Comparing adults with severe SARS-CoV-2 or influenza infection: South Africa, 2016–2021

Background Comparisons of the characteristics of individuals hospitalised with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or seasonal influenza in low-to middle-income countries with high human immunodeficiency virus (HIV) prevalence are limited. Objectives Determine the epidemiological differences with those hospitalised with influenza or SARS-CoV-2 infection. Method We investigated hospitalised individuals ≥18 years of age testing positive for seasonal influenza (2016–2019) or SARS-CoV-2 (2020–2021). We used random effects multivariable logistic regression, controlling for clustering by site, to evaluate differences among adults hospitalised with influenza or SARS-CoV-2 infection. Results Compared to individuals with influenza, individuals with SARS-CoV-2 infection were more likely to be diabetic (adjusted odds ratio [aOR]: 1.70, 95% confidence interval [CI]: 1.11–2.61) or die in hospital (aOR: 2.57, 95% CI: 1.61–4.12). Additionally, those with SARS-CoV-2 infection were less likely to be living with HIV (not immunosuppressed) (aOR: 0.50, 95% CI: 0.34–0.73) or living with HIV (immunosuppressed) (aOR: 0.27, 95% CI: 0.18–0.39) compared to not living with HIV and less likely to be asthmatic (aOR: 0.21, 95% CI: 0.13–0.33) rather than those living with influenza. Conclusion Individuals hospitalised with SARS-CoV-2 had different characteristics to individuals hospitalised with influenza before the coronavirus disease 2019 (COVID-19) pandemic. Risk factors should be considered in health management especially as we move into an era of co-circulation of SARS-CoV-2 and influenza pathogens. Contribution Identifying groups at high risk of severe disease could help to better monitor, prevent and control SARS-CoV-2 or influenza severe disease.