The changing characteristics of COVID-19 presentations. A regional comparison of SARS-CoV-2 hospitalised patients during the first and second wave

  1. Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, United Kingdom
  2. Cat Atkin
  3. Vicky Kamwa
  4. Department of Acute Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn way, Birmingham, West Midlands
  5. V Reddy-Kolanu
  6. Acute Medicine, University Hospitals Birmingham NHS Foundation Trust
  7. D Parekh
  8. A. Intensive Care Medicine, University Hospitals Birmingham NHS Foundation Trust
  9. F Evison
  10. Research Analytics, Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust
  11. P Nightingale
  12. China
  13. S Gallier
  14. Territories, Hong Kong SAR,
  15. S Ball
  16. Hospital, Shatin, New
  17. E Sapey
  18. Kong, Prince of Wales

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Abstract

Background: This study assesses COVID-19 hospitalised patient demography and outcomes during wave 1 and wave 2, prior to new variants of the virus. Methods: All patients with a positive SARS-CoV-2 swab between 10th March 2020 and 5th July 2020 (wave 1) and 1st September 2020 and 16th November 2020 (wave 2) admitted to University Hospitals Birmingham NHS Foundation Trust were included (n=4856), followed for 28 days. Results: Wave 2 patients were younger, more ethnically diverse, had less co-morbidities and disease presentation was milder on presentation. After matching for these factors, mortality was reduced, but without differences in intensive care admissions. Conclusion: Prior to new SARS-CoV-2 variants, outcomes for hospitalised patients with COVID-19 were improving but with similar intensive care needs.

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  1. Version published to 10.52964/amja.0848
  2. ScreenIT

    SciScore for 10.1101/2021.02.07.21251297: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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 to this study. First, 5.5% of patients from wave 2 remained in hospital at the time of the data lock (albeit after 28 days from their positive swab) and more patients have been admitted, so our findings will evolve. Second, this study does not include confirmation of genetic variation in the SARS-CoV-2 virus for all patients, but results are based on screening data from the UK. Third, this study focuses on hospitalised care and we are therefore unable to comment upon the natural history of COVID-19 prior to admission to secondary care or in those without hospital admission. In summary, there are differences in the demography, co-morbid disease burden, COVID-severity and outcomes in patients hospitalised with COVID-19 comparing wave 1 and wave 2 timelines, with wave 2 generally associated with better outcomes. The reduction in mortality was seen even after accounting for age, ethnicity and co-morbidity. However, mortality remained high and intensive care admissions were not reduced, highlighting the continuing impact of SARS-CoV-2 on our population and healthcare systems. This dataset will provide a robust means to compare the severity of hospitalised illness associated with any new variant of COVID-19, and the potential impact of vaccination, assisting with service planning during this pandemic.

    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.

    About SciScore

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  3. Version published to 10.1101/2021.02.07.21251297v1 on medRxiv