Comparison between first and second wave of COVID-19 outbreak in older people: The COPE multicentre European observational cohort study

Alessia Verduri* (Corresponding Author), Roxanna Short, Ben Carter, Philip Braude, Arturo Vilches-Moraga, Terence J Quinn, Jemima Collins, Jane Lumsden, Kathryn McCarthy, Louis A Evans, Phyo Kyaw Myint, Jonathan Hewitt, COPE Study Team

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
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Background: Effective shielding measures and virus mutations have progressively modified the disease between the waves, likewise health care systems have adapted to the outbreak.
Our aim was to compare clinical outcomes for older people with COVID-19 in Wave 1 (W1) and 2 (W2).
Methods: All data, including the Clinical Frailty Scale (CFS), were collected for COVID-19 consecutive patients, aged ≥65, from thirteen hospitals, in W1 (February-June 2020) and W2 (October 2020-March 2021). The primary outcome was mortality (time to mortality and 28-day mortality). Data were analysed with multilevel Cox proportional hazards, linear and logistic regression models, adjusted for wave baseline demographic and clinical characteristics.
Results: Data from 611 people admitted in W2 were added to and compared with data collected during W1 (N=1340). Patients admitted in W2 were of similar age, median [IQR], W2= 79 [73-84]; W1=80 [74-86]; had a greater proportion of men (59.4% vs 53.0%); had lower 28-day mortality (29.1% vs 40.0%), compared to W1. For combined W1-W2 sample, W2 was independently associated with improved survival: time-to-mortality aHR= 0.78 (95%CI 0.65-0.93), 28-day mortality aOR=0.80 (95%CI 0.62-1.03). W2 was associated with increased length of hospital stay aHR=0.69 (95%CI 0.59-0.81). Patients in W2 were less
frail, CFS (adjusted mean difference [aMD]=-0.50, 95%CI -0.81, -0.18), as well as presented with lower CRP (aMD=-22.52, 95%CI -32.00, -13.04).
Conclusions: COVID-19 older adults in W2 were less likely to die than during W1. Patients presented to hospital during W2 were less frail and with lower disease severity and less likely to have renal decline.
Original languageEnglish
Pages (from-to)807–812
Number of pages6
JournalEuropean Journal of Public Health
Issue number5
Early online date23 Aug 2022
Publication statusPublished - Oct 2022

Bibliographical note

This study received no specific funding. The work was partially supported through the NIHR Maudsley Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust in partnership with King's College London (BC).
Contributions of authors
All authors contributed to the interpretation of results and in making an important intellectual contribution to the manuscript. All authors read and approved the final manuscript. JH conceived the concept of the study. BC managed the project, AV did the literature review. BC and RS did data analysis and interpreted the findings and RS did statistical analysis and graphics. AV, BC, JH, RS wrote the first draft of the manuscript. All authors approved the final manuscript. JH is the guarantor of the study.

Data Availability Statement

Supplementary data are available at EURPUB online.


  • COVID-19
  • frailty
  • older patients
  • mortality rate
  • predictors of death


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