Review

. 2022 Apr 23;22(1):544.

doi: 10.1186/s12913-022-07847-0.

Health system impacts of SARS-CoV - 2 variants of concern: a rapid review

Justine Dol¹, Leah Boulos², Mari Somerville³, Lynora Saxinger⁴, Alexander Doroshenko⁵, Stephanie Hastings⁶, Bearach Reynolds⁷, Allyson Gallant¹, Hwayeon Danielle Shin³, Helen Wong¹, Daniel Crowther³, Marilyn Macdonald³, Ruth Martin-Misener³, Holly McCulloch⁸, Andrea C Tricco^{9

10

11}, Janet A Curran¹²

Affiliations

¹ Faculty of Health, Dalhousie University, Halifax, NS, Canada.
² Maritime SPOR SUPPORT Unit, Halifax, NS, Canada.
³ School of Nursing, Dalhousie University, Halifax, NS, Canada.
⁴ Division of Infectious Diseases, Departments of Medicine and Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada.
⁵ Division of Preventive Medicine, Faculty of Medicine and Dentistry, University of Alberta, Calgary, AB, Canada.
⁶ Alberta Health Services, Calgary, AB, Canada.
⁷ Evidence Synthesis, Galway, Ireland.
⁸ IWK Health, Halifax, NS, Canada.
⁹ Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health, Toronto, ON, Canada.
¹⁰ Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹¹ Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, School of Nursing, Queen's University, Toronto, ON, Canada.
¹² School of Nursing, Dalhousie University, Halifax, NS, Canada. jacurran@dal.ca.

PMID: 35461246
PMCID: PMC9034743
DOI: 10.1186/s12913-022-07847-0

Review

Health system impacts of SARS-CoV - 2 variants of concern: a rapid review

Justine Dol et al. BMC Health Serv Res. 2022.

. 2022 Apr 23;22(1):544.

doi: 10.1186/s12913-022-07847-0.

Authors

Affiliations

¹ Faculty of Health, Dalhousie University, Halifax, NS, Canada.
² Maritime SPOR SUPPORT Unit, Halifax, NS, Canada.
³ School of Nursing, Dalhousie University, Halifax, NS, Canada.
⁴ Division of Infectious Diseases, Departments of Medicine and Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada.
⁵ Division of Preventive Medicine, Faculty of Medicine and Dentistry, University of Alberta, Calgary, AB, Canada.
⁶ Alberta Health Services, Calgary, AB, Canada.
⁷ Evidence Synthesis, Galway, Ireland.
⁸ IWK Health, Halifax, NS, Canada.
⁹ Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health, Toronto, ON, Canada.
¹⁰ Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹¹ Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, School of Nursing, Queen's University, Toronto, ON, Canada.
¹² School of Nursing, Dalhousie University, Halifax, NS, Canada. jacurran@dal.ca.

PMID: 35461246
PMCID: PMC9034743
DOI: 10.1186/s12913-022-07847-0

Abstract

Background: As of November 25th 2021, four SARS-CoV - 2 variants of concern (VOC: Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), and Delta (B.1.617.2)) have been detected. Variable degrees of increased transmissibility of the VOC have been documented, with potential implications for hospital and health system capacity and control measures. This rapid review aimed to provide a synthesis of evidence related to health system responses to the emergence of VOC worldwide.

Methods: Seven databases were searched up to September 27, 2021, for terms related to VOC. Titles, abstracts, and full-text documents were screened independently by two reviewers. Data were extracted independently by two reviewers using a standardized form. Studies were included if they reported on at least one of the VOC and health system outcomes.

Results: Of the 4877 articles retrieved, 59 studies were included, which used a wide range of designs and methods. Most of the studies reported on Alpha, and all except two reported on impacts for capacity planning related to hospitalization, intensive care admissions, and mortality. Most studies (73.4%) observed an increase in hospitalization, but findings on increased admission to intensive care units were mixed (50%). Most studies (63.4%) that reported mortality data found an increased risk of death due to VOC, although health system capacity may influence this. No studies reported on screening staff and visitors or cohorting patients based on VOC.

Conclusion: While the findings should be interpreted with caution as most of the sources identified were preprints, evidence is trending towards an increased risk of hospitalization and, potentially, mortality due to VOC compared to wild-type SARS-CoV - 2. There is little evidence on the need for, and the effect of, changes to health system arrangements in response to VOC transmission.

Keywords: Health system impact; Rapid review; SARS-CoV − 2; Variants of concern.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 2**
Overview of country or region of data collection and VOC up to September 27, 2021

**Fig. 3**
Overview of country or region of data collection and outcome up to September 27, 2021

See this image and copyright information in PMC

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Health system impacts of SARS-CoV - 2 variants of concern: a rapid review

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Health system impacts of SARS-CoV - 2 variants of concern: a rapid review

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