COVID-19 Outcomes and Genomic Characterization of SARS-CoV-2 Isolated From Veterans in New England States: Retrospective Analysis

Abstract

Background Clinical and virologic characteristics of COVID-19 infections in veterans in New England have not been described. The average US veteran is a male older than the general US population. SARS-CoV-2 infection is known to cause poorer outcomes among men and older adults, making the veteran population an especially vulnerable group for COVID-19. Objective This study aims to evaluate clinical and virologic factors impacting COVID-19 outcomes. Methods This retrospective chart review included 476 veterans in six New England states with confirmed SARS-CoV-2 infection between April and September 2020. Whole genome sequencing was performed on SARS-CoV-2 RNA isolated from these veterans, and the correlation of genomic data to clinical outcomes was evaluated. Clinical and demographic variables were collected by manual chart review and were correlated to the end points of peak disease severity (based on oxygenation requirements), hospitalization, and mortality using multivariate regression analyses. Results Of 476 veterans, 274 had complete and accessible charts. Of the 274 veterans, 92.7% (n=254) were men and 83.2% (n=228) were White, and the mean age was 63 years. In the multivariate regression, significant predictors of hospitalization (C statistic 0.75) were age (odds ratio [OR] 1.05, 95% CI 1.03-1.08) and non-White race (OR 2.39, 95% CI 1.13-5.01). Peak severity (C statistic 0.70) also varied by age (OR 1.07, 95% CI 1.03-1.11) and O2 requirement on admission (OR 45.7, 95% CI 18.79-111). Mortality (C statistic 0.87) was predicted by age (OR 1.06, 95% CI 1.01-1.11), dementia (OR 3.44, 95% CI 1.07-11.1), and O2 requirement on admission (OR 6.74, 95% CI 1.74-26.1). Most (291/299, 97.3%) of our samples were dominated by the spike protein D614G substitution and were from SARS-CoV-2 B.1 lineage or one of 37 different B.1 sublineages, with none representing more than 8.7% (26/299) of the cases. Conclusions In a cohort of veterans from the six New England states with a mean age of 63 years and a high comorbidity burden, age was the largest predictor of hospitalization, peak disease severity, and mortality. Non-White veterans were more likely to be hospitalized, and patients who required oxygen on admission were more likely to have severe disease and higher rates of mortality. Multiple SARS-CoV-2 lineages were distributed in patients in New England early in the COVID-19 era, mostly related to viruses from New York State with D614G mutation.

Peer Review of “COVID-19 Outcomes and Genomic Characterization of SARS-CoV-2 Isolated From Veterans in New England States: Retrospective Analysis”

“…Many factors have been reported to either account for or to be associated with the clinical characteristics and prognosis of patients with COVID-19 [ 6 - 8 ]. Given that the aforementioned body of knowledge among veterans in New England is currently limited, the authors of the paper titled “COVID-19 Outcomes and Genomic Characterization of SARS-CoV-2 Isolated From Veterans in New England States” [ 9 ] investigated the patient characteristics, comorbidities, and disease predictors in a cohort of 426 veterans hospitalized for COVID-19. They found using a multivariate regression that age was the most significant predictor of being hospitalized, the severity of disease, and mortality; being non-White was more associated with being hospitalized; and those in need of oxygen upon admission were more likely to die.…”

Peer Review of “COVID-19 Outcomes and Genomic Characterization of SARS-CoV-2 Isolated From Veterans in New England States: Retrospective Analysis”

“…The authors presented a study [ 1 ] about the clinical and genomic characterization of COVID-19 from a veteran group. I have some questions for the authors.…”

Authors' Response to Peer Reviews of “COVID-19 Outcomes and Genomic Characterization of SARS-CoV-2 Isolated From Veterans in New England States: Retrospective Analysis”

“…Many factors have been reported to either account for or to be associated with the clinical characteristics and prognosis of patients with COVID-19 [ 7 - 9 ]. Given that the aforementioned body of knowledge among veterans in New England is currently limited, the authors of the paper titled “COVID-19 Outcomes and Genomic Characterization of SARS-CoV-2 Isolated From Veterans in New England States” [ 10 ] investigated the patient characteristics, comorbidities, and disease predictors in a cohort of 426 veterans hospitalized for COVID-19. They found using a multivariate regression that age was the most significant predictor of being hospitalized, the severity of disease, and mortality; being non-White was more associated with being hospitalized; and those in need of oxygen upon admission were more likely to die.…”