Increased hazard of mortality in cases compatible with SARS-CoV-2 variant of concern 202012/1 - a matched cohort study

Objectives To establish whether there is any change in mortality associated with infection of a new variant of SARS-CoV-2, designated a Variant of Concern in December 2020 (VOC-202012/1) compared to that associated with infection with circulating SARS-CoV-2 variants. Design Matched cohort study. Cases are matched by age, gender, ethnicity, index of multiple deprivation, lower tier local authority region, and sample date of positive specimen, and differing only by detectability of the spike protein gene using the TaqPath assay - a proxy measure of VOC-202012/1 infection. Setting United Kingdom, community - based (Pillar 2) COVID-19 testing centres using the TaqPath assay. Participants 54,906 pairs of participants testing positive for SARS-CoV-2 in Pillar 2 between 1st October 2020 and 29th January 2021, followed up until the 12th February 2021. Main outcome measures Death within 28 days of first positive SARS-CoV-2 test. Results There is a high probability that the risk of mortality is increased by infection with VOC-202012/01 (p <0.001). The mortality hazard ratio associated with infection with VOC-202012/1 compared to infection with previously circulating variants is 1.64 (95% CI 1.32 - 2.04) in patients who have tested positive for COVID-19 in the community. In this comparatively low risk group, this represents an increase from 2.5 to 4.1 deaths per 1000 detected cases. Conclusions If this finding is generalisable to other populations, VOC-202012/1 infections have the potential to cause substantial additional mortality compared to previously circulating variants. Healthcare capacity planning, national and international control policies are all impacted by this finding, with increased mortality lending weight to the argument that further coordinated and stringent measures are justified to reduce deaths from SARS-CoV-2.