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Clinical Severity of COVID-19 Patients Admitted to Hospitals in Gauteng, South Africa During the Omicron-Dominant Fourth Wave

19 Pages Posted: 29 Dec 2021

See all articles by Waasila Jassat

Waasila Jassat

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Salim Abdool Karim

University of KwaZulu-Natal - Centre for the AIDS Programme of Research in South Africa (CAPRISA)

Caroline Mudara

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Richard Welch

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Lovelyn Ozougwu

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Michelle Groome

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases; University of the Witwatersrand - School of Pathology

Nevashan Govender

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Anne von Gottberg

National Health Laboratory Services - Centre for Respiratory Diseases and Meningitis; University of the Witwatersrand - School of Pathology

Nicole Wolter

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

DATCOV Author Group

Lucille Blumberg

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Cheryl Cohen

National Health Laboratory Services (NHLS) - Centre for Respiratory Diseases and Meningitis; University of the Witwatersrand - School of Public Health

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Abstract

Background: As Omicron became the dominant variant in South Africa, little is known about the severity of its clinical presentation. We describe the clinical severity of patients hospitalised with SARS-CoV-2 infection during the first four weeks of the Omicron-dominated fourth wave and compare this to the first four weeks of the Betadominated second and Delta-dominated third waves in Gauteng Province.

Methods: Polymerase chain reaction and antigen positive SARS-CoV-2 case data were collated daily from laboratory reports. Data on hospital admissions were collected through an active surveillance programme established specifically for COVID-19. In addition to descriptive statistics, post-imputation random effect multivariable logistic regression models were used to compare disease severity in the three wave periods. Severe disease was defined as one or more of acute respiratory distress, supplemental oxygen, mechanical ventilation, high/intensive care or death.

Results: There were 41,046, 33,423, and 133,551 SARS-CoV-2 cases in the second, third and fourth waves respectively. About 4.9% of cases were admitted to hospital during the fourth wave compared to 18.9% and 13.7% during the second and third waves (p<0.001). During the fourth wave, 28.8% of admissions were severe disease compared to 60.1% and 66.9% in the second and third waves (p<0.001). Admitted patients in the omicron-dominated fourth wave were 73% less likely to have severe disease than patients admitted during the delta-dominated third wave (adjusted odds ratio [aOR] 0.27, 95% confidence interval [CI] 0.25-0.31).

Conclusion: The proportion of cases admitted was lower and those admitted were less severe during the first four weeks of the Omicron-dominated fourth wave in Gauteng province of South Africa. Since any combination of a less-virulent virus, comorbidities, high immunity from prior infection(s) or vaccination may be important contributors to this clinical presentation, care should be taken in extrapolating this to other populations with different co-morbidity profiles, prevalence of prior infection and vaccination coverage.

Funding Information: DATCOV as a national surveillance system, is funded by the National Institute for Communicable Diseases (NICD) and the South African National Government. No additional funding was obtained towards the completion of this analysis and the development of this manuscript.

Declaration of Interests: The authors declare that there are no conflicts of interest.

Keywords: COVID-19, hospital admissions, severity, Omicron SAR-CoV-2 variant

Suggested Citation

Jassat, Waasila and Karim, Salim Abdool and Mudara, Caroline and Welch, Richard and Ozougwu, Lovelyn and Groome, Michelle and Govender, Nevashan and von Gottberg, Anne and Wolter, Nicole and Group, DATCOV Author and Blumberg, Lucille and Cohen, Cheryl, Clinical Severity of COVID-19 Patients Admitted to Hospitals in Gauteng, South Africa During the Omicron-Dominant Fourth Wave (December 29, 2021). Available at SSRN: https://ssrn.com/abstract=3996320 or http://dx.doi.org/10.2139/ssrn.3996320

Waasila Jassat (Contact Author)

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases ( email )

Johannesburg
South Africa

Salim Abdool Karim

University of KwaZulu-Natal - Centre for the AIDS Programme of Research in South Africa (CAPRISA)

2nd Floor, Doris Duke Medical Research Institute
719 Umbilo Road
Durban, 4041
South Africa

Caroline Mudara

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Johannesburg
South Africa

Richard Welch

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Johannesburg
South Africa

Lovelyn Ozougwu

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Johannesburg
South Africa

Michelle Groome

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Johannesburg
South Africa

University of the Witwatersrand - School of Pathology ( email )

Johannesburg
South Africa

Nevashan Govender

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Johannesburg
South Africa

Anne Von Gottberg

National Health Laboratory Services - Centre for Respiratory Diseases and Meningitis

Johannesburg
South Africa

University of the Witwatersrand - School of Pathology

Johannesburg, 2000
South Africa

Nicole Wolter

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases ( email )

Johannesburg
South Africa

Lucille Blumberg

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Johannesburg
South Africa

Cheryl Cohen

National Health Laboratory Services (NHLS) - Centre for Respiratory Diseases and Meningitis ( email )

Johannesburg
South Africa

University of the Witwatersrand - School of Public Health

Johannesburg
South Africa

No contact information is available for DATCOV Author Group

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