key: cord-0705997-qz3f47a5
authors: Dao, Thi Loi; Hoang, Van Thuan; Nguyen, Nhu Ngoc; Delerce, Jérémy; Chaudet, Hervé; Levasseur, Anthony; Lagier, Jean Christophe; Raoult, Didier; Colson, Philippe; Gautret, Philippe
title: Clinical outcomes in COVID-19 patients infected with different SARS-cov-2 variants in marseille, France
date: 2021-05-24
journal: Clin Microbiol Infect
DOI: 10.1016/j.cmi.2021.05.029
sha: 7dd71d77a649ba3f061e0d1b7170c3b3f6389840
doc_id: 705997
cord_uid: qz3f47a5

OBJECTIVES: To compare the clinical and epidemiological aspects associated with different predominant lineages circulating in Marseille from March 2020 to January 2021. METHODS: In this single-center retrospective cohort study, characteristics of patients infected with four different SARS-CoV-2 variants were documented from medical files. The outcome was the occurrence of clinical failure, defined as hospitalization (for outpatients), transfer to the intensive-care unit (inpatients), and death (all). RESULTS: 254 patients were infected with clade 20A (20AS), 85 with Marseille-1 (M1V), 190 with Marseille-4 (M4V) and 211 with N501Y (N501YV) variants. 20AS presented a bell-shaped epidemiological curve and nearly disappeared around May 2020. M1V reached a very weak peak, then disappeared after a month-and-a-half. M4V appeared in July presented an atypical wave form during seven months. N501YV has only recently appeared. As compared to 20AS, patients infected with M1V were less likely to report dyspnoea (aOR=0.50, p=0.04), rhinitis (aOR=0.57, p=0.04) and to be hospitalised (aOR=0.22, p=0.002). Patients infected with M4V were more likely to report fever than those with 20AS and M1V (aOR=2.49, p<0.0001 and aOR=2.30, p=0.007, respectively) and to be hospitalised than those with M1V (aOR=4.81, p=0.003). Patients infected with N501YV reported lower rate of rhinitis (aOR=0.50, p=0.001) and anosmia (aOR=0.57, p=0.02), as compared to those infected with 20AS. A lower rate of hospitalisation associated with N501YV infection as compared to 20AS and M4V (aOR=0.33, p<0.0001 and aOR=0.27, p<0.0001, respectively). CONCLUSIONS: The four lineages have presentations which differ from one other, epidemiologically and clinically. This supports SARS-CoV-2 genomic surveillance through next-generation sequencing.

Very little is known about viral factors underlying the clinical presentation and severity of 43 COVID-19. To date, most studies showed that the viral mutations, especially the D614G 44 mutation in the spike protein, correlated with a higher infectivity than the wild-type virus. 45 However, the evidence of an association between viral mutations and severity of the disease is conclusions cannot yet be reached as to the epidemic form it will take. Clinical data were 138 available from 740 patients whose virus genome was documented and who were treated at our 139 institute ( were transferred to an intensive care unit (ICU) and 4.3% (32/704) died. It should be noted 142 that no patient infected with the M1V was transferred to an ICU or died.

In univariate analysis, significant differences were observed between patients infected with 144 different lineages of SARS-CoV-2 with regards to age, certain co-morbidities and symptoms 145 and disease severity (Table 2 ). In multivariate, some characteristics appeared to be 146 independent factors associated with infection with different virus lineages (Table 3) . Notably, 147 lower rates of dyspnoea, rhinitis and hospitalisation were seen in patients infected with the 148 M1V as compared to those infected with 20AS. Compared to those infected with 20AS or the 149 M1V, patients infected with the M4V were older and more likely to present with fever. In points. These variants look completely different in the same location at different times. 160 Clinically, the age of the patients is different. Patients infected with the M1V are clearly 161 younger than those with the initial virus or those with the M4V and the N501YV. This is also 162 associated with lower disease severity. Differences in the frequency of fever, dyspnoea, 163 rhinitis and anosmia were observed according to lineages. Hospitalisation rates also varied 164 with lineages. The N501YV is known to associate with an increased infectivity, but the 165 correlation with the severity of the disease is unclear. Initially, it was described as associating In practice, as for the influenza virus, SARS-CoV-2 seems to present mutants with a severity 197 and an epidemiological course that is specifically linked to these mutations. The severity is 198 also different since the M1V was less severe than other lineages, the N501YV appears to be 199 less severe than the M4V, which seems to have had the greatest severity compared to others. Available at: https://www.ecdc.europa.eu/en/publications-data/covid-19-risk-assessment-240 spread-new-variants-concern-eueea-first-update (accessed March 3, 2021). J o u r n a l P r e -p r o o f 

Risk 274 of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: matched 275 cohort study

Genomic 277 characteristics and clinical effect of the emergent SARS-CoV-2 B.1.1.7 lineage in London, 278 UK: a whole-genome sequencing and hospital-based cohort study