COVID-19: A comparative study of severity of patients hospitalized during the first and the second wave in South Africa
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Abstract
Background
South Africa has experienced two waves of COVID-19 infections, the second of which was inter alia attributed to the emergence of a novel SARS-CoV2 variant, 501Y.V2. This variant possibly has increased virulence and may be associated with increased mortality. The objective of this study was to determine if patients admitted in the second wave had more severe illness and higher mortality than those admitted in the first.
Methods
We analysed and compared the characteristics, biological severity markers, treatments, level of care and outcomes of patients hospitalised in a private hospital in the Eastern Cape Province, South Africa.
Results
Compared to the first wave, patients admitted in the second were older and less likely to have co-morbidities. In contrast, the D-dimer and interleukin-6 (IL-6) levels were significantly higher. Despite this, significantly less patients were admitted to ICU and/or were mechanically ventilated. The total length of hospital stay was identical in both groups. Whereas the overall mortality was not significantly higher during the second wave, the ICU mortality was. Those that died in the second wave were older than those in the first wave. Multivariable logistic regression showed that being admitted during the second wave was an independent risk factor for mortality.
Conclusion
This study appears to confirm previous reports that the 501Y.V2 variant is possibly more virulent as indicated by the higher levels of D-dimer and IL-6, the slight increase in mortality of hospitalised patients and the higher ICU mortality in the second wave.
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SciScore for 10.1101/2021.05.11.21257033: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Food and Drug Administration (FDA), International Conference for Harmonization (ICH), Good Clinical Practice (GCP), Declaration of Helsinki and current local Ethics guidelines (reference 200923584). Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources All statistical analyses were conducted using IBM SPSS version 27.0.1.0. SPSSsuggested: (SPSS, RRID:SCR_002865)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 …SciScore for 10.1101/2021.05.11.21257033: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Food and Drug Administration (FDA), International Conference for Harmonization (ICH), Good Clinical Practice (GCP), Declaration of Helsinki and current local Ethics guidelines (reference 200923584). Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources All statistical analyses were conducted using IBM SPSS version 27.0.1.0. SPSSsuggested: (SPSS, RRID:SCR_002865)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:There are limitations in our study. This was a single centre study and thus the results cannot be generalised to other regions in South Africa, nor to other countries. Patient numbers were, however, adequate. Furthermore, being a single centre study, it also excluded our need to have to evaluate the impact that different skill sets and resource availability at different hospitals may have had on the outcomes. We could not perform genotyping for all patients included in the study and thus relied on screening results performed by the Kwazulu-Natal Research Innovation and Sequencing Platform (KRISP), which indicated that all the patients genotyped in the second wave in the ECP had the variant. As most data were extracted from our billing platform, certain clinical data were missing. Obesity, which is known to be an important risk factor for COVID-19 severity, was not evaluated as the body mass indices were not recorded [22]. Data on alternative non-invasive oxygen strategies, such as high frequency nasal oxygen delivery devices were also not available. Patients in the second wave did have higher IL-6 and D-dimer levels on admission but the date of symptom onset was not recorded and although admission delays could not be excluded, all patients presenting via the emergency department were admitted promptly.
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.
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