Comparison of patients with severe COVID-19 admitted to an intensive care unit in South Africa during the first and second wave of the COVID-19 pandemic

doi:10.7196/AJTCCM.2021.v27i4.185

. 2021 Dec 31;27(4):10.7196/AJTCCM.2021.v27i4.185.

doi: 10.7196/AJTCCM.2021.v27i4.185. eCollection 2021.

Comparison of patients with severe COVID-19 admitted to an intensive care unit in South Africa during the first and second wave of the COVID-19 pandemic

U Lalla¹, C F N Koegelenberg¹, B W Allwood¹, L N Sigwadhi², E M Irusen¹, A E Zemlin³, T E Masha⁴, R T Erasmus³, Z C Chapanduka⁵, H Prozesky⁶, J Taljaard⁶, A Parker⁶, E H Decloedt⁷, F Retief⁸, T P Jalavu³, V D Ngah², A Yalew^{2

9

10}, J L Tamuzi², N Baines¹, M McAllister², A Zumla¹¹, P S Nyasulu^{2

12}

Affiliations

¹ Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
² Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
³ Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service (NHLS) Tygerberg Hospital, Cape Town, South Africa.
⁴ Faculty of Health and Wellness Sciences, Peninsula University of Technology Bellville Campus, Cape Town.
⁵ Division of Haematological Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS Tygerberg Hospital, Cape Town, South Africa.
⁶ Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
⁷ Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
⁸ Department of Anaesthesia and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
⁹ Department of Statistics, College of Natural and Computational Sciences, Addis Ababa University, Ethiopia.
¹⁰ National Data Management Centre for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
¹¹ Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, Royal Free Campus, London, UK; NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
¹² Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

PMID: 35359698
PMCID: PMC8948479
DOI: 10.7196/AJTCCM.2021.v27i4.185

Comparison of patients with severe COVID-19 admitted to an intensive care unit in South Africa during the first and second wave of the COVID-19 pandemic

U Lalla et al. Afr J Thorac Crit Care Med. 2021.

. 2021 Dec 31;27(4):10.7196/AJTCCM.2021.v27i4.185.

doi: 10.7196/AJTCCM.2021.v27i4.185. eCollection 2021.

Authors

Affiliations

¹ Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
² Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
³ Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service (NHLS) Tygerberg Hospital, Cape Town, South Africa.
⁴ Faculty of Health and Wellness Sciences, Peninsula University of Technology Bellville Campus, Cape Town.
⁵ Division of Haematological Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS Tygerberg Hospital, Cape Town, South Africa.
⁶ Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
⁷ Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
⁸ Department of Anaesthesia and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
⁹ Department of Statistics, College of Natural and Computational Sciences, Addis Ababa University, Ethiopia.
¹⁰ National Data Management Centre for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
¹¹ Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, Royal Free Campus, London, UK; NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
¹² Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

PMID: 35359698
PMCID: PMC8948479
DOI: 10.7196/AJTCCM.2021.v27i4.185

Abstract

Background: The second wave of coronavirus disease 2019 (COVID-19), dominated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Beta variant, has been reported to be associated with increased severity in South Africa (SA).

Objectives: To describe and compare clinical characteristics, management and outcomes of COVID-19 patients admitted to an intensive care unit (ICU) in SA during the first and second waves.

Methods: In a prospective, single-centre, descriptive study, we compared all patients with severe COVID-19 admitted to ICU during the first and second waves. The primary outcomes assessed were ICU mortality and ICU length of stay (LOS).

Results: In 490 patients with comparable ages and comorbidities, no difference in mortality was demonstrated during the second compared with the first wave (65.9% v. 62.5%, p=0.57). ICU LOS was longer in the second wave (10 v. 6 days, p<0.001). More female admissions (67.1% v. 44.6%, p<0.001) and a greater proportion of patients were managed with invasive mechanical ventilation than with non-invasive respiratory support (39.0% v. 14%, p<0.001) in the second wave.

Conclusion: While clinical characteristics were comparable between the two waves, a higher proportion of patients was invasively ventilated and ICU stay was longer in the second. ICU mortality was unchanged.

Keywords: COVID-19; ICU; SARS-CoV-2; clinical characteristics; management; mortality; outcomes; waves.

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Conflict of interest statement

Conflicts of interest: None.

Figures

**Fig. 1**
Assessing proportional hazards function using Schoenfeld residuals

**Fig. 2**
Probability of survival curve of COVID-19 patients admitted in the ICU: first v. second wave. HR = hazard ratio

See this image and copyright information in PMC

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References

1. Jassat W, Mudara C, Ozougwu L, et al. Difference in mortality among individuals admitted to hospital with COVID-19 during the first and second waves in South Africa: A cohort study. Lancet Glob Health. 2021;9:e1216–1225. doi: 10.1016/S2214109X(21)00289-8. - DOI - PMC - PubMed
1. Fan G, Yang Z, Lin Q, et al. Decreased case fatality rate of COVID-19 in the second wave: A study in 53 countries or regions. Transbound Emerg Dis. 2021;68(2):213–215. doi: 10.1111/tbed.13819. - DOI - PubMed
1. Iftimie S, López-Azcona AF, Vallverdú I, et al. First and second waves of coronavirus disease-19: A comparative study in hospitalised patients in Reus, Spain. PLoS One. 2021;16(3):e0248029. doi: 10.1371/journal.pone.0248029. - DOI - PMC - PubMed
1. Karagiannidis C, Windisch W, McAuley DF, et al. Major differences in ICU admissions during the first and second COVID-19 wave in Germany. Lancet Respir Med. 2021;9(5):e47–e48. doi: 10.1016/s2213-2600(21)00101-6. - DOI - PMC - PubMed
1. Saito S, Asai Y, Matsunaga N, et al. First and second COVID-19 waves in Japan: A comparison of disease severity and characteristics. J Infect. 2021;82(4):84–123. doi: 10.1016/j.jinf.2020.10.033. - DOI - PMC - PubMed

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[1] Jassat W, Mudara C, Ozougwu L, et al. Difference in mortality among individuals admitted to hospital with COVID-19 during the first and second waves in South Africa: A cohort study. Lancet Glob Health. 2021;9:e1216–1225. doi: 10.1016/S2214109X(21)00289-8. - DOI - PMC - PubMed

[2] Jassat W, Mudara C, Ozougwu L, et al. Difference in mortality among individuals admitted to hospital with COVID-19 during the first and second waves in South Africa: A cohort study. Lancet Glob Health. 2021;9:e1216–1225. doi: 10.1016/S2214109X(21)00289-8. - DOI - PMC - PubMed

[3] Fan G, Yang Z, Lin Q, et al. Decreased case fatality rate of COVID-19 in the second wave: A study in 53 countries or regions. Transbound Emerg Dis. 2021;68(2):213–215. doi: 10.1111/tbed.13819. - DOI - PubMed

[4] Fan G, Yang Z, Lin Q, et al. Decreased case fatality rate of COVID-19 in the second wave: A study in 53 countries or regions. Transbound Emerg Dis. 2021;68(2):213–215. doi: 10.1111/tbed.13819. - DOI - PubMed

[5] Iftimie S, López-Azcona AF, Vallverdú I, et al. First and second waves of coronavirus disease-19: A comparative study in hospitalised patients in Reus, Spain. PLoS One. 2021;16(3):e0248029. doi: 10.1371/journal.pone.0248029. - DOI - PMC - PubMed

[6] Iftimie S, López-Azcona AF, Vallverdú I, et al. First and second waves of coronavirus disease-19: A comparative study in hospitalised patients in Reus, Spain. PLoS One. 2021;16(3):e0248029. doi: 10.1371/journal.pone.0248029. - DOI - PMC - PubMed

[7] Karagiannidis C, Windisch W, McAuley DF, et al. Major differences in ICU admissions during the first and second COVID-19 wave in Germany. Lancet Respir Med. 2021;9(5):e47–e48. doi: 10.1016/s2213-2600(21)00101-6. - DOI - PMC - PubMed

[8] Karagiannidis C, Windisch W, McAuley DF, et al. Major differences in ICU admissions during the first and second COVID-19 wave in Germany. Lancet Respir Med. 2021;9(5):e47–e48. doi: 10.1016/s2213-2600(21)00101-6. - DOI - PMC - PubMed

[9] Saito S, Asai Y, Matsunaga N, et al. First and second COVID-19 waves in Japan: A comparison of disease severity and characteristics. J Infect. 2021;82(4):84–123. doi: 10.1016/j.jinf.2020.10.033. - DOI - PMC - PubMed

[10] Saito S, Asai Y, Matsunaga N, et al. First and second COVID-19 waves in Japan: A comparison of disease severity and characteristics. J Infect. 2021;82(4):84–123. doi: 10.1016/j.jinf.2020.10.033. - DOI - PMC - PubMed

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Comparison of patients with severe COVID-19 admitted to an intensive care unit in South Africa during the first and second wave of the COVID-19 pandemic

Affiliations

Comparison of patients with severe COVID-19 admitted to an intensive care unit in South Africa during the first and second wave of the COVID-19 pandemic

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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References

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