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      Comparison of Patients Infected With Delta Versus Omicron COVID-19 Variants Presenting to Paris Emergency Departments : A Retrospective Cohort Study

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      , MD, PhD, , PharmD, PhD, , MD, , MD, , MD, , MD, , MD, PhD, , MD, PhD, , MD, PhD, , MD, PhD, , MD, PhD, , MD, PhD, , MD, , MD, PhD, , MD, PhD, , MD, PhD, , MSc, , MD, PhD, , MD, PhD, IMProving Emergency Care (IMPEC) FHU Collaborators Group * , , , , , , , , , , , , , , , , , , , , , , , , , , , ,
      (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab)
      Annals of Internal Medicine
      American College of Physicians

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          Abstract

          At the end of 2021, infections with the B.1.1.529 SARS-CoV-2 variant (Omicron) superseded those with the B.1.617.2 variant (Delta). This study compares baseline characteristics and in-hospital outcomes of patients who presented to 13 emergency departments in Paris from 29 November 2021 to 10 January 2022.

          Abstract

          Visual Abstract. Patients With Delta Versus Omicron Variants in the Emergency Department. At the end of 2021, infections with the B.1.1.529 SARS-CoV-2 variant (Omicron) superseded those with the B.1.617.2 variant (Delta). This study compares baseline characteristics and in-hospital outcomes of patients who presented to 13 emergency departments in Paris from 29 November 2021 to 10 January 2022.
          Visual Abstract.
          Patients With Delta Versus Omicron Variants in the Emergency Department.

          At the end of 2021, infections with the B.1.1.529 SARS-CoV-2 variant (Omicron) superseded those with the B.1.617.2 variant (Delta). This study compares baseline characteristics and in-hospital outcomes of patients who presented to 13 emergency departments in Paris from 29 November 2021 to 10 January 2022.

          Abstract

          Background:

          At the end of 2021, the B.1.1.529 SARS-CoV-2 variant (Omicron) wave superseded the B.1.617.2 variant (Delta) wave.

          Objective:

          To compare baseline characteristics and in-hospital outcomes of patients with SARS-CoV-2 infection with the Delta variant versus the Omicron variant in the emergency department (ED).

          Design:

          Retrospective chart reviews.

          Setting:

          13 adult EDs in academic hospitals in the Paris area from 29 November 2021 to 10 January 2022.

          Patients:

          Patients with a positive reverse transcriptase polymerase chain reaction (RT-PCR) test result for SARS-CoV-2 and variant identification.

          Measurements:

          Main outcome measures were baseline clinical and biological characteristics at ED presentation, intensive care unit (ICU) admission, mechanical ventilation, and in-hospital mortality.

          Results:

          A total of 3728 patients had a positive RT-PCR test result for SARS-CoV-2 during the study period; 1716 patients who had a variant determination (818 Delta and 898 Omicron) were included. Median age was 58 years, and 49% were women. Patients infected with the Omicron variant were younger (54 vs. 62 years; difference, 8.0 years [95% CI, 4.6 to 11.4 years]), had a lower rate of obesity (8.0% vs. 12.5%; difference, 4.5 percentage points [CI, 1.5 to 7.5 percentage points]), were more vaccinated (65% vs. 39% for 1 dose and 22% vs. 11% for 3 doses), had a lower rate of dyspnea (26% vs. 50%; difference, 23.6 percentage points [CI, 19.0 to 28.2 percentage points]), and had a higher rate of discharge home from the ED (59% vs. 37%; difference, 21.9 percentage points [−26.5 to −17.1 percentage points]). Compared with Delta, Omicron infection was independently associated with a lower risk for ICU admission (adjusted difference, 11.4 percentage points [CI, 8.4 to 14.4 percentage points]), mechanical ventilation (adjusted difference, 3.6 percentage points [CI, 1.7 to 5.6 percentage points]), and in-hospital mortality (adjusted difference, 4.2 percentage points [CI, 2.0 to 6.5 percentage points]).

          Limitation:

          Patients with COVID-19 illness and no SARS-CoV-2 variant determination in the ED were excluded.

          Conclusion:

          Compared with the Delta variant, infection with the Omicron variant in patients in the ED had different clinical and biological patterns and was associated with better in-hospital outcomes, including higher survival.

          Primary Funding Source:

          None.

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          Most cited references17

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          The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

          Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September, 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles.18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies.A detailed explanation and elaboration document is published separately and is freely available on the websites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE statement will contribute to improving the quality of reporting of observational studies
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            Omicron SARS-CoV-2 variant: a new chapter in the COVID-19 pandemic

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              Is Open Access

              Omicron extensively but incompletely escapes Pfizer BNT162b2 neutralization

              The emergence of the SARS-CoV-2 variant of concern Omicron (Pango lineage B.1.1.529), first identified in Botswana and South Africa, may compromise vaccine effectiveness and lead to re-infections 1 . Here we investigated Omicron escape from neutralization by antibodies from South African individuals vaccinated with Pfizer BNT162b2. We used blood samples taken soon after vaccination from individuals who were vaccinated and previously infected with SARS-CoV-2 or vaccinated with no evidence of previous infection. We isolated and sequence-confirmed live Omicron virus from an infected person and observed that Omicron requires the angiotensin-converting enzyme 2 (ACE2) receptor to infect cells. We compared plasma neutralization of Omicron relative to an ancestral SARS-CoV-2 strain and found that neutralization of ancestral virus was much higher in infected and vaccinated individuals compared with the vaccinated-only participants. However, both groups showed a 22-fold reduction in vaccine-elicited neutralization by the Omicron variant. Participants who were vaccinated and had previously been infected exhibited residual neutralization of Omicron similar to the level of neutralization of the ancestral virus observed in the vaccination-only group. These data support the notion that reasonable protection against Omicron may be maintained using vaccination approaches.
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                Author and article information

                Contributors
                Journal
                Ann Intern Med
                Ann Intern Med
                aim
                Annals of Internal Medicine
                American College of Physicians
                0003-4819
                1539-3704
                15 March 2022
                15 March 2022
                : M22-0308
                Affiliations
                [01]Emergency Department, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris, and Université Paris Cité, IAME (Infection, Antimicrobial, Modelisation, Evolution), Inserm, Paris, France (D.B.)
                [02]Virology Department, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris, and Université Paris Cité, IAME (Infection, Antimicrobial, Modelisation, Evolution), Inserm, Paris, France (B.V.)
                [03]Emergency Department, Hôpital Henri, Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France (C.K.)
                [04]Emergency Department, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France (A.D.)
                [05]Emergency Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, and Toxicology and Chemical Risks Department, French Armed Forces Biomedical Institute, Bretigny-Sur-Orges, France (F.F.)
                [06]Emergency Department, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France (C.H.)
                [07]Emergency Department, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France (J.T.)
                [08]Emergency Department, Hôpital Ambroise Paré, Assistance Publique - Hôpitaux de Paris, Université Versailles – Saint Quentin en Yvelines, Boulogne, France (S.B.)
                [09]Emergency Department, Hôpital Louis-Mourier, Assistance Publique - Hôpitaux de Paris, Reference Center for bradykinin angiœdema (CRéAk), Université Paris Cité, Colombes, France (N.J.)
                [10]Emergency Department, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Paris, France (O.P.)
                [11]Emergency Department, Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France (A.C.)
                [12]Emergency Department, Hôpital Beaujon, Assistance Publique - Hôpitaux de Paris, Clichy, France (P.V.A.)
                [13]Emergency Department, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France (A.B.)
                [14]Sorbonne Université, UMR Inserm 1166, IHU ICAN, and Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France (B.R., Y.F.)
                [15]Virology Department, Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, Paris, France (S.M.)
                [16]Emergency Department, Royal London Hospital, London, United Kingdom (B.B.)
                [17]Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), Hôpital Saint-Antoine, Assistance Publique–Hôpitaux de Paris, Paris, France (M.C.)
                [18]Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), Hôpital Saint-Antoine, Assistance Publique–Hôpitaux de Paris, and Sorbonne Université, Paris, France (T.S.)
                Hôpital Saint-Louis, Paris
                Hôpital Saint-Louis, Paris
                Hôpital Europeen George Pompidou, Paris
                Hôpital Europeen George Pompidou, Paris
                Hôpital Cochin, Paris
                Hôpital Cochin, Paris
                Hôpital Cochin, Paris
                Hôpital Trousseau, Paris
                Hôpital Henri Mondor, Créteil
                Hôpital Henri Mondor, Créteil
                Hôpital Henri Mondor, Créteil
                Hôpital Henri Mondor, Créteil
                Hôpital Henri Mondor, Créteil
                Hôpital Lariboisière, Paris
                Hôpital Lariboisière, Paris
                Hôpital Bichat, Paris
                Hôpital Bichat, Paris
                Hôpital Bichat, Paris
                Hôpital Bichat, Paris
                Hôpital Bichat, Paris
                Hôpital Louis Mourier, Colombes
                Hôpital Tenon, Paris
                Hôpital Saint Antoine, Paris
                Hôpital Saint Antoine, Paris
                Hôpital Saint Antoine, Paris
                Assistance Publique – Hôpitaux de Paris, Paris
                Assistance Publique – Hôpitaux de Paris, Paris
                Assistance Publique – Hôpitaux de Paris, Paris
                Assistance Publique – Hôpitaux de Paris, Paris
                Hôpital Saint-Louis, Paris
                Hôpital Saint-Louis, Paris
                Hôpital Europeen George Pompidou, Paris
                Hôpital Europeen George Pompidou, Paris
                Hôpital Cochin, Paris
                Hôpital Cochin, Paris
                Hôpital Cochin, Paris
                Hôpital Trousseau, Paris
                Hôpital Henri Mondor, Créteil
                Hôpital Henri Mondor, Créteil
                Hôpital Henri Mondor, Créteil
                Hôpital Henri Mondor, Créteil
                Hôpital Henri Mondor, Créteil
                Hôpital Lariboisière, Paris
                Hôpital Lariboisière, Paris
                Hôpital Bichat, Paris
                Hôpital Bichat, Paris
                Hôpital Bichat, Paris
                Hôpital Bichat, Paris
                Hôpital Bichat, Paris
                Hôpital Louis Mourier, Colombes
                Hôpital Tenon, Paris
                Hôpital Saint Antoine, Paris
                Hôpital Saint Antoine, Paris
                Hôpital Saint Antoine, Paris
                Assistance Publique – Hôpitaux de Paris, Paris
                Assistance Publique – Hôpitaux de Paris, Paris
                Assistance Publique – Hôpitaux de Paris, Paris
                Assistance Publique – Hôpitaux de Paris, Paris
                Author notes
                Acknowledgment: The authors thank Mrs. Vanessa Lemaitre, MSc (IMproving Emergency Care FHU); Sara Salhi, MSc (APHP, Clinical Research Platform Paris-East); and Sophie Courtial-Destembert (Délégation à la Recherche Clinique et à l'Innovation of APHP) for their valuable help and support.
                Reproducible Research Statement: Study protocol: See the Supplement. Statistical code: Available from Dr. Simon (e-mail, tabassom.simon@ 123456aphp.fr ). Data set: Available from Dr. Freund (e-mail, Yonathan.freund@ 123456aphp.fr ).
                Corresponding Author: Yonathan Freund, MD, PhD, Service d'Accueil des Urgences, 83 Boulevard de l'hôpital, 75013 Paris, France; e-mail, yonathan.freund@ 123456aphp.fr .
                Author Contributions: Conception and design: B. Bloom, D. Bouzid, A. Chauvin, Y. Freund, C. Kassasseya, B. Riou, T. Simon.
                Analysis and interpretation of the data: B. Bloom, D. Bouzid, M. Cachanado, A. Chauvin, F. Fémy, Y. Freund, S. Marot, B. Riou, J. Truchot, B. Visseaux.
                Drafting of the article: S. Beaune, B. Bloom, D. Bouzid, A. Chauvin, Y. Freund, C. Hermand, B. Riou, B. Visseaux.
                Critical revision of the article for important intellectual content: S. Beaune, B. Bloom, A. Bourg, D. Bouzid, M. Cachanado, A. Chauvin, A. Daoud, F. Fémy, Y. Freund, N. Javaud, C. Kassasseya, T. Simon, J. Truchot, B. Visseaux.
                Final approval of the article: S. Beaune, B. Bloom, A. Bourg, D. Bouzid, M. Cachanado, A. Chauvin, A. Daoud, F. Fémy, Y. Freund, C. Hermand, N. Javaud, C. Kassasseya, S. Marot, O. Peyrony, B. Riou, T. Simon, J. Truchot, P. Vaittinada Ayar, B. Visseaux.
                Provision of study materials or patients: C. Hermand, O. Peyrony.
                Statistical expertise: M. Cachanado, A. Chauvin.
                Administrative, technical, or logistic support: A. Chauvin, Y. Freund, N. Javaud, C. Kassasseya, T. Simon, J. Truchot.
                Collection and assembly of data: S. Beaune, A. Bourg, D. Bouzid, A. Chauvin, A. Daoud, F. Fémy, Y. Freund, C. Hermand, N. Javaud, C. Kassasseya, S. Marot, O. Peyrony, J. Truchot, P. Vaittinada Ayar, B. Visseaux.
                Author information
                https://orcid.org/0000-0002-7538-3320
                https://orcid.org/0000-0002-9279-5538
                https://orcid.org/0000-0003-2045-4985
                https://orcid.org/0000-0003-3673-5837
                https://orcid.org/0000-0001-6831-0054
                https://orcid.org/0000-0001-8819-0061
                https://orcid.org/0000-0003-2043-3391
                https://orcid.org/0000-0003-1205-4738
                https://orcid.org/0000-0002-3016-4925
                https://orcid.org/0000-0002-9739-7950
                https://orcid.org/0000-0002-4550-0450
                Article
                aim-olf-M220308
                10.7326/M22-0308
                8941485
                35286147
                0dbaa70f-d12d-48bd-8fec-1fd12774c0c1
                Copyright @ 2022

                This article is made available via the PMC Open Access Subset for unrestricted re-use for research, analyses, and text and data mining through PubMed Central. Acknowledgement of the original source shall include a notice similar to the following: "© 2020 American College of Physicians. Some rights reserved. This work permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited." These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Categories
                Original Research
                3122457, COVID-19
                3123478, Emergency department
                362, Hospitalizations
                3124810, Mortality
                3123756, Reverse transcriptase polymerase chain reaction
                4073, Vaccines
                early, Currently Online First
                coronavirus, Coronavirus Disease 2019 (COVID-19)
                poc-eligible, POC Eligible

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