COVID-19 Cases from the First Local Outbreak of the SARS-CoV-2 B.1.1.7 Variant in China May Present More Serious Clinical Features: A Prospective, Comparative Cohort Study

Abstract

The SARS-CoV-2 B.1.1.7 variant has increased sharply in numbers worldwide and is reported to be more contagious than the nonvariant. Little is known regarding the detailed clinical features of B.1.1.7 variant infection. Data on 74 COVID-19 cases from two outbreaks in two districts of Beijing, China were extracted from a cloud database, including 41 cases from Shunyi District (Shunyi B.1.470 group) and 33 from Daxing (Daxing B.1.1.7 group) from December 25, 2020 to January 17, 2021. We conducted a comparison of the clinical characteristics. Seven clinical indicators of the Daxing B.1.1.7 group were significantly higher than those of the Shunyi group, including the proportion with fever over 38°C, the levels of C-reactive protein (CRP), serum amyloid A (SAA), creatine kinase (CK), d-dimer (DD), and CD4⁺ T lymphocytes (CD4⁺ T), and the proportion with ground-glass opacity (GGO) in the lung (P values of ≤0.05). After adjusting for age, B.1.1.7 variant infection was a risk factor for elevated CRP (P = 0·045), SAA (P = 0·011), CK (P = 0·034), and CD4⁺ T (P = 0.029) and for the presence of GGO (P = 0.005). The median threshold cycle (C_T) value of reverse transcriptase quantitative PCR (RT-qPCR) tests of the N gene target in the Daxing B.1.1.7 group was significantly lower (P = 0.036) than that in the Shunyi B.1.470 group. Clinical features, including a more serious inflammatory response, pneumonia, and a possibly higher viral load, were detected in the cases infected with B.1.1.7 SARS-CoV-2. The B.1.1.7 variant may have increased pathogenicity. IMPORTANCE The SARS-CoV-2 B.1.1.7 variant, which was first identified in the United Kingdom, has increased sharply in numbers worldwide and was reported to be more contagious than the nonvariant. To our knowledge, no studies investigating the detailed clinical features of COVID-19 cases infected with the B.1.1.7 variant have been published. Local epidemics have rarely occurred in China, but occasionally, a small clustered outbreak triggered by an imported SARS-CoV-2 strain with only one chain of transmission could happen. From late 2020 to early 2021, two clustered COVID-19 outbreaks occurred in Beijing, one of which was caused by the B.1.1.7 variant. The COVID-19 patients from the two outbreaks received similar clinical tests, diagnoses, and treatments. We found that the B.1.1.7 variant infection could lead to a more serious inflammatory response, acute response process, more severe pneumonia, and probably higher viral loads. This therefore implies that the B.1.1.7 variant may have increased pathogenicity.

Keywords: B.1.1.7 variant; COVID-19; SARS-CoV-2; clinical features; whole-genome analysis.

FIG 1

Neighbor-joining phylogenetic tree based on the whole-genome sequences of the SARS-CoV-2 representative strains. The two representative strains from the Daxing B.1.1.7 group are indicated by deep blue dots, deep blue font, and a blue left arrow, while the strains from the Shunyi B.1.470 group are indicated by red dots, red font, and a red left arrow. Strains associated with other previous outbreaks in China are indicated with ice-blue triangles. The B.1.1.7 and B.1.470 lineages are highlighted with blue and light red backgrounds, respectively, and the two strains that shared high homology with the strains of the Shunyi B.1.470 group are colored purple. The Wuhan reference strain is shaded in gray. The PANGO lineages are marked and colored on the right. The tree was rooted using strain WH04 (EPI_ISL_406801) in accordance with the root of the Pangolin tree.

FIG 2

Scatterplot of the RT-qPCR Ct values of the Daxing B.1.1.7 group and the Shunyi B.1.470 group. (A) C_t values of the OFR1ab gene target. (B) C_t values of the N gene target. Samples from the Daxing B.1.1.7 group are shown as red dots, while those from the Shunyi B.1.470 group are shown as blue dots. Median C_t is indicated by a black horizontal bar.