Division of Infectious Diseases, Steve Biko Academic Hospital; Department of Internal Medicine, Steve Biko Academic Hospital and University of Pretoria; South African Medical Research Council.
School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town.
Int J Infect Dis. 2022 Mar;116:38-42. doi: 10.1016/j.ijid.2021.12.357. Epub 2021 Dec 28.
INTRODUCTION: The coronavirus disease 2019 (COVID-19) first reported in Wuhan, China in December 2019 is a global pandemic that is threatening the health and wellbeing of people worldwide. To date there have been more than 274 million reported cases and 5.3 million deaths. The Omicron variant first documented in the City of Tshwane, Gauteng Province, South Africa on 9 November 2021 led to exponential increases in cases and a sharp rise in hospital admissions. The clinical profile of patients admitted at a large hospital in Tshwane is compared with previous waves. METHODS: 466 hospital COVID-19 admissions since 14 November 2021 were compared to 3962 admissions since 4 May 2020, prior to the Omicron outbreak. Ninety-eight patient records at peak bed occupancy during the outbreak were reviewed for primary indication for admission, clinical severity, oxygen supplementation level, vaccination and prior COVID-19 infection. Provincial and city-wide daily cases and reported deaths, hospital admissions and excess deaths data were sourced from the National Institute for Communicable Diseases, the National Department of Health and the South African Medical Research Council. RESULTS: For the Omicron and previous waves, deaths and ICU admissions were 4.5% vs 21.3% (p<0.00001), and 1% vs 4.3% (p<0.00001) respectively; length of stay was 4.0 days vs 8.8 days; and mean age was 39 years vs 49,8 years. Admissions in the Omicron wave peaked and declined rapidly with peak bed occupancy at 51% of the highest previous peak during the Delta wave. Sixty two (63%) patients in COVID-19 wards had incidental COVID-19 following a positive SARS-CoV-2 PCR test . Only one third (36) had COVID-19 pneumonia, of which 72% had mild to moderate disease. The remaining 28% required high care or ICU admission. Fewer than half (45%) of patients in COVID-19 wards required oxygen supplementation compared to 99.5% in the first wave. The death rate in the face of an exponential increase in cases during the Omicron wave at the city and provincial levels shows a decoupling of cases and deaths compared to previous waves, corroborating the clinical findings of decreased severity of disease seen in patients admitted to the Steve Biko Academic Hospital. CONCLUSION: There was decreased severity of COVID-19 disease in the Omicron-driven fourth wave in the City of Tshwane, its first global epicentre.
引言：2019 年 12 月在中国武汉首次报告的 2019 年冠状病毒病（COVID-19）是一种全球性大流行疾病，正在威胁着全世界人民的健康和福祉。迄今为止，全球已报告超过 2.74 亿例病例和 530 万人死亡。2021 年 11 月 9 日，在南非豪登省茨瓦内市首次记录到奥密克戎变异株，导致病例数呈指数级增长，住院人数急剧上升。本研究比较了茨瓦内市一家大医院在奥密克戎疫情期间和之前几波疫情期间住院的患者的临床特征。
方法：自 2021 年 11 月 14 日以来，共有 466 例 COVID-19 住院患者，与奥密克戎疫情前 2020 年 5 月 4 日的 3962 例住院患者进行比较。在疫情期间床位占用率达到峰值时，对 98 例患者的记录进行了主要入院指征、临床严重程度、氧补充水平、疫苗接种和既往 COVID-19 感染情况的回顾性分析。省级和市级每日病例数和报告死亡数、住院人数和超额死亡数的数据来自国家传染病研究所、国家卫生部和南非医学研究理事会。
结果：奥密克戎变异株和之前几波疫情的死亡和 ICU 入院率分别为 4.5%比 21.3%（p<0.00001）和 1%比 4.3%（p<0.00001）；住院时间分别为 4.0 天和 8.8 天；平均年龄分别为 39 岁和 49.8 岁。奥密克戎波的住院人数达到峰值并迅速下降，床位占用率达到之前德尔塔波最高峰值的 51%。在 COVID-19 病房的 62（63%）例患者中，在 SARS-CoV-2 PCR 检测呈阳性后发现有 COVID-19。仅有三分之一（36 例）有 COVID-19 肺炎，其中 72%为轻度至中度疾病。其余 28%需要高护理或 ICU 入院。与第一波疫情中 99.5%的患者需要吸氧相比，COVID-19 病房中需要吸氧的患者不到一半（45%）。在奥密克戎疫情期间，城市和省级病例呈指数级增长，死亡率显示出与以往几波疫情不同的病例和死亡脱钩，这与史蒂夫·比科学术医院（Steve Biko Academic Hospital）收治的患者疾病严重程度降低的临床发现相吻合。
结论：茨瓦内市作为奥密克戎变异株的首个全球中心，其第四次疫情中 COVID-19 疾病的严重程度有所降低。
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