Increased mortality in community-tested cases of SARS-CoV-2 lineage B.1.1.7

Nicholas G. Davies (), Christopher I. Jarvis, W. John Edmunds, Nicholas P. Jewell, Karla Diaz-Ordaz and Ruth H. Keogh
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Nicholas G. Davies: Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine
Christopher I. Jarvis: Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine
W. John Edmunds: Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine
Nicholas P. Jewell: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine
Karla Diaz-Ordaz: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine
Ruth H. Keogh: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine

Nature, 2021, vol. 593, issue 7858, 270-274

Abstract: Abstract SARS-CoV-2 lineage B.1.1.7, a variant that was first detected in the UK in September 20201, has spread to multiple countries worldwide. Several studies have established that B.1.1.7 is more transmissible than pre-existing variants, but have not identified whether it leads to any change in disease severity2. Here we analyse a dataset that links 2,245,263 positive SARS-CoV-2 community tests and 17,452 deaths associated with COVID-19 in England from 1 November 2020 to 14 February 2021. For 1,146,534 (51%) of these tests, the presence or absence of B.1.1.7 can be identified because mutations in this lineage prevent PCR amplification of the spike (S) gene target (known as S gene target failure (SGTF)1). On the basis of 4,945 deaths with known SGTF status, we estimate that the hazard of death associated with SGTF is 55% (95% confidence interval, 39–72%) higher than in cases without SGTF after adjustment for age, sex, ethnicity, deprivation, residence in a care home, the local authority of residence and test date. This corresponds to the absolute risk of death for a 55–69-year-old man increasing from 0.6% to 0.9% (95% confidence interval, 0.8–1.0%) within 28 days of a positive test in the community. Correcting for misclassification of SGTF and missingness in SGTF status, we estimate that the hazard of death associated with B.1.1.7 is 61% (42–82%) higher than with pre-existing variants. Our analysis suggests that B.1.1.7 is not only more transmissible than pre-existing SARS-CoV-2 variants, but may also cause more severe illness.

Date: 2021
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DOI: 10.1038/s41586-021-03426-1

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