SARS-CoV-2 strains and clinical profiles of COVID-19 patients in a Southern Brazil hospital

Front Immunol. 2024 Dec 18:15:1444620. doi: 10.3389/fimmu.2024.1444620. eCollection 2024.

Abstract

Introduction: The COVID-19 pandemic had a widespread global impact and presented numerous challenges. The emergence of SARS-CoV-2 variants has changed transmission rates and immune evasion, possibly impacting the severity. This study aims to investigate the impact of variants on clinical outcomes in southern Brazil.

Methods: In total, samples from 277 patients, hospitalized and non-hospitalized, were collected between March 2020 and March 2021, before the vaccine was made widely available to the general population in Brazil. Whole genome sequencing of SARS-CoV-2 was performed and bioinformatics and biostatistics analyses were implemented on molecular and clinical data, respectively.

Results: The study identified significant demographic and clinical differences. The hospitalized group exhibited a higher proportion of males (51.9%) and an increased prevalence of comorbidities, including hypertension (66.0%), obesity (42.6%), and chronic kidney disease (23.6%). Patients were identified with twelve SARS-CoV-2 strains, predominantly B.1.1.28 and B.1.1.33 in the early 2020 first wave, and P.1 overlapping in the late 2020 and early 2021 second wave of COVID-19. Significant differences in hospitalization rates were found among patients infected with the different SARS-CoV-2 lineages: B.1.1.33 (46.0%), B.1.1.28 (65.9%), and P.1 (97.9%). Severity markers, such as pneumonia (62.5%, p=0.002), acute respiratory distress syndrome (ARDS, 72.9%, p<0.001), and oxygen support >6 L/min O2 (64.6%, p<0.001), were more frequent in patients from the second wave. These findings highlight the impact of different variants on the clinical evolution and prognosis of COVID-19, especially when comparing the first and second waves of the pandemic.

Conclusions: The study underscores the association between SARS-CoV-2 strains and COVID-19 severity by integrating clinical and viral data for public health responses during different pandemic phases, highlighting the importance of adapting pandemic strategies as the pandemic evolves.

Keywords: Brazilian population; Coronavirus disease; Coronavirus strains; clinical outcomes; healthcare.

MeSH terms

  • Adult
  • Aged
  • Brazil / epidemiology
  • COVID-19* / epidemiology
  • COVID-19* / virology
  • Comorbidity
  • Female
  • Hospitalization* / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • SARS-CoV-2* / genetics
  • Severity of Illness Index
  • Whole Genome Sequencing

Supplementary concepts

  • SARS-CoV-2 variants

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study received funding from Financiamento e Incentivo à Pesquisa (FIPE/HCPA), Hospital de Cĺınicas de Porto Alegre (grant: 2020-0479), and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001. Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) grant n° 88887.712615/2022-00, Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) grant n° 307145/2021-2. GG is the recipient of an HCPA Scholarship grant n° 23092.012897/2021-71. ATRV is the recipient of the Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro, FAPERJ, grant no. E-26, CNPq 307145/2021-2 and 404136/2020-6. FV is the recipient of a CNPq scholarship 312960/2021-2.