Clinical severity of COVID-19 in patients admitted to hospital during the omicron wave in South Africa: a retrospective observational study

Jassat, Waasila; Karim, Salim S. Abdool; Mudara, Caroline; Welch, Richard; Ozougwu, Lovelyn; Groome, Michelle; Govender, Nevashan; Gottberg, Anne von; Wolter, Nicole; Wolmarans, Milani; Rousseau, Petro; Blumberg, Lucille; Cohen, Cheryl

doi:10.1016/s2214-109x(22)00114-0

Cited by 170 publications

(216 citation statements)

References 24 publications

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“…The high frequency of incidental COVID-19 infection among hospitalized patients detected using the case definition based on lack of oxygen requirement exceeds the rates reported in previous studies that used more stringent case definition based on complete absence of COVID-19 symptoms (2) or were performed during periods of the pandemic prior to the Omicron variant surge (3). However, the high frequency of incidental COVID-19 is very similar to measurements based on case definition of severe COVID-19 (6) or correlates such as administration of steroid treatment (5) during the Omicron surge. Given that non-severe COVID-19 infections not requiring supplementary oxygen can generally be treated on an outpatient basis, we propose that incidental infections in hospitalized patients should not be considered as COVID-19 hospitalizations in public health statistics used to inform the public or make policy decisions.…”

supporting

confidence: 65%

“…While preventing infection was the initial focus of the COVID-19 pandemic response, with increasing population immunity and variant transmissibility, the current focus has shifted to reducing hospitalization and deaths, particularly in vulnerable communities (1). During the recent surge in disease activity driven by the Omicron variant, an increased proportion of “COVID-19 hospitalizations” were incidentally discovered infections in patients newly hospitalized for other reasons (2-6), resulting in decreased measurements of in-hospital disease severity and mortality compared to prior disease surges (6-9). However, estimates of the proportion of total COVID-19 hospitalizations accounted for by these incidental infections range widely from 15% to 68% (2-6), due to heterogeneity in case definitions for these incidental infections and variability across populations with respect to vaccination status and other risk factors for severe COVID-19.…”

mentioning

confidence: 99%

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A More Accurate Measurement of COVID-19 Hospitalizations

Kawaguchi

Torres

et al. 2022

Preprint

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COVID-19 hospitalizations are a key indicator of the SARS-CoV-2 pandemic. The US Centers for Disease Prevention and Control describes oxygen supplementation as a measure of severe disease. SARS-CoV-2 PCR positive patients hospitalized without hypoxia or requiring oxygen may have been identified incidentally due to routine screening practices. We describe the application of a revised case definition for COVID-19 hospitalization based on the case-patient oxygen requirement on admission. Using data collected from consecutive SARS-CoV-2 PCR positive hospital admissions in December 2021 and January 2022 at a large safety net hospital in Los Angeles County, we highlight differences between patients hospitalized with COVID-19 (i.e., no oxygen requirement on admission or `incidental` infection) and those hospitalized for COVID-19 (i.e., oxygen requirement on admission). We conducted multivariable modeling to determine the effect of age as a positive predictor of COVID-19 hospitalization and vaccination or prior infection as a negative predictor. The revised case-definition resulted in a substantial decrease in the number of COVID-19 hospitalizations during the study period: 67.5% of SARS-CoV-2 PCR positive hospital admissions were not for COVID-19 but with COVID-19. A revised case-definition for COVID-19 hospitalization that includes the oxygen requirement on admission is needed to more accurately monitor the pandemic and inform public health policy.

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supporting

confidence: 65%

mentioning

confidence: 99%

A More Accurate Measurement of COVID-19 Hospitalizations

Kawaguchi

Torres

et al. 2022

Preprint

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“…Real world data have subsequently con rmed that vaccine effectiveness is substantially lower against symptomatic disease with Omicron than with Delta and other prior variants [8,9]. However, numbers of hospitalisations as a proportion of cases during the Omicron wave have been considerably lower than previous waves [2,10]. Moreover, observational data suggest that vaccines remain effective against Omicron-related hospitalization in the general population [11,12].…”

Section: Introductionmentioning

confidence: 99%

Severity of Omicron (B.1.1.529) and Delta (B.1.1.617.2) SARS-CoV-2 infection among hospitalised adults: a prospective cohort study

Hyams

Challen

Marlow

et al. 2022

Preprint

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Limited data exist assessing severity of disease in adults hospitalised with Omicron SARS-CoV-2 variant infections, and to what extent patient-factors, including vaccination and pre-existing disease, affect variant-dependent disease severity. This prospective cohort study of all adults (≥18 years of age) hospitalised at acute care hospitals in Bristol, UK assessed disease severity using 3 different measures: FiO2 >28%, World Health Organization (WHO) outcome score >5, and hospital length of stay (LOS) >3 days following admission for Omicron or Delta variant infection. Independent of other variables, including vaccination, Omicron variant infection was associated with a statistically lower severity compared to Delta; risk reductions were 58%, 67%, and 16% for FiO2, WHO score, and LOS, respectively. Younger age and vaccination with two or three doses were also independently associated with lower COVID-19 severity. Despite lower severity relative to Delta, Omicron infection still resulted in substantial patient and public health burden following admission.

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“…A large retrospective study on the Omicron outbreak in South Africa showed that the hospitalization rate in adolescents and children to be significantly higher than those reported in the previous outbreaks. Children under the age of 20 years accounted for 14.3% of the total number of hospitalized patients, and about 25.4% of infected children under the age of 5 years needed hospitalization [ 7 ]. In the United States, the hospitalization rate of children infected with Omicron was also reported to be high, and 19% infected children required ICU treatment [ 8 ].…”

Section: Omicron Strains and Childhood Hepatitismentioning

confidence: 99%