Outcomes of laboratory-confirmed SARS-CoV-2 infection during resurgence driven by Omicron lineages BA.4 and BA.5 compared with previous waves in the Western Cape Province, South Africa
Mary‐Ann Davies, Erna Morden, Petro Rousseau, Juanita Arendse, Jamy‐Lee Bam, Linda Boloko, Keith Cloete, Cheryl Cohen, Nicole Chetty, Pierre Dane, Alexa Heekes, Marvin Hsiao, Mehreen Hunter, Hannah Hussey, Theuns Jacobs, Waasila Jassat, Saadiq Kariem, Reshma Kassanjee, Inneke Laenen, Sue Le Roux, Richard Lessells, Hassan Mahomed, Deborah Maughan, Graeme Meintjes, Marc Mendelson, Ayanda Trevor Mnguni, Melvin Moodley, Katy Murie, Jonathan Naudé, Ntobeko Ntusi, Masudah Paleker, Arifa Parker, David Pienaar, Wolfgang Preiser, Hans Prozesky, Peter Raubenheimer, Liezel Rossouw, Neshaad Schrueder, Barry Smith, Mariette Smith, Wesley Solomon, Greg Symons, Jantjie Taljaard, Sean Wasserman, Robert J. Wilkinson, Milani Wolmarans, Nicole Wolter, Andrew Boulle
Abstract
OBJECTIVES: We aimed to compare the clinical severity of Omicron BA.4/BA.5 infection with BA.1 and earlier variant infections among laboratory-confirmed SARS-CoV-2 cases in the Western Cape, South Africa, using timing of infection to infer the lineage/variant causing infection. METHODS: We included public sector patients aged ≥20 years with laboratory-confirmed COVID-19 between May 01-May 21, 2022 (BA.4/BA.5 wave) and equivalent previous wave periods. We compared the risk between waves of (i) death and (ii) severe hospitalization/death (all within 21 days of diagnosis) using Cox regression adjusted for demographics, comorbidities, admission pressure, vaccination, and previous infection. RESULTS: Among 3793 patients from the BA.4/BA.5 wave and 190,836 patients from previous waves, the risk of severe hospitalization/death was similar in the BA.4/BA.5 and BA.1 waves (adjusted hazard ratio [aHR] 1.12; 95% confidence interval [CI] 0.93; 1.34). Both Omicron waves had a lower risk of severe outcomes than previous waves. Previous infection (aHR 0.29, 95% CI 0.24; 0.36) and vaccination (aHR 0.17; 95% CI 0.07; 0.40 for at least three doses vs no vaccine) were protective. CONCLUSION: Disease severity was similar among diagnosed COVID-19 cases in the BA.4/BA.5 and BA.1 periods in the context of growing immunity against SARS-CoV-2 due to previous infection and vaccination, both of which were strongly protective.