Medlars ProCite RefWorks ReferenceManager Mendeley ©2021 Permissions ResearchLetter December 30,2021 CharacteristicsandOutcomesofHospitalizedPatientsinSouthAfricaDuringtheCOVID-19OmicronWaveComparedWithPreviousWaves Caroline Maslo, MD,PhD1;Richard Friedland, MD,BVSc1;Mande Toubkin, RN,RM,Rpaeds1;etal Anchen Laubscher, MD,DipPEC,DCH,PGDipGM1;Teshlin Akaloo, FIA1;Boniswa Kama, BCOMHons1 AuthorAffiliations ArticleInformation 1NetcareLtdSouthAfrica,Johannesburg,SouthAfrica JAMA.PublishedonlineDecember30,2021.doi:10.1001/jama.2021.24868 visualabstracticon VisualAbstract editorialcommenticon EditorialComment relatedarticlesicon RelatedArticles authorinterviewicon Interviews multimediaicon Multimedia NewsFromtheCentersforDiseaseControlandPrevention DeltaVariantLinkedWithSpikeinYouthHospitalizations BridgetM. Kuehn, MSJ Viewpoint WinterofOmicron—TheEvolvingCOVID-19Pandemic Carlos delRio, MD;SaadB. Omer, MBBS,MPH,PhD;PreetiN. Malani, MD,MSJ OriginalInvestigation SeverityofIllnessinPersonsInfectedWiththeSARS-CoV-2DeltaVariantvsBetaVariantinQatar AdeelA. Butt, MBBS,MS;SohaR. Dargham, MPH;Hiam Chemaitelly, MS;Abdullatif AlKhal, MD;Patrick Tang, MD,PhD;MohammadR. Hasan, PhD;PeterV. Coyle, MD;AnilG. Thomas, MHA,BSN;AbdelsalamM. Borham, MQM;ElliG. Concepcion, BSN;AnvarH. Kaleeckal, MS;AliNizar Latif, MD;Roberto Bertollini, MD,MPH;Abdul-Badi Abou-Samra, MD,PhD;LaithJ. Abu-Raddad, PhD MedicalNews&Perspectives OmicronHasReachedtheUS—Here’sWhatInfectiousDiseaseExpertsKnowAbouttheVariant Jennifer Abbasi OnNovember24,2021,aSARS-CoV-2variantofconcern,Omicron(B.1.1.529),wasidentifiedinSouthAfricaasresponsibleforafourthwaveofCOVID-19.1,2Thehighnumberofspikemutationshasraisedconcernsaboutitsabilitytoevadevaccineandspread.3,4WeassessedhospitalizedpatientswithapositiveSARS-CoV-2testresultduringthefourthwavecomparedwithpreviouswaves. Methods Netcareisaprivatehealthcaregroupconsistingof49acutecarehospitals(>10 000beds)acrossSouthAfrica.SouthAfricahasexperienced3COVID-19waves:(1)JunetoAugust2020(ancestralvariant),(2)November2020toJanuary2021(Beta),and(3)MaytoSeptember2021(Delta).CasesagainstartedtoincreasebeginningNovember15,2021,coincidingwiththeidentificationofOmicron;asofDecember7,26%communitypositivityrateswerereached.Weidentifiedtheperiodwhen26%positivityrateswerereachedinthepreviouswaves(wave1:June14toJuly6,2020;wave2:December1-23,2020;wave3:June1-23,2021)andcomparedthemwiththefourthwave(November15toDecember7,2021). Fortriagepurposes,Netcare’spolicyistotestalladmittedpatientsforCOVID-19withreversetranscriptase–polymerasechainreactionor,fromwave2onward,arapidantigentestobtainedfromanasopharyngealswab.AllpatientshospitalizedwithapositiveCOVID-19resultwereincluded.Patientcharacteristics,needforoxygensupplyandmechanicalventilation,admissiontointensivecare,lengthofstay(LOS),andmortalityrateswereextractedfromtheelectronicadministrationsystem.Follow-upwasthroughDecember20,2021. Categoricalvariableswerecomparedbetweenwavesusingaχ2testandcontinuousvariablesusing1-wayanalysisofvariance(ANOVA).A5%significancelevel(2-sided)wasused.AnalysiswasperformedusingSASversion9.4forWindows(SASInstituteInc). ThisstudywasapprovedbyPharma-ethics.Allpatientsprovidedwritteninformedconsent. Results Thenumberofpatientstreatedinthehospitalsduringthesameearlyperiodofeachwavediffered(2351inwave4vsmaximum6342inwave3);however,68%to69%ofpatientspresentingtotheemergencydepartmentwithapositiveCOVID-19resultwereadmittedtothehospitalinthefirst3wavesvs41.3%inwave4(Table1).Patientshospitalizedduringwave4wereyounger(medianage,36yearsvsmaximum59yearsinwave3;P 50%ofthepopulationhashadpreviousexposuretoSARS-CoV-26)orifOmicronmaybelesspathogenicthanpreviousvariants. SectionEditors:JodyW.Zylke,MD,DeputyEditor;KristinWalter,MD,AssociateEditor. Backtotop ArticleInformation CorrespondingAuthor:CarolineMaslo,MD,PhD,Netcare,76MaudeSt,Sandton2196,Johannesburg,SouthAfrica([email protected]).AcceptedforPublication:December27,2021.PublishedOnline:December30,2021.doi:10.1001/jama.2021.24868AuthorContributions:DrsMasloandKamahadfullaccesstoallofthedatainthestudyandtakeresponsibilityfortheintegrityofthedataandtheaccuracyofthedataanalysis.Conceptanddesign:Maslo,Friedland.Acquisition,analysis,orinterpretationofdata:Allauthors.Draftingofthemanuscript:Maslo,Friedland.Criticalrevisionofthemanuscriptforimportantintellectualcontent:Allauthors.Statisticalanalysis:Maslo,Akaloo.Administrative,technical,ormaterialsupport:Laubscher,Toubkin,Kama.Supervision:Maslo,Friedland,Laubscher.ConflictofInterestDisclosures:Nonereported. References 1.NewCOVID-19variantdetectedinSouthAfrica.NationalInstituteforCommunicableDiseases(NICD).AccessedDecember20,2021.https://www.nicd.ac.za/new-covid-19-variant-detected-in-south-africa/2.ClassificationofOmicron(B.1.1.529)SARS-CoV-2variantofconcern.AccessedDecember20,2021.https://www.who.int/news/item/26-11-2021-classification-of-omicron-(b.1.1.529)-sars-cov-2-variant-of-concern3.UpdateonOmicron.AccessedDecember20,2021.https://www.who.int/news/item/28-11-2021-update-on-omicron4.NetworkforGenomicSurveillanceinSouthAfrica(NGS-SA).SARS-CoV-2sequencingupdate.December17,2021.AccessedDecember20,2021.https://www.nicd.ac.za/wp-content/uploads/2021/12/Update-of-SA-sequencing-data-from-GISAID-17-Dec-21_Final.pdf5.Latestvaccinestatistics.DepartmentofHealth,RepublicofSouthAfrica.AccessedDecember20,2021.https://sacoronavirus.co.za/latest-vaccine-statistics/6.Kleynhans  J,Tempia  S,Wolter  N,  etal;PHIRST-CGroup. SARS-CoV-2seroprevalenceinaruralandurbanhouseholdcohortduringfirstandsecondwavesofinfections,SouthAfrica,July2020-March2021.  EmergInfectDis.2021;27(12):3020-3029.doi:10.3201/eid2712.211465PubMedGoogleScholarCrossref X . × Accessyoursubscriptions Signin|personalaccount Accessthroughyourinstitution Addorchangeinstitution Freeaccesstonewlypublishedarticles Createafreepersonalaccount Toregisterforemailalertswithlinkstofreefull-textarticles Purchaseaccess Subscribetojournal Getfulljournalaccessfor1year Buyarticle GetunlimitedaccessandaprintablePDF($30.00)—Signinorcreateafreeaccount Rentarticle RentthisarticlefromDeepDyve Accessyoursubscriptions Signin|personalaccount Accessthroughyourinstitution Addorchangeinstitution Freeaccesstonewlypublishedarticles Createafreepersonalaccount Toregisterforemailalertswithlinkstofreefull-textarticles Purchaseaccess Subscribetojournal Getfulljournalaccessfor1year Buyarticle GetunlimitedaccessandaprintablePDF($30.00)—Signinorcreateafreeaccount Rentarticle RentthisarticlefromDeepDyve AccesstofreearticlePDFdownloads Signin|personalaccount Accessthroughyourinstitution Addorchangeinstitution Freeaccesstonewlypublishedarticles Createafreepersonalaccount Toregisterforemailalertswithlinkstofreefull-textarticles Saveyoursearch Signin|personalaccount Freeaccesstonewlypublishedarticles Createafreepersonalaccount Toregisterforemailalertswithlinkstofreefull-textarticles Purchaseaccess Subscribenow Customizeyourinterests Signin|personalaccount Freeaccesstonewlypublishedarticles Createafreepersonalaccount Toregisterforemailalertswithlinkstofreefull-textarticles Createapersonalaccountorsigninto: Registerforemailalertswithlinkstofreefull-textarticles AccessPDFsoffreearticles Manageyourinterests Savesearchesandreceivesearchalerts PrivacyPolicy Makeacomment Signin|personalaccount Freeaccesstonewlypublishedarticles Createafreepersonalaccount Toregisterforemailalertswithlinkstofreefull-textarticles Createapersonalaccountorsigninto: Registerforemailalertswithlinkstofreefull-textarticles AccessPDFsoffreearticles Manageyourinterests Savesearchesandreceivesearchalerts PrivacyPolicy