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  • The beta variant of the coronavirus first detected in South Africa may have caused more severe disease during the country’s second wave, but other factors were likely involved.
  • Researchers looked at COVID-19 patient admission data from over 644 South African hospitals from March 2020 through March 2021, along with the number of coronavirus cases during that time.
  • Researchers found that COVID-19 cases, hospitalizations, and in-hospital deaths were all higher during the second wave when the beta variant was more common than the first wave when the alpha variant was more common.

During South Africa’s second wave of the pandemic, COVID-19 cases, hospitalizations, and in-hospital deaths were all increased than with the first wave, a new study showed.

This came at a time when the coronavirus’ beta variant was predominant in the country, which suggests “that the new lineage (beta) in South Africa might be associated with increased in-hospital mortality during the second wave,” the authors wrote July 9 in Lancet Global Health.

However, they noted limitations to the study. Also, other factors likely contributed to the higher death rate in hospitalized COVID-19 patients during the country’s second wave.

Earlier research found that the alpha variant (B.1.1.7) was associated with higher hospitalizations and deaths in the United Kingdom. But little is known about whether the beta variant causes more severe disease.

For the new study, researchers looked at COVID-19 patient admission data from over 644 South African hospitals from March 2020 through March 2021, along with the number of coronavirus cases during that time.

The first wave in South Africa peaked in July 2020, with the second wave peaking in January 2021. A third wave began this month.

The beta variant, also known as B.1.351, was first detected in South Africa in September 2020. By the second wave, this variant was the predominant strain in the country.

Researchers found that COVID-19 cases, hospitalizations, and in-hospital deaths were all higher during the second wave than the first.

Many factors can affect the chance of dying from COVID-19 in the hospital, including high numbers of hospital admissions, which can lead to a hospital system becoming overwhelmed.

But when researchers took into account the weekly hospital admissions, COVID-19 patients still had a 31 percent higher chance of dying during the second wave than the first

This suggests the beta variant may cause more severe disease.

However, researchers note they did not have data on which strain patients had, so it’s not possible to directly link worse patient outcomes to the beta variant.

In addition, other factors contributed to the higher mortality during the second wave, such as the spike in hospital admissions.

“The observed increase in mortality of patients admitted to hospital at the peaks of the first and second waves reflects in part increasing pressure on the health system,” the authors wrote.

During the second wave, weeks with “very high” admissions were associated with a 24 percent increase in mortality, compared to weeks with low admissions.

“Even the perception of a strained health system can lead to excess mortality from COVID-19 and other conditions,” the authors added, “because individuals might avoid seeking care until their clinical condition has deteriorated or might die at home.”

In an accompanying editorial, Linda-Gail Bekker, PhD, and Dr. Ntobeko AB Ntusi, both from the University of Cape Town in South Africa, reiterated the importance of maintaining hospital capacity during COVID-19 surges.

“A crucial public health measure is to find ways to mitigate overcrowding through rapid expansion of hospital facilities or through a so-called curve flattening strategy,” they wrote.

Another key way to prevent deaths is to ensure all countries have equal access to COVID-19 vaccines.

“South Africa, and Africa at large, has not yet had the same vaccine coverage as most of the rest of the world,” wrote Bekker and Ntusi. “This is largely due to vaccine supply, global vaccine availability and vaccine nationalism.”

The beta variant accounts for less than 1 percent of U.S. coronavirus cases, according to data from the Centers for Disease Control and Prevention.

Some additional cases of beta continue to pop up across the country.

But given the fast spread of the delta variant (B.1.617.2) — which accounted for 57.6 percent of cases during the two weeks ending July 3 — it’s unlikely the beta variant will spread widely in the United States.

Delta’s high transmissibility is also playing out in South Africa. As the country battles its third wave of the pandemic, the delta variant is dominant, reports Reuters.

Scientists will continue to monitor the spread of beta and other variants by analyzing genetic information, or genome, of the virus samples — what’s known as genomic sequencing.

Dr. Nahed Ismail, professor of pathology and director of the clinical microbiology laboratory at the University of Illinois Chicago, says genomic sequencing is important for several reasons.

First is knowing which strains are circulating in the community.

“We have to prevent the transmission of those [coronavirus] strains that are spreading more aggressively than the wild type strain, the initial strain,” said Ismail. “The only way we can determine which ones are spreading faster is by sequencing.”

Genomic sequencing can also impact the care COVID-19 patients receive. Certain variants are resistant to the monoclonal antibodies that received emergency approval from the Food and Drug Administration (FDA).

“The physician needs to know what type of variant strains exist [in the patient’s sample] in order to select the appropriate monoclonal antibody,” said Ismail.

Scientists also monitor which variants are causing breakthrough infections — ones that occur in people fully vaccinated against COVID-19.

If a certain variant causes a high number of severe breakthrough infections, it might indicate the current vaccine is no longer highly effective against that strain.

Most breakthrough infections are not severe. Many fully vaccinated people experience only mild symptoms if they acquire the virus. Scientists are mainly concerned about breakthrough infections that lead to people being hospitalized with severe COVID-19.

Early during the pandemic, scientists looked mainly for mutations in the part of the genome that contains instructions for the coronavirus spike region. The virus uses the spike protein to enter human cells.

But mutations can occur in any part of the virus’ genetic information, so scientists have since focused on the entire genome.

“This virus is extremely adaptable and continues to mutate,” said Ismail. “So, if you want to detect all the variants, you cannot sequence only one region, you have to sequence the whole virus.”