Near real-time severe acute respiratory illness surveillance characterising influenza and COVID-19 epidemiology in hospitalised adults, 2021-22

We report the findings of a novel enhanced syndromic surveillance that characterised influenza- and SARS-CoV-2-associated severe acute respiratory illness (SARI) in the 2021/2022 winter season. Prospective cohort study of adults admitted to the Queen Elizabeth University Hospital, Glasgow, with a severe acute respiratory illness. Patient demographics, clinical history, admission details, and outcomes were recorded. Data were available to Public Health Scotland (PHS) and clinicians weekly. Between November 2021 and May 2022, 1063 hospitalised SARI episodes in 1037 adult patients were identified. Median age was 72.0 years, and 44.5% were male. Most (82.6%) SARI cases had ≥1 co-morbidity; chronic lung disease (50.0%) and malignancy (22.5%) were the most frequently reported. Overall, 229 (22%) and 33 (3%) SARI episodes were SARS-CoV-2 and influenza A PCR positive, respectively. 74.7%, 6.5% and 43.0% SARI episodes received antibiotics, antivirals, and steroids, respectively (54.5%, 11.0% and 51.3% among COVID-19 patients). 1.1% required mechanical ventilation and 7.8% died. Male sex, multimorbidity, frailty, respiratory rate >30, low GCS and chest X-ray consolidation were predictive of in-hospital mortality. Near real-time hospitalised SARI syndromic surveillance characterised the evolving clinical epidemiology of SARS-CoV-2 and influenza, high antimicrobial use, and predictors of inpatient mortality among hospitalised SARI patients. •Syndromic adult SARI surveillance provided near real-time data to PHS & clinicians.•SARS-CoV-2 dominant pathogen in 2021/22 season, but influenza activity was low.•60% required supplemental oxygen, but only ∼1% required mechanical ventilation.•45% had appropriate microbiological investigations but 75% received antibiotics.•Male, multimorbidity, frailty, RR>30, low GCS & consolidation predicted mortality.