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SARS-CoV-2 Variant Associated with Milder COVID-19

Rajesh T. Gandhi, MD reviewing Young BE et al. Lancet 2020 Aug 29

Patients whose virus had a 382-nucleotide deletion had less severe disease than those who were infected with wild-type virus.

Whether SARS-CoV-2 variants affect COVID-19 severity is a topic of intense interest. Early in the pandemic, a SARS-CoV-2 variant with a 382-nucleotide deletion in open reading frame (ORF)-8 (which has an unknown function) emerged in China and was subsequently detected in cases in Singapore and Taiwan. Now, investigators have compared clinical outcomes in people infected with wild-type virus or the delta 382-variant.

Between January and March 2020, 131 patients hospitalized in Singapore were enrolled into the study; 70% had wild-type virus, 22% had delta 382-variant virus, and 8% had mixed infection. Compared with the group infected with wild-type virus, those infected with delta 382-variant alone were younger (median age, 37 vs. 47 years), had a longer duration of symptoms (6 vs. 4 days), and had lower virus levels on initial nasopharyngeal polymerase chain reaction. After adjustment for age and comorbidities, patients infected with delta 382-variant had a lower likelihood of developing hypoxia than those infected with wild-type virus (odds ratio, 0.07). People with the delta 382-variant had lower plasma levels of pro-inflammatory cytokines and higher concentrations of interferon-gamma than those with wild-type virus.

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