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. 2021 Oct:111:47-54.
doi: 10.1016/j.ijid.2021.08.003. Epub 2021 Aug 11.

SARS-CoV-2 variant of concern P.1 (Gamma) infection in young and middle-aged patients admitted to the intensive care units of a single hospital in Salvador, Northeast Brazil, February 2021

Carolina Kymie Vasques Nonaka  1 , Tiago Gräf  2 , Camila Araújo de Lorenzo Barcia  3 , Vanessa Ferreira Costa  4 , Janderson Lopes de Oliveira  4 , Rogério da Hora Passos  5 , Iasmin Nogueira Bastos  2 , Maria Clara Brito de Santana  2 , Ian Marinho Santos  6 , Karoline Almeida Felix de Sousa  2 , Thamires Gomes Lopes Weber  7 , Isadora Cristina de Siqueira  2 , Clarissa Araújo Gurgel Rocha  8 , Ana Verena Almeida Mendes  3 , Bruno Solano de Freitas Souza  9
Affiliations

SARS-CoV-2 variant of concern P.1 (Gamma) infection in young and middle-aged patients admitted to the intensive care units of a single hospital in Salvador, Northeast Brazil, February 2021

Carolina Kymie Vasques Nonaka et al. Int J Infect Dis. 2021 Oct.

Abstract

Objectives: To evaluate changes in the characteristics of patients with coronavirus disease 2019 (COVID-19) after the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant of concern (VOC) P.1 (Gamma), by comparing the clinical, demographic, and laboratory profiles of patients hospitalized during the first (May to July 2020) and second (December 2020 to February 2021) pandemic waves.

Methods: Data were collected from the records of COVID-19 patients (n = 4164) admitted to a single hospital in Salvador, Northeast Brazil. SARS-CoV-2 genome sequencing was performed on nasopharyngeal swab samples from 12 patients aged <60 years admitted to the intensive care unit (ICU) in February 2021.

Results: Between June 2020 and February 2021, the median age of patients admitted to the ICU decreased from 66 to 58 years (P < 0.05). This was accompanied by an increased proportion of patients without comorbidities (15.32% vs 32.20%, P < 0.0001). A significant reduction in the cycle threshold values of SARS-CoV-2 RT-PCR tests was observed in the second wave (P < 0.0001). Sequencing analysis detected lineage Gamma in all 12 ICU patients sampled in February 2021.

Conclusions: The results of this study demonstrated an increased proportion of younger adults without comorbidities with severe disease during the second COVID-19 wave, shortly after the confirmation of local Gamma circulation.

Keywords: COVID-19; Gamma; P.1; SARS-CoV-2; Variants of concern.

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Conflict of interest statement

Conflict of interest The authors claim no conflict of interest.

Figures

Figure 1
Figure 1
Confirmed COVID-19 hospitalizations. (A) Cumulative confirmed COVID-19 cases in Bahia State, Salvador, and patients admitted to the São Rafael Hospital (HSR) since May 2020. (B) The total number of patients hospitalized (n = 4164, blue line) and admitted to the ICU (n = 2087, orange line) from May 2020 to February 2021.
Figure 2
Figure 2
Temporal changes in the demographic profile of the patients admitted to the ICU due to COVID-19. (A) Individual age values (≥18 years old) are represented, along with median and 95% CI. The first wave includes the months of May, June, and July 2020; the second wave includes the months of December 2020, January 2021, and February 2021. (B) Total numbers of patients admitted to the ICU stratified by age group. **P < 0.001, ***P < 0.0001.
Figure 3
Figure 3
Temporal change in the SARS-CoV-2 RT-PCR cycle threshold (Ct) values. N gene Ct values were evaluated and compared between samples from COVID-19 patients referred to the hospital in June 2020 (n = 1589) and in February 2021 (n = 771). Single Ct values and the median are plotted. ****P < 0.0001.
Figure 4
Figure 4
Circular maximum likelihood phylogenetic tree of the P.1 (Gamma) lineage diversity in Brazil. Samples isolated in Bahia are shown with circles, and the colors represent the origin of the sample, when available. Travel history data are those reported by Tosta et al., 2021 (Tosta et al., 2021). Three clusters with samples isolated in Bahia are highlighted and SH-aLRT support is shown. The tree was rooted in the oldest P.1 sampled genome.
See this image and copyright information in PMC

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