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. 2024 Feb 21:12:1294261.
doi: 10.3389/fpubh.2024.1294261. eCollection 2024.

Comparing COVID-19 severity in patients hospitalized for community-associated Delta, BA.1 and BA.4/5 variant infection

Maja Sočan  1 , Maja Mrzel  1 , Katarina Prosenc  2 , Miša Korva  3 , Tatjana Avšič-Županc  3 , Mario Poljak  3 , Maja M Lunar  3 , Tina Zupanič  1
Affiliations

Comparing COVID-19 severity in patients hospitalized for community-associated Delta, BA.1 and BA.4/5 variant infection

Maja Sočan et al. Front Public Health. .

Abstract

Background: Despite decreasing COVID-19 disease severity during the Omicron waves, a proportion of patients still require hospitalization and intensive care.

Objective: To compare demographic characteristics, comorbidities, vaccination status, and previous infections in patients hospitalized for community-associated COVID-19 (CAC) in predominantly Delta, Omicron BA.1 and BA.4/5 SARS-CoV-2 waves.

Methods: Data were extracted from three national databases-the National COVID-19 Database, National Vaccination Registry and National Registry of Hospitalizations.

Results: Among the hospitalized CAC patients analyzed in this study, 5,512 were infected with Delta, 1,120 with Omicron BA.1, and 1,143 with the Omicron BA.4/5 variant. The age and sex structure changed from Delta to BA.4/5, with the proportion of women (9.5% increase), children and adolescents (10.4% increase), and octa- and nonagenarians increasing significantly (24.5% increase). Significantly more patients had comorbidities (measured by the Charlson Comorbidity Index), 30.3% in Delta and 43% in BA.4/5 period. The need for non-invasive ventilatory support (NiVS), ICU admission, mechanical ventilation (MV), and in-hospital mortality (IHM) decreased from Delta to Omicron BA.4/5 period for 12.6, 13.5, 11.5, and 6.3%, respectively. Multivariate analysis revealed significantly lower odds for ICU admission (OR 0.68, CI 0.54-0.84, p < 0.001) and IHM (OR 0.74, CI 0.58-0.93, p = 0.011) during the Delta period in patients who had been fully vaccinated or boosted with a COVID-19 vaccine within the previous 6 months. In the BA.1 variant period, patients who had less than 6 months elapsed between the last vaccine dose and SARS-CoV-2 positivity had lower odds for MV (OR 0.38, CI 0.18-0.72, p = 0.005) and IHM (OR 0.56, CI 0.37- 0.83, p = 0.005), but not for NIVS or ICU admission.

Conclusion: The likelihood of developing severe CAC in hospitalized patients was higher in those with the Delta and Omicron BA.1 variant compared to BA.4/5.

Keywords: BA.1; BA.4; BA.5; COVID-19; Delta; Omicron; hospitalization.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart outlining inclusion and exclusion criteria to generate the Delta, the Omicron BA.1 and BA.4/5 hospitalized cohort for analysis.
Figure 2
Figure 2
The cumulative vaccination coverage with all types of COVID-19 vaccines available in Slovenia.
Figure 3
Figure 3
(A–C) Adjusted odds ratios for non-invasive ventilatory support, ICU admission, mechanical ventilation and in-hospital mortality in patients hospitalized for COVID-19 in the Delta, the Omicron BA.1 and BA.4/5 periods. Calculation is based on the following reference: sex: female; age group: 18–64 years old; CCI score: 0; time since last vaccine dose (for fully or additionally vaccinated individuals only): non-vaccinated or partially vaccinated; and reinfection: primary infection. *p < 0.05; **p < 0.01; ***p < 0.001.
Figure 4
Figure 4
Adjusted odds ratios from logistic regression for non-invasive ventilatory support, ICU admission, mechanical ventilation and in-hospital mortality in patients hospitalized for COVID-19 in the Omicron BA.1 and BA.4/5 variants with respect to the Delta variant. *p < 0.05; **p < 0.01; ***p < 0.001.
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