The concordance between the evolutionary trend and the clinical manifestation of the two SARS-CoV-2 variants

The spread of COVID-19, the disease caused by SARS-CoV-2, has progressed into a global pandemic. To date, thousands of genetic variants have been identified across strains of SARS-CoV-2 isolated from worldwide patients. However, there is still little direct evidence linking viral variants and clinical features. Based on two tightly linked SNPs, we previously divided SARS-CoV-2 into two major lineages: the ancestral “S lineage” (U8,782 and C28,144) and the derived “L lineage” (C8,782 and U28,144). Here, we identified SARS-CoV-2 lineages from 271 COVID-19 patients during the early outbreak of this pandemic in Wuhan, including 73 S- and 198 L-lineage patients. The S-lineage patients exhibited significantly worse clinical severity than the L-lineage patients, even after excluding other risk factors. This study suggests that SARS-CoV-2 lineage may provide useful clinical information for the management of COVID-19 and support the argument that viral clades should be analyzed as a function of clinical severity.