Clinical and virologic factors associated with outcomes of COVID‐19 before and after vaccination among Veterans: Retrospective analysis from six New England states

  1. Megan Lee
  2. Danielle Cosentino
  3. Tassos C. Kyriakides
  4. Tricia Cavallaro
  5. Gary Stack
  6. Shaili Gupta

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Abstract

We aimed to characterize clinical and demographic factors affecting clinical outcomes of COVID‐19 and describe viral epidemiology among unvaccinated Veterans in New England. Veterans infected with COVID‐19 in Veterans Administration healthcare systems in six New England states from April 8, 2020, to September 2, 2021, were correlated with outcomes of 30‐day mortality, nonpsychiatric hospitalization, and intensive care unit admission (ICU‐care). We sequenced 827 viral genomes. Of 3950 Veterans with COVID‐19 before full vaccination, 81% were White, 8% were women, and the mean age was 60 years. Overall, 19% of Veterans required hospitalization, 2.8% required ICU care, and 4.9% died. In this largely male and older cohort, poor outcomes correlated with increasing age. Most New England Veterans (>97%) were infected with B.1 sublineages with the D614G mutation in 2020 and early 2021. B.1.617.2 lineage (68%) predominated after July 2021.

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  1. Version published to 10.1002/jhm.12852
  2. ScreenIT

    SciScore for 10.1101/2022.02.24.22271468: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsField Sample Permit: System (VACHS) in West Haven, Connecticut has carried out testing for SARS-CoV-2 on nasopharyngeal specimens from all six VA healthcare centers in New England states (Connecticut, Massachusetts, Maine
    IRB: The VACHS Institutional Review Board (IRB) approved the creation and maintenance of a data repository of all Veterans in New England diagnosed with COVID-19 and a viral repository of the SARS-CoV-2 RNA received from all six New England facilities.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Deaths were identified as occurring within the VA facility or the VA was provided a death certificate, which was archived in the electronic Veteran registration package of VISTA.
    VISTA
    suggested: (VISTA Browser, RRID:SCR_011808)
    We evaluated viral genomes from 951 Veterans: WGS was conducted on 723 viral genomes using Illumina (n = 224)
    WGS
    suggested: None
    All analyses were performed using STATA v16 (College Station, TX).
    STATA
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations of this work include that it is specific to Veterans, a largely older male cohort, and results may not be generalizable to other populations. Evaluation of Veteran population is critical, however, given that these sex and age limitations also are known associations for COVID-19 infection. Our study spanned the course of the COVID-19 pandemic since its beginning in our region, and although triage algorithms in our hospital system did not significantly change over this time period, our study encompasses both pre- and post-vaccination time periods. We therefore analyzed outcomes in fully vaccinated Veterans and compared to those among unvaccinated. We were only able to record hospitalizations within the VA system and did not have results if Veterans were seen at outside hospitals. Furthermore, we are limited by the retrospective nature of our review, and analysis via ICD codes may have missed diagnoses due to incorrect or inaccurate coding. We did not have data on patients who did not test positive for COVID-19; future work would report COVID-19 positivity based on vaccine status/type. Post-vaccine hospitalizations had a shorter time to accumulate, and future studies should assess how time-based factors (including waves of the virus and likelihood of being hospitalized or infected over time) as well as vaccine uptake over time affect outcomes. Our study’s strengths include its comprehensive inclusion of all Veterans in New England, large study size, and novel analysi...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2022.02.24.22271468 on medRxiv