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COVID-19 cases from the first local outbreak of SARS-CoV-2 B.1.1.7 variant in China presented more serious clinical features: a prospective, comparative cohort study
Yang Song M.D.; Ziruo Ge M.D.; Shuping Cui M.Sc.; Di Tian M.D.; Gang Wan M.D.; Shuangli Zhu B.Sc.; Xianbo Wang M.D.; Yu Wang M.D.; Xiang Zhao M.D.; Pan Xiang M.D.; Yanli Xu M.D.; Tingyu Zhang M.D.; Long Liu M.D.; Gang Liu M.D.; Yanhai Wang M.Sc.; Jianbo Tan M.D.; Wei Zhang M.D.; Wenbo Xu M.D.; Zhihai Chen M.D..
  • Yang Song M.D.; National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
  • Ziruo Ge M.D.; Emergency department of COVID-19, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Shuping Cui M.Sc.; Emergency department of COVID-19, Beijing Ditan Hospital, Capital Medical University, Beijing, China and Peking University, Ditan Teaching Hospital, Beijing, Ch
  • Di Tian M.D.; Emergency department of COVID-19, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Gang Wan M.D.; Emergency department of COVID-19, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Shuangli Zhu B.Sc.; National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
  • Xianbo Wang M.D.; Emergency department of COVID-19, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Yu Wang M.D.; Emergency department of COVID-19, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Xiang Zhao M.D.; National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
  • Pan Xiang M.D.; Emergency department of COVID-19, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Yanli Xu M.D.; Emergency department of COVID-19, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Tingyu Zhang M.D.; Emergency department of COVID-19, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Long Liu M.D.; Emergency department of COVID-19, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Gang Liu M.D.; Emergency department of COVID-19, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Yanhai Wang M.Sc.; National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
  • Jianbo Tan M.D.; Emergency department of COVID-19, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Wei Zhang M.D.; Emergency department of COVID-19, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Wenbo Xu M.D.; National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
  • Zhihai Chen M.D.; Emergency department of COVID-19, Beijing Ditan Hospital, Capital Medical University, Beijing, China
Preprint in English | medRxiv | ID: ppmedrxiv-21256655
ABSTRACT
BackgroundThe SARS-CoV-2 B.1.1.7 variant which was first identified in the United Kingdom (U.K.) has increased sharply in numbers worldwide and was reported to be more contagious. On January 17, 2021, a COVID-19 clustered outbreak caused by B.1.1.7 variant occurred in a community in Daxing District, Beijing, China. Three weeks prior, another non-variant (lineage B.1.470) COVID-19 outbreak occurred in Shunyi District, Beijing. This study aimed to investigate the clinical features of B.1.1.7 variant infection. MethodsA prospective cohort study was conducted on COVID-19 cases admitted to Ditan hospital since January 2020. Data of 74 COVID-19 cases from two independent COVID-19 outbreaks in Beijing were extracted as study subjects from a Cloud Database established in Ditan hospital, which included 41 Shunyi cases (Shunyi B.1.470 group) and 33 Daxing cases (Daxing B.1.1.7 group) that have been hospitalized since December 25, 2020 and January 17, 2021, respectively. We conducted a comparison of the clinical characteristics, RT-qPCR results and genomic features between the two groups. FindingsCases from Daxing B.1.1.7 group (15 [45.5%] male; median age, 39 years [range, 30.5, 62.5]) and cases from Shunyi B.1.470 group (25 [61.0%] male; median age, 31 years [range, 27.5, 41.0]) had a statistically significant difference in median age (P =0.014). Seven clinical indicators of Daxing B.1.1.7 group were significantly higher than Shunyi B.1.470 group including patients having fever over 38{degrees}C (14/33 [46.43%] in Daxing B.1.1.7 group vs. 9/41 (21.95%) in Shunyi B.1.470 group [P = 0 .015]), C-reactive protein ([CRP, mg/L], 4.30 [2.45, 12.1] vs. 1.80, [0.85, 4.95], [P = 0.005]), Serum amyloid A ([SAA, mg/L], 21.50 [12.50, 50.70] vs. 12.00 [5.20, 26.95], [P = 0.003]), Creatine Kinase ([CK, U/L]), 110.50 [53.15,152.40] vs. 70.40 [54.35,103.05], [P = 0.040]), D-dimer ([DD, mg/L], 0.31 [0.20, 0.48] vs. 0.24 [0.17,0.31], [P = 0.038]), CD4+ T lymphocyte ([CD4+ T, mg/L], [P = 0.003]), and Ground-glass opacity (GGO) in lung (15/33 [45.45%] vs. 5/41 [12.20%], [P =0.001]). After adjusting for the age factor, B.1.1.7 variant infection was the risk factor for CRP (P = 0.045, Odds ratio [OR] 2.791, CI [1.025, 0.8610]), SAA (0.011, 5.031, [1.459, 17.354]), CK (0.034, 4.34, [0.05, 0.91]), CD4+ T (0.029, 3.31, [1.13, 9.71]), and GGO (0.005, 5.418, [1.656, 17.729]) of patients. The median Ct value of RT-qPCR tests of the N-gene target in the Daxing B.1.1.7 group was significantly lower than the Shunyi B.1.470 group (P=0.036). The phylogenetic analysis showed that only 2 amino acid mutations in spike protein were detected in B.1.470 strains while B.1.1.7 strains had 3 deletions and 7 mutations. InterpretationClinical features including a more serious inflammatory response, pneumonia and a possible higher viral load were detected in the cases infected with B.1.1.7 SARS-CoV-2 variant. It could therefore be inferred that the B.1.1.7 variant may have increased pathogenicity. FundingThe study was funded by the National Key Research and Development Program (grant nos.2020YFC0846200 and 2020YFC0848300) and National Natural Science Foundation of China (grant no. 82072295).
Full text: Available Collection: Preprints Database: medRxiv Type of study: Etiology study / Observational study / Prognostic study / Randomized controlled trials / Risk factors Topics: Variants Language: English Year: 2021 Document Type: Preprint

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Full text: Available Collection: Preprints Database: medRxiv Type of study: Etiology study / Observational study / Prognostic study / Randomized controlled trials / Risk factors Topics: Variants Language: English Year: 2021 Document Type: Preprint