JMIR Publications

ABSTRACT

Background:

Clinical and virologic characteristics of COVID-19 infections in veterans in New England have not been described.

Objective:

To evaluate clinical and virologic factors impacting COVID-19 outcomes.

Methods:

We reviewed charts and sequenced virus from nasopharyngeal specimens with confirmed SARS-CoV-2 from 426 veterans in six New England states between April and September, 2020. Peak disease severity, hospitalization, and mortality were correlated to clinical, demographic, and virologic factors.

Results:

Of 426 veterans, 274 had complete and accessible charts. 92.7% were men, 83.2% White, with mean age 63 years. On multivariate regression, significant predictors of hospitalization were age (OR: 1.05) and non-white race (OR: 2.39). Mortality and peak disease severity varied by age (OR 1.06 and 1.07 respectively) and oxygen requirement on admission (OR6.74 and 45.7). Dementia (OR: 3.44) was also associated with mortality. Most (97.3%) of our samples were dominated by the spike protein D614G substitution, and were from SARS-CoV-2 B.1 lineage or one of 37 different B.1 sub-lineages, with none representing more than 8.7% of the cases.

Conclusions:

In an older cohort of veterans from the six New England states with a high comorbidity burden, age was the largest predictor of hospitalization, peak disease severity, and mortality. Non-white veterans were more likely to be hospitalized, and patients who required oxygen on admission were more likely to have severe disease and higher rates of mortality. Multiple SARS-CoV-2 lineages were distributed in patients in New England early in the COVID-19 era, mostly related to viruses from New York with D614G mutation.