Neurological diagnoses in hospitalized COVID‐19 patients during the B.1.1.529 surge

OBJECTIVE: Emerging variants and sublineages of SARS‐CoV‐2 have differing disease severity, transmissibility, and immune evasion. The neurological conditions associated with the original strain of SARS‐CoV‐2 are well established. Our study assessed the neurological presentations specific to hospitalized patients during the B.1.1.529 (Omicron) variant surge in New York City. METHODS: A total of 178 cases with positive RT‐PCR result within 6 weeks before admission, and subsequent development of select neurological conditions during the SARS‐CoV‐2 B.1.1.529 (Omicron) surge between December 1, 2021 and February 28, 2022, were included from 12,800 SARS‐CoV‐2‐positive hospital admissions. Clinical data from acute hospitalizations were compared to findings of inpatient neurological cases with COVID‐19 infections from the initial surge in NYC in the same hospital system. RESULTS: Compared to SARS‐CoV‐2 infections of the original strain, COVID‐19 cases hospitalized during the Omicron surge (B.1.1.529) were associated with incidental and/or asymptomatic COVID‐19 cases (96, 53.9%) and an increased incidence of pre‐existing neurological and immunocompromising conditions. Encephalopathy, seizures, and stroke remained the most prevalent neurological conditions identified in hospitalized COVID‐19 cases during the study period, reflecting a similar distribution of neurological presentations associated with the original strain. INTERPRETATION: In our cohort of 178 admitted SARS‐CoV‐2‐positive patients with select neurological conditions during the Omicron B.1.1.529 surge, 54% of COVID‐19 cases were considered incidental and/or asymptomatic, and the identified neurological conditions resembled those associated with the original SARS‐CoV‐2 strain. Further studies characterizing neurological presentation in Omicron sublineages and other variants are warranted in an ongoing COVID‐19 pandemic.