Characteristics and outcomes of COVID-19 patients during the BA.5 omicron wave in Tehran, Iran: a prospective observational study
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Updated: Aug 2, 2025
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Published on: November 10, 2023
Mohammadreza Salehi1, Arezoo Salami Khaneshan2, Abbas Shakoori Farahani3
1Research center for antibiotic stewardship and antimicrobial resistance, Infectious diseases department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Background:
Omicron (B.1.1.529) is the fifth variant of concern of SARS-CoV-2, which has several subvariants. Clinical features of BA.1 and BA.2 infections have been described in the literature, but we have limited information about the clinical profile of BA.5, which caused the seventh wave in Iran.
Methods:
A prospective observational study was conducted on the BA.5 confirmed patients referred to Imam Khomeini Hospital Complex, Tehran, Iran, from 11th to 31st August 2022. The patients were divided into the two groups of outpatients and hospitalized patients, and their clinical, radiological, and laboratory data and outcomes were recorded and analyzed.
Results:
We included 193 patients with confirmed BA.5 infection, of whom 48 patients (24·8%) were hospitalized. The mean age of the patients was 45·3 ± 16·5 years, and 113 patients (58·5%) were female. The mean number of days patients had symptoms was 6·8 ± 2·4 days. The most common symptoms were weakness (69·9%), sore throat (67·4%), myalgia (66·3%), hoarseness (63·7%), headache (55·4%), fatigue (54·9%), and dry cough (50·3%). Fever and dyspnea were significantly more observed in the hospitalized patients (p < 0·0001). The COVID-19 vaccination rate was significantly lower in hospitalized patients than in outpatients (35/48-72·9% vs. 140/145 - 96·6%, p < 0·0001). The most common underlying diseases were hypertension (16·1%), diabetes mellitus (9·8%), and cardiovascular diseases (9·8%), all of which were significantly more common in hospitalized patients. Lung opacities were observed in 81·2% of hospitalized patients. By the end of our study, 1·5% of patients died despite receiving critical care services.
Conclusions:
Our findings suggested that BA.5 symptoms are more non-respiratory and usually improve within 7 days. Although the proportion of hospitalized patients is still significant, very few patients require intensive care. COVID-19 vaccination is effective in reducing the hospitalization rate.
Trial Registration:
Not applicable. This study is not a clinical trial.
Insights
The Omicron BA.5 subvariant of SARS-CoV-2 primarily caused non-respiratory symptoms that resolved within a week. COVID-19 vaccination significantly reduced hospitalization rates for BA.5 infections.
Area of Science:
- Virology
- Infectious Diseases
- Public Health
Background:
- Omicron (B.1.1.529) is a SARS-CoV-2 variant of concern with multiple subvariants.
- Limited clinical data exists for the BA.5 subvariant, responsible for Iran's seventh COVID-19 wave.
Purpose of the Study:
- To describe the clinical profile of the SARS-CoV-2 BA.5 subvariant.
- To compare clinical features and outcomes between outpatient and hospitalized BA.5 patients in Iran.
Main Methods:
- A prospective observational study was conducted in Tehran, Iran, from August 11-31, 2022.
- 193 patients with confirmed BA.5 infection were analyzed, categorizing them into outpatients and inpatients.
- Clinical, radiological, and laboratory data, along with patient outcomes, were recorded.
Main Results:
- Of 193 BA.5 patients, 24.8% were hospitalized. Common symptoms included weakness, sore throat, myalgia, hoarseness, headache, fatigue, and dry cough.
- Hospitalized patients showed higher rates of fever, dyspnea, underlying conditions (hypertension, diabetes), and lung opacities.
- Vaccination rates were significantly lower in hospitalized patients (72.9%) compared to outpatients (96.6%).
Conclusions:
- BA.5 infection symptoms are predominantly non-respiratory and typically resolve within 7 days.
- While hospitalization rates were significant, intensive care was rarely required.
- COVID-19 vaccination proved effective in mitigating severe disease and reducing hospitalization risk.
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