RACGP - COVID 19 and sotrovimab

RACGP – COVID 19 and sotrovimab

At the beginning of November 2021, Moree Plains, the traditional country of the Kamilaroi/Gamilaraay/Gomeroi People, had the highest number of COVID-19 cases per 100,000 population in NSW. Moree remained in first or second place for cases for the next four weeks.one The double vaccination rate was low, <80% for the general population and about 60% for the Aboriginal and Torres Strait Islander population.two In November 2021, sotrovimab was the only early treatment for COVID-19 patients who were not hospitalized and at risk for serious illness. This is an intravenous monoclonal antibody associated with an 85% relative risk reduction in the likelihood of hospitalization or death if given within five days of symptom onset.3

The Moree Area Health Service (MDH) is located 665 km northwest of Sydney and serves a population of 12,750, 20% of whom identify as Aboriginal or Torres Strait Islander. MDH includes a 33-bed hospital run by a general practitioner (GP) and a community health service that visits non-GP specialists. Located in Tamworth, 270 km from the nearest intensive care unit (ICU), the hospital can offer maximum respiratory support for short-term ventilation. The town has an Aboriginal Health Service (Pius X), an Aboriginal and Torres Strait Islander youth center (Miyay Birray Youth Service), and two general practices. During the pandemic, these services helped with testing, vaccination, welfare, housing and social support services.

In 2021, direct care of COVID-19 patients was limited to certain services. For the Moree Plains local government district, this was MDH and Community COVID Care (CCitC) in Newcastle. CCitC is a clinician-led (doctors/registered nurses/co-healthcare) virtual service of the Hunter New England Local Health District (HNELHD) that assesses and manages all COVID-19 outpatients in HNELHD. MDH was tasked with local response to the outbreak, including identifying, locating, isolating, supporting and monitoring patients with COVID-19. They also had to rapidly implement an early treatment program to identify eligible individuals for sotrovimab, obtain their permission, and transport them safely. Additionally, MDH was required to create mobile and static COVID-19 testing, deliver oximetry/care packages and staff in a COVID-19-safe infusion room.

The first week saw essential MDH acute and community services turn towards the COVID-19 outbreak. Staff honed their skills for previous assignments.

Six Aboriginal and Torres Strait Islander Health Workers from MDH were the backbone in locating people within their family networks, providing telephone calls when needed, and communicating available treatment options in appropriate language. They provided support both during and outside working hours. The fact that these healthcare professionals were respected and knowledgeable members in the community was crucial in ensuring the rapid response and subsequent high uptake of sotrovimab, which became even more popular as it spread among community networks for symptom relief with sotrovimab therapy.

With sotrovimab services running from 10:00 am to 6:00 pm, MDH adjusted wards and increased and adapted working hours to suit the needs of the community. Local services were extended within a week. HNELHD responded by sending COVID-19 trained personnel and transport drivers/vehicles. Special pathology provided rapid polymerase chain reaction test equipment. CCitC virtually managed outpatients by assessing severity and risk of treatment and reviewing clinical status daily up to day 14 and increasing care as needed.

Sotrovimab eligibility was determined daily by morning meetings between MDH clinicians and CCitC physicians. CCitC sought consent from eligible patients with the help of Aboriginal and Torres Strait Islander Health Workers. The first infusion of sotrovimab was administered within two days of the identification of the first case. Between November 4, 2021 and December 1, 2021, sotrovimab was administered to 35 subjects, 34 of whom identified as Aboriginal or Torres Strait Islander.4 During this period, 18.6% of COVID-19 patients received sotrovimab.4

The result of this rapid and coordinated effort was that there were no deaths from COVID-19, no intensive care admissions, and only two transfers to Tamworth Hospital, this region’s tertiary referral hospital during this period.4

In late 2021, sotrovimab was known to be effective in preventing progression of the COVID-19 Delta variant, but timely administration is crucial. In a remote rural setting with a high number of at-risk patients and limited resources, this requires a coordinated approach at several levels. In this case, MDH, local Aboriginal and Torres Strait Islander Health Workers, and the wider networks have been tireless and resourceful in their dealings with the local community, possibly preventing hospitalizations and deaths. Although sotrovimab is no longer the treatment of choice, the pathways developed at Moree demonstrate the importance and impact of community ownership and leadership for the effective implementation of a public health intervention.

It was first published on November 28, 2022.

Conflicting interests: None.

Source and peer review: Not commissioned, peer reviewed.

Financing: None.
Citation: Broughton J, Joseph B, Williams S, Conners J, Evans J, Loewenthal M. COVID-19 and sotrovimab: The Moree experience. Aust J Gen Pract 2022;51 Supplement 6. doi: 10.31128/AJGP-COVID-51-6.


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