key: cord-0773485-40glwyj2
authors: Garvey, Mark I.; McMurray, Claire; Casey, Anna L; Ratcliffe, Liz; Stockton, Joanne; Wilkinson, Martyn A C; Holden, Elisabeth; Osman, Husam; Loman, Nick J
title: Observations of SARS-CoV-2 variant of concern B.1.1.7 at the UK's largest hospital Trust
date: 2021-04-28
journal: J Infect
DOI: 10.1016/j.jinf.2021.04.026
sha: 0ebefaaf06a0850dcdbc5165de0a487d4f4aa297
doc_id: 773485
cord_uid: 40glwyj2

nan

 SARS-CoV-2 variant of concern B.1.1.7, with increased transmissibility, was identified in the UK in October 2020.

 We report our observations of B.1.1.7 in patients admitted to University Hospitals Birmingham NHS Foundation Trust (UHB), one of the largest tertiary referral centres in the UK.

 B1.1.7 was observed to affect patients of younger age, led to increased admission to critical care with longer stay but the association wasn't statistically significant  Significantly more patients presented with a cough (odds ratio of 2.19; p = 0.0443) Increased coughing could be associated with increased transmissibility and nosocomial infections.

 Importantly, UHB have seen more outbreaks within the acute setting in January 2021 when the new variant became the dominant strain.

 Real time whole genome sequencing will be useful to rapidly identify new variants within the hospital setting to facilitate appropriate patient management.

To the editor,

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has placed unprecedented strain on health-care services, leading to 134,125,854 cases and more than 2,905,412 deaths worldwide, as of 09/04/21. 1 Globally it has been observed that more transmissible variants develop. 2 Since October, one such variant of concern (VOC) (SARS-CoV-2 20B/GR clade; VOC-202012/01; lineage B.1.1.7) has been described in the UK. 3 (Table 1) ; for the former, total length of stay was longer, length of stay on critical care was shorter, the proportion of patients on critical care was lower, the proportion of patients who died was higher and patients were older. A multiple logistic regression suggests that VOCs are significantly associated with the probability of developing a cough when compared to a similar patient with one of the other variants, with an odds ratio of 2.19 (p = 0.0443).

UHB has seen the largest number of COVID-19 cases in the country compared to other hospital Trusts: between 01/03/20-09/04/21, the Trust had 13,677 cases of COVID-19. In our small data set, B.1.1.7 was associated with younger age, an increased proportion of patients being admitted to critical care for longer periods but the association wasn't statistically significant. Whilst numbers of patients were relatively low, no increase in mortality was observed. Interestingly, significantly more patients infected with B.1.1.7 presented with a cough which could be a factor contributing to the increased transmission observed with this variant. This concurs with the report issued by the Office for National Statistics. 5 The NERVTAG report on (2020) showed that when a patient coughs, the average particle number is higher than that of someone talking, singing or shouting. 8 

LoSlength of stay, * P <0.05 

Coronavirus COVID-19 Global cases by the Center for Systems Science and Engineering

despite high seroprevalence

Emergence of a new SARS-CoV-2 variant in the UK

Meeting on SARS-CoV-2 variant under investigation VUI-202012/01

COVID-19) infection survey: characteristics of people testing positive for covid-19 in England

yinengland/characteristicsofpeopletestingpositiveforcovid19inengland27januar y2021

A dynamic nomenclature proposal for SARS-CoV-2 to assist genomic epidemiology

The R Foundation for Statistical Computing

Comparing the respirable aerosol concentrations and particle size distributions generated by singing, speaking and breathing

Investigation of novel SARS-CoV-2 variant of Concern 202012/01 -Technical briefing 5

All authors have contributed to the manuscript.

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