Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: Matched cohort study

Robert Challen*, Ellen Brooks-Pollock, Jonathan M. Read, Louise Dyson, Krasimira Tsaneva-Atanasova, Leon Danon

*Corresponding author for this work

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Abstract

Objective To establish whether there is any change in mortality from infection with a new variant of SARS-CoV-2, designated a variant of concern (VOC-202012/1) in December 2020, compared with circulating SARS-CoV-2 variants. Design Matched cohort study. Setting Community based (pillar 2) covid-19 testing centres in the UK using the TaqPath assay (a proxy measure of VOC-202012/1 infection). Participants 54 906 matched pairs of participants who tested positive for SARS-CoV-2 in pillar 2 between 1 October 2020 and 29 January 2021, followed-up until 12 February 2021. Participants were matched on age, sex, ethnicity, index of multiple deprivation, lower tier local authority region, and sample date of positive specimens, and differed only by detectability of the spike protein gene using the TaqPath assay. Main outcome measure Death within 28 days of the first positive SARS-CoV-2 test result. Results The mortality hazard ratio associated with infection with VOC-202012/1 compared with infection with previously circulating variants was 1.64 (95% confidence interval 1.32 to 2.04) in patients who tested positive for covid-19 in the community. In this comparatively low risk group, this represents an increase in deaths from 2.5 to 4.1 per 1000 detected cases. Conclusions The probability that the risk of mortality is increased by infection with VOC-202012/01 is high. If this finding is generalisable to other populations, infection with VOC-202012/1 has the potential to cause substantial additional mortality compared with previously circulating variants. Healthcare capacity planning and national and international control policies are all impacted by this finding, with increased mortality lending weight to the argument that further coordinated and stringent measures are justified to reduce deaths from SARS-CoV-2.

Original languageEnglish
Article numbern579
JournalThe BMJ
Volume372
DOIs
Publication statusPublished - 9 Mar 2021

Bibliographical note

Funding Information:
Funding: RC and KTA were supported by the Engineering and Physical Sciences Research Council (EPSRC; grants EP/N014391/1, EP/ T017856/1) and NHS England, Global Digital Exemplar programme. LDanon and KTA were supported by The Alan Turing Institute (EPSRC grant EP/N510129/1). LDanon, RC, and EBP are supported by the Medical Research Council (MRC; MC/PC/19067). JMR is supported by EPSRC (EP/N014499/1) and MRC (MR/S004793/1, MR/ V028456/1). EBP was partly supported by the National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, in partnership with Public Health England. LDanon, EBP, JMR, and LDyson are further supported by MRC (MR/V038613/1), and LDanon by EPSRC EP/ V051555/1. LDyson also received support through the MRC through the covid-19 rapid response rolling call (grant No MR/V009761/1). Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from the Engineering and Physical Sciences Research Council, NHS England, Global Digital Exemplar programme, Alan Turing Institute, Medical Research Council, and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, in partnership with Public Health England; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. Ethical approval: The data were supplied from the Second Generation Surveillance System (SGSS) database and death reports after anonymisation under strict data protection protocols agreed between the University of Exeter and Public Health England. The ethics of the use of these data for these purposes was agreed by Public Health England with the UK government SPI-M(O)/SAGE committees. The research was assessed as not needing NHS research ethics committee review.

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Structured keywords

  • Covid19

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