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Increased mortality in community-tested cases of SARS-CoV-2 lineage B.1.1.7.
Nature. 2021 05; 593(7858):270-274.Nat

Abstract

SARS-CoV-2 lineage B.1.1.7, a variant that was first detected in the UK in September 20201, has spread to multiple countries worldwide. Several studies have established that B.1.1.7 is more transmissible than pre-existing variants, but have not identified whether it leads to any change in disease severity2. Here we analyse a dataset that links 2,245,263 positive SARS-CoV-2 community tests and 17,452 deaths associated with COVID-19 in England from 1 November 2020 to 14 February 2021. For 1,146,534 (51%) of these tests, the presence or absence of B.1.1.7 can be identified because mutations in this lineage prevent PCR amplification of the spike (S) gene target (known as S gene target failure (SGTF)1). On the basis of 4,945 deaths with known SGTF status, we estimate that the hazard of death associated with SGTF is 55% (95% confidence interval, 39-72%) higher than in cases without SGTF after adjustment for age, sex, ethnicity, deprivation, residence in a care home, the local authority of residence and test date. This corresponds to the absolute risk of death for a 55-69-year-old man increasing from 0.6% to 0.9% (95% confidence interval, 0.8-1.0%) within 28 days of a positive test in the community. Correcting for misclassification of SGTF and missingness in SGTF status, we estimate that the hazard of death associated with B.1.1.7 is 61% (42-82%) higher than with pre-existing variants. Our analysis suggests that B.1.1.7 is not only more transmissible than pre-existing SARS-CoV-2 variants, but may also cause more severe illness.

Authors+Show Affiliations

Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK. nicholas.davies@lshtm.ac.uk.Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.No affiliation info availableCentre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK.Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK.Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33723411

Citation

Davies, Nicholas G., et al. "Increased Mortality in Community-tested Cases of SARS-CoV-2 Lineage B.1.1.7." Nature, vol. 593, no. 7858, 2021, pp. 270-274.
Davies NG, Jarvis CI, CMMID COVID-19 Working Group, et al. Increased mortality in community-tested cases of SARS-CoV-2 lineage B.1.1.7. Nature. 2021;593(7858):270-274.
Davies, N. G., Jarvis, C. I., Edmunds, W. J., Jewell, N. P., Diaz-Ordaz, K., & Keogh, R. H. (2021). Increased mortality in community-tested cases of SARS-CoV-2 lineage B.1.1.7. Nature, 593(7858), 270-274. https://doi.org/10.1038/s41586-021-03426-1
Davies NG, et al. Increased Mortality in Community-tested Cases of SARS-CoV-2 Lineage B.1.1.7. Nature. 2021;593(7858):270-274. PubMed PMID: 33723411.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increased mortality in community-tested cases of SARS-CoV-2 lineage B.1.1.7. AU - Davies,Nicholas G, AU - Jarvis,Christopher I, AU - ,, AU - Edmunds,W John, AU - Jewell,Nicholas P, AU - Diaz-Ordaz,Karla, AU - Keogh,Ruth H, Y1 - 2021/03/15/ PY - 2021/01/26/received PY - 2021/03/08/accepted PY - 2021/3/17/pubmed PY - 2021/5/19/medline PY - 2021/3/16/entrez SP - 270 EP - 274 JF - Nature JO - Nature VL - 593 IS - 7858 N2 - SARS-CoV-2 lineage B.1.1.7, a variant that was first detected in the UK in September 20201, has spread to multiple countries worldwide. Several studies have established that B.1.1.7 is more transmissible than pre-existing variants, but have not identified whether it leads to any change in disease severity2. Here we analyse a dataset that links 2,245,263 positive SARS-CoV-2 community tests and 17,452 deaths associated with COVID-19 in England from 1 November 2020 to 14 February 2021. For 1,146,534 (51%) of these tests, the presence or absence of B.1.1.7 can be identified because mutations in this lineage prevent PCR amplification of the spike (S) gene target (known as S gene target failure (SGTF)1). On the basis of 4,945 deaths with known SGTF status, we estimate that the hazard of death associated with SGTF is 55% (95% confidence interval, 39-72%) higher than in cases without SGTF after adjustment for age, sex, ethnicity, deprivation, residence in a care home, the local authority of residence and test date. This corresponds to the absolute risk of death for a 55-69-year-old man increasing from 0.6% to 0.9% (95% confidence interval, 0.8-1.0%) within 28 days of a positive test in the community. Correcting for misclassification of SGTF and missingness in SGTF status, we estimate that the hazard of death associated with B.1.1.7 is 61% (42-82%) higher than with pre-existing variants. Our analysis suggests that B.1.1.7 is not only more transmissible than pre-existing SARS-CoV-2 variants, but may also cause more severe illness. SN - 1476-4687 UR - https://www.unboundmedicine.com/medline/citation/33723411/Increased_mortality_in_community_tested_cases_of_SARS_CoV_2_lineage_B_1_1_7_ L2 - https://doi.org/10.1038/s41586-021-03426-1 DB - PRIME DP - Unbound Medicine ER -