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Inpatient Outcomes in a SARS-CoV-2 Naïve Population Achieving High Vaccination Coverage Preceding Planned Virus
Eamon P Raith1, Hao Z Wong1, Joshua V Ross1
1Eamon P. Raith, MBBS, PhD, FCICM, is an Associate Professor and Research Lead at Mackay Clinical School, College of Medicine and Dentistry, James Cook University, Queensland; an ICU Consultant, Department of Intensive Care Services, Mackay Hospital and Health Service, Mackay, Queensland; a Senior Fellow, Critical Care Research Group, Prince Charles Hospital, Chermside, Queensland; an Adjunct Senior Research Fellow, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria; and a Clinical Senior Lecturer, School of Medicine, College of Health, Adelaide University, South Australia. Krishnaswamy Sundararajan, MD, FCICM, is Director, Department of Intensive Care Medicine, Royal Adelaide Hospital, and an Associate Professor, School of Medicine, College of Health, Adelaide University, Adelaide, South Australia. Mark Plummer, MBBS, PhD, FCICM, is Head of Research and Innovation, Department of Intensive Care Medicine, Royal Adelaide Hospital, and an Associate Professor, School of Medicine, College of Health, Adelaide University, Adelaide, South Australia. Hao Z. Won, MBBS, FCICM, is an ICU Consultant, Department of Intensive Care Medicine, Lyell McEwin Hospital, Elizabeth Vale, South Australia. Joshua V. Ross, PhD, is Chief Data and Analytics Officer, and Nicola Spurrier, MBBS, PhD, FRACP, is Chief Public Health Officer; both in the Department for Health and Wellbeing, Government of South Australia, Adelaide, South Australia. Samuel Ziesing is a Research and Evaluation Officer, and Caroline Miller, MPH, PHD, is Director of the Health Policy Centre; both at the Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia. Imogen Asser is a Research Scientist, and Michael Maclean, MBBS, is Resident Medical Officer, Department of Intensive Care Medicine, Royal Adelaide Hospital, Adelaide, South Australia. Lauren Fielke, MBBS, FRACP, is Director, Department of General Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia. Shailesh Bihari, MBBS, MD, DDU, FCICM, PhD, is an ICU Consultant, Intensive and Critical Care Unit, Flinders Medical Centre, and the College of Medicine and Public Health, Flinders University; both in Bedford Park, South Australia. All of the authors are located in Australia.
Abstract:
On November 23, 2021, South Australia lifted border restrictions allowing passive entry of COVID-19 cases into the community. On this date the adult South Australian population was highly vaccinated and COVID-19 naïve (prior infection rate <1:1000). There are no previous outcome data following introduction of SARS-CoV-2 to a susceptible population that was highly vaccinated. The aim of this study was to measure the effect of sole vaccine-derived immunity against SARS-CoV-2, in a virus-naïve population without prior community transmission. This retrospective cohort study of 132,579 adults with COVID-19 was conducted between November 2021 and March 2022. The primary outcome was in-hospital mortality; secondary outcomes were hospital and intensive care unit admission, stratified by vaccination status. Risk-adjusted multivariable logistic regression analysis was performed using a Bayesian framework. Unvaccinated patients had increased odds of death (OR 3.78, 95% credible interval [CrI] 1.20 to 10.58, Bayesian probability of effect [Pr] 0.99), hospital admission (OR 23.9, 95% CrI 19.38 to 29.13, Pr 1.0), and ICU admission (OR 4.68, 95% CrI 1.58 to 12.34, Pr 1.0). Exclusively vaccine-derived immunity against SARS-CoV-2 is unequivocally protective against hospitalization and death. South Australia's pandemic response may be informative in planning for future pandemics, and management of future variants of SARS-CoV-2.
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