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Difference in mortality among individuals admitted to hospital with COVID-19 during the first and second waves in South Africa: a cohort study.
Jassat, Waasila; Mudara, Caroline; Ozougwu, Lovelyn; Tempia, Stefano; Blumberg, Lucille; Davies, Mary-Ann; Pillay, Yogan; Carter, Terence; Morewane, Ramphelane; Wolmarans, Milani; von Gottberg, Anne; Bhiman, Jinal N; Walaza, Sibongile; Cohen, Cheryl.
  • Jassat W; National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa. Electronic address: waasilaj@nicd.ac.za.
  • Mudara C; National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
  • Ozougwu L; National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
  • Tempia S; National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
  • Blumberg L; National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
  • Davies MA; Health Impact Assessment Directorate, Western Cape Government, Cape Town, South Africa.
  • Pillay Y; Clinton Health Access Initiative, Pretoria, South Africa.
  • Carter T; Clinton Health Access Initiative, Pretoria, South Africa.
  • Morewane R; National Department of Health, Pretoria, South Africa.
  • Wolmarans M; National Department of Health, Pretoria, South Africa.
  • von Gottberg A; National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
  • Bhiman JN; National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
  • Walaza S; National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
  • Cohen C; National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
Lancet Glob Health ; 9(9): e1216-e1225, 2021 09.
Article in English | MEDLINE | ID: covidwho-1368858
ABSTRACT

BACKGROUND:

The first wave of COVID-19 in South Africa peaked in July, 2020, and a larger second wave peaked in January, 2021, in which the SARS-CoV-2 501Y.V2 (Beta) lineage predominated. We aimed to compare in-hospital mortality and other patient characteristics between the first and second waves.

METHODS:

In this prospective cohort study, we analysed data from the DATCOV national active surveillance system for COVID-19 admissions to hospital from March 5, 2020, to March 27, 2021. The system contained data from all hospitals in South Africa that have admitted a patient with COVID-19. We used incidence risk for admission to hospital and determined cutoff dates to define five wave periods pre-wave 1, wave 1, post-wave 1, wave 2, and post-wave 2. We compared the characteristics of patients with COVID-19 who were admitted to hospital in wave 1 and wave 2, and risk factors for in-hospital mortality accounting for wave period using random-effect multivariable logistic regression.

FINDINGS:

Peak rates of COVID-19 cases, admissions, and in-hospital deaths in the second wave exceeded rates in the first wave COVID-19 cases, 240·4 cases per 100 000 people vs 136·0 cases per 100 000 people; admissions, 27·9 admissions per 100 000 people vs 16·1 admissions per 100 000 people; deaths, 8·3 deaths per 100 000 people vs 3·6 deaths per 100 000 people. The weekly average growth rate in hospital admissions was 20% in wave 1 and 43% in wave 2 (ratio of growth rate in wave 2 compared with wave 1 was 1·19, 95% CI 1·18-1·20). Compared with the first wave, individuals admitted to hospital in the second wave were more likely to be age 40-64 years (adjusted odds ratio [aOR] 1·22, 95% CI 1·14-1·31), and older than 65 years (aOR 1·38, 1·25-1·52), compared with younger than 40 years; of Mixed race (aOR 1·21, 1·06-1·38) compared with White race; and admitted in the public sector (aOR 1·65, 1·41-1·92); and less likely to be Black (aOR 0·53, 0·47-0·60) and Indian (aOR 0·77, 0·66-0·91), compared with White; and have a comorbid condition (aOR 0·60, 0·55-0·67). For multivariable analysis, after adjusting for weekly COVID-19 hospital admissions, there was a 31% increased risk of in-hospital mortality in the second wave (aOR 1·31, 95% CI 1·28-1·35). In-hospital case-fatality risk increased from 17·7% in weeks of low admission (<3500 admissions) to 26·9% in weeks of very high admission (>8000 admissions; aOR 1·24, 1·17-1·32).

INTERPRETATION:

In South Africa, the second wave was associated with higher incidence of COVID-19, more rapid increase in admissions to hospital, and increased in-hospital mortality. Although some of the increased mortality can be explained by admissions in the second wave being more likely in older individuals, in the public sector, and by the increased health system pressure, a residual increase in mortality of patients admitted to hospital could be related to the new Beta lineage.

FUNDING:

DATCOV as a national surveillance system is funded by the National Institute for Communicable Diseases and the South African National Government.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Hospital Mortality / COVID-19 / Hospitalization Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Variants Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Africa Language: English Journal: Lancet Glob Health Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Hospital Mortality / COVID-19 / Hospitalization Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Variants Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Africa Language: English Journal: Lancet Glob Health Year: 2021 Document Type: Article