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 - CMMID COVID-19 Working Group
AU - van Zandvoort, Kevin
AU - Clifford, Samuel
AU - Sun, Fiona Yueqian
AU - Funk, Sebastian
AU - Medley, Graham
AU - Jafari, Yalda
AU - Meakin, Sophie R.
AU - Lowe, Rachel
AU - Quaife, Matthew
AU - Waterlow, Naomi R.
AU - Eggo, Rosalind M.
AU - Lei, Jiayao
AU - Koltai, Mihaly
AU - Krauer, Fabienne
AU - Tully, Damien C.
AU - Munday, James D.
AU - Showering, Alicia
AU - Foss, Anna M.
AU - Prem, Kiesha
AU - Flasche, Stefan
AU - Kucharski, Adam J.
AU - Abbott, Sam
AU - Quilty, Billy J.
AU - Jombart, Thibaut
AU - Rosello, Alicia
AU - Knight, Gwenan M.
AU - Jit, Mark
AU - Liu, Yang
AU - Williams, Jack
AU - Hellewell, Joel
AU - O’Reilly, Kathleen
AU - Chan, Yung Wai Desmond
AU - Russell, Timothy W.
AU - Procter, Simon R.
AU - Endo, Akira
AU - Nightingale, Emily S.
AU - Bosse, Nikos I.
AU - Villabona-Arenas, C. Julian
AU - Sandmann, Frank G.
AU - Gimma, Amy
AU - Abbas, Kaja
AU - Waites, William
AU - Atkins, Katherine E.
AU - Barnard, Rosanna C.
AU - Klepac, Petra
AU - Gibbs, Hamish P.
AU - Pearson, Carl A.B.
AU - Brady, Oliver
AU - Edmunds, W. John
AU - Jewell, Nicholas P.
AU - Diaz-Ordaz, Karla
AU - Keogh, Ruth H.
N1 - Funding Information:
Acknowledgements We gratefully acknowledge the assistance of Public Health England in providing the analysis data and authorizing the release of an anonymized dataset. This work was supported by grants from UK Research and Innovation, the National Institutes of Health Research (NIHR) Health Protection Research Unit in Immunisation (NIHR200929) and the UK Medical Research Council (MC_PC_19065) (N.G.D.); Global Challenges Research Fund project ‘RECAP’ managed through Research Councils UK and the Economic and Social Research Council (ES/P010873/1) (C.I.J.); European Commission project ‘EpiPose’ (101003688) and the NIHR (NIHR200908) (W.J.E.); the National Institutes of Health/National Institute of Allergy and Infectious Diseases (R01AI148127) (N.P.J.); a Royal Society-Wellcome Trust Sir Henry Dale Fellowship (218554/Z/19/Z) (K.D.-O.); and a UKRI Future Leaders Fellowship (MR/S017968/1) (R.H.K.). See Supplementary Note 2 for working group acknowledgements.
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Nature Limited.
PY - 2021/3/15
Y1 - 2021/3/15
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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85102715298&partnerID=8YFLogxK
U2 - 10.1038/s41586-021-03426-1
DO - 10.1038/s41586-021-03426-1
M3 - Article
C2 - 33723411
AN - SCOPUS:85102715298
SN - 0028-0836
VL - 593
SP - 270
EP - 274
JO - Nature
JF - Nature
IS - 7858
ER -