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Increased mortality in community-tested cases of SARS-CoV-2 lineage B.1.1.7

Increased mortality in community-tested cases of SARS-CoV-2 lineage B.1.1.7
Increased mortality in community-tested cases of SARS-CoV-2 lineage B.1.1.7
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.
0028-0836
270-274
Davies, Nicholas G.
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Jarvis, Christopher I.
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van Zandvoort, Kevin
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Atkins, Katherine E.
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Klepac, Petra
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Diaz-Ordaz, Karla
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CMMID COVID-19 Working Group
Davies, Nicholas G.
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Jarvis, Christopher I.
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van Zandvoort, Kevin
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Clifford, Samuel
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Sun, Fiona Yueqian
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Funk, Sebastian
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Medley, Graham
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Jafari, Yalda
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Meakin, Sophie R.
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Lowe, Rachel
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Krauer, Fabienne
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Tully, Damien C.
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Munday, James D.
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Showering, Alicia
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Foss, Anna M.
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Prem, Kiesha
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Flasche, Stefan
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Kucharski, Adam J.
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Abbott, Sam
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Rosello, Alicia
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Knight, Gwenan M.
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Jit, Mark
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Liu, Yang
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Williams, Jack
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Hellewell, Joel
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Russell, Timothy W.
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Procter, Simon R.
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Endo, Akira
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Nightingale, Emily S.
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Bosse, Nikos I.
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Villabona-Arenas, C. Julian
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Sandmann, Frank G.
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Gimma, Amy
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Abbas, Kaja
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Waites, William
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Atkins, Katherine E.
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Barnard, Rosanna C.
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Klepac, Petra
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Gibbs, Hamish P.
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Pearson, Carl A.B.
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Edmunds, W. John
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Jewell, Nicholas P.
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Diaz-Ordaz, Karla
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Keogh, Ruth H.
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Davies, Nicholas G., Jarvis, Christopher I., Edmunds, W. John, Jewell, Nicholas P., Diaz-Ordaz, Karla and Keogh, Ruth H. , CMMID COVID-19 Working Group (2021) Increased mortality in community-tested cases of SARS-CoV-2 lineage B.1.1.7. Nature, 593, 270-274. (doi:10.1038/s41586-021-03426-1).

Record type: Article

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.

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More information

Accepted/In Press date: 8 March 2021
e-pub ahead of print date: 15 March 2021
Published date: 13 May 2021

Identifiers

Local EPrints ID: 500254
URI: http://eprints.soton.ac.uk/id/eprint/500254
DOI: doi:10.1038/s41586-021-03426-1
ISSN: 0028-0836
PURE UUID: 30f1083b-78a3-4125-b9d8-d4c27eab91eb
ORCID for William Waites: ORCID iD orcid.org/0000-0002-7759-6805

Catalogue record

Date deposited: 23 Apr 2025 16:45
Last modified: 24 Apr 2025 02:11

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Contributors

Author: Nicholas G. Davies
Author: Christopher I. Jarvis
Author: Kevin van Zandvoort
Author: Samuel Clifford
Author: Fiona Yueqian Sun
Author: Sebastian Funk
Author: Graham Medley
Author: Yalda Jafari
Author: Sophie R. Meakin
Author: Rachel Lowe
Author: Matthew Quaife
Author: Naomi R. Waterlow
Author: Rosalind M. Eggo
Author: Jiayao Lei
Author: Mihaly Koltai
Author: Fabienne Krauer
Author: Damien C. Tully
Author: James D. Munday
Author: Alicia Showering
Author: Anna M. Foss
Author: Kiesha Prem
Author: Stefan Flasche
Author: Adam J. Kucharski
Author: Sam Abbott
Author: Billy J. Quilty
Author: Thibaut Jombart
Author: Alicia Rosello
Author: Gwenan M. Knight
Author: Mark Jit
Author: Yang Liu
Author: Jack Williams
Author: Joel Hellewell
Author: Kathleen O’Reilly
Author: Yung Wai Desmond Chan
Author: Timothy W. Russell
Author: Simon R. Procter
Author: Akira Endo
Author: Emily S. Nightingale
Author: Nikos I. Bosse
Author: C. Julian Villabona-Arenas
Author: Frank G. Sandmann
Author: Amy Gimma
Author: Kaja Abbas
Author: William Waites ORCID iD
Author: Katherine E. Atkins
Author: Rosanna C. Barnard
Author: Petra Klepac
Author: Hamish P. Gibbs
Author: Carl A.B. Pearson
Author: W. John Edmunds
Author: Nicholas P. Jewell
Author: Karla Diaz-Ordaz
Author: Ruth H. Keogh
Corporate Author: CMMID COVID-19 Working Group

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