The SARS-CoV-2 Alpha variant was associated with increased clinical severity of COVID-19 in Scotland : a genomics-based retrospective cohort analysis
Abstract
Objectives The SARS-CoV-2 Alpha variant was associated with increased transmission relative to other variants present at the time of its emergence and several studies have shown an association between Alpha variant infection and increased hospitalisation and 28-day mortality. However, none have addressed the impact on maximum severity of illness in the general population classified by the level of respiratory support required, or death. We aimed to do this. Methods In this retrospective multi-centre clinical cohort sub-study of the COG-UK consortium, 1475 samples from Scottish hospitalised and community cases collected between 1st November 2020 and 30th January 2021 were sequenced. We matched sequence data to clinical outcomes as the Alpha variant became dominant in Scotland and modelled the association between Alpha variant infection and severe disease using a 4-point scale of maximum severity by 28 days: 1. no respiratory support, 2. supplemental oxygen, 3. ventilation and 4. death. Results Our cumulative generalised linear mixed model analyses found evidence (cumulative odds ratio: 1.40, 95% CI: 1.02, 1.93) of a positive association between increased clinical severity and lineage (Alpha variant versus pre-Alpha variants). Conclusions The Alpha variant was associated with more severe clinical disease in the Scottish population than co-circulating lineages.
Citation
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 , Lewis , T , Lycett , S , MacLean , O , McHugh , M , Mollett , G , Onishi , Y , Parcell , B , Ray , S , Robertson , D L , Shabaan , S , Shepherd , J G , Smollett , K , Templeton , K , Wastnedge , E , Wilkie , C , Williams , T , Thomson , E C & Consortium , T COVID G UK 2023 , ' The SARS-CoV-2 Alpha variant was associated with increased clinical severity of COVID-19 in Scotland : a genomics-based retrospective cohort analysis ' , PLoS ONE , vol. 18 , no. 4 , e0284187 . https://doi.org/10.1371/journal.pone.0284187
Publication
PLoS ONE
Status
Peer reviewed
ISSN
1932-6203Type
Journal article
Rights
Copyright: © 2023 Pascall et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Description
Funding: COG-UK is supported by funding from the Medical Research Council (MRC) part of UK Research & Innovation (UKRI), the National Institute of Health Research (NIHR) and Genome Research Limited, operating as the Wellcome Sanger Institute. Funding was also provided by UKRI through the JUNIPER consortium (MR/V038613/1). Sequencing, bioinformatics and statistical support was funded by the Medical Research Council (MRC) core awards for the MRC-University of Glasgow Centre for Virus Research (MC UU 1201412) and MRC Biostatistics Unit (MC UU 00002/11).Collections
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