Outbreak of SARS-CoV-2 variants in Iraqi Kurdistan region.

Introduction: Coronavirus disease 2019 (COVID-19) first appeared in Iraq, including the Iraqi Kurdistan region governorates, in March 2020.

Methodology: 48,494 samples were collected from public hospitals in the Kurdish governates from February 2021 to May 2022. Viral RNA was extracted, and real time quantitative polymerase chain reaction (RT-PCR) was used to detect the COVID-19 variants. Statistical analysis of patients' clinical data was performed.

Results: The RT-PCR results identified the Alpha (B.1.1.7), Delta (B.1.617.2), and Omicron (B.1.1.529) variants in the Kurdistan governorates. Young adults (20-39 years) had significantly higher rate of infection than children (1-11 months) and older adults (80-89 years). The Delta wave was more contiguous, spread more easily, and more fatal than the Alpha and Omicron waves. The highest number of COVID-19 cases was reported in Sulaymaniyah and Duhok; and the highest death rate was reported in Sulaymaniyah. The death rate in males was higher than in females, especially among older people. Fatigue, cough, and fever were common symptoms among the three variants. The phylogenetic tree revealed that the L-type of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was a descendant of the S-type at an early stage of evolution. The L-type could spread faster in Kurdistan. Multiple sequence alignment (MSA) confirmed that all L-type variants in different countries were 100% similar in sequence, and all were mutated in the regions 8782: ORF1ab and 28144: ORF8 703.

Conclusions: This study described the COVID-19 waves, pathogenesis, and evolution of the virus in the Iraqi Kurdistan region.