Was Alpha deadlier than wild-type COVID? Analysis in rural England

BACKGROUND: It is useful to document whether each newly dominant SARS-CoV-2 variant of concern was more or less dangerous than preceding dominant variant(s). We assessed if the emergence of the Alpha (B.1.1.7) variant in autumn 2020 could be linked to higher case fatality rates, compared to original wild-type COVID-19, subgrouping by age band, sex, deprivation or month of diagnosis as potential risk factors. METHODS: Observational study and secondary analysis were conducted of SARS-CoV-2 cases diagnosed due to medical need or occupational exposure in an administrative area of Eastern England, UK (base population 1 million), who first tested positive in the period 1 March 2020 to 28 February 2021. Multivariate logistic regression was performed to examine relationships of age group, sex, deprivation group and month of diagnosis with case fatality rates within 28 days of diagnosis. Marginal probabilities for risk of dying were calculated separately for the first two main ‘wave’ periods of the English pandemic. RESULTS: Older age and male sex consistently raised the risk of mortality in both wave periods. Higher deprivation was linked to mortality risk in the first wave period, but not in the second wave. Mortality decreased over time during the first wave period, but slightly increased over time during the second wave. Cases were younger in the second wave, and median age of the deceased varied little between waves. INTERPRETATION: The Alpha variant of SARS-CoV-2 did not lead to higher mortality rates for any age, deprivation or sex group, compared to case fatality rates in the early part of the pandemic period. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s15010-022-01787-x.