Becker's Clinical Quality & Infection Control

28 PATIENT SAFETY AND OUTCOMES to open 17 infusion sites, which essentially covered the majority of a population corri- dor representing about 2.5 million people. is meant no one would have to drive more than 60 minutes to get to an infusion site. In most cases it was much shorter than that. Q: What do you think has been key to Intermountain's successful rollout? BW: We've been participating in the clinical trial that led to the authorization of these treatments, so we were able to get some familiarity of how the infusions work even before they were authorized by the FDA. e other thing that was helpful was the fact that we were already doing clinical trials in outpatient COVID-19 populations. Because of our research participation, we had already developed a platform for identifying patients who were at higher risk and would stand to benefit from treatments designed to prevent hospitalization. I think two factors gave us confidence. One, that we could appropriately match the drug supply and infusion capacity that we did have to the patients who were most likely to benefit. And two, that we already had the framework to do that because of our partici- pation in clinical research. Q: Do you have any insights on how well the treatment appears to be working in your patient population? BW: When we started this program, we paired it with a planned approach to do re- search analysis to understand how well they work. We recognized that while FDA-au- thorized, these antibody treatments are still technically investigational, and we have an incomplete understanding of their safety and effectiveness. As of March 11, Intermountain alone has delivered 1,000 treatments. We have now treated enough patients that we have a large enough sample to do a meaningful analy- sis. So we are just now starting to do that analysis. I can speak to some very prelim- inary numbers right now. Of the patients who receive infusions, about 4.5 percent of them end up being hospitalized. By our estimation, we are targeting a population that normally would be hospitalized at a rate of at least 10 percent to 15 percent. So very preliminarily, we expect that this treatment is indeed preventing hospitalization, and we are anxious to have a more robust analysis with adjustment for other factors that will help us and others know even better in a real-world setting how well this actually works. n Northwestern performs 1st 'COVID to COVID' double-lung transplant By Mackenzie Bean S urgeons at Northwestern Medicine performed one of the nation's first known "COVID to COVID" double-lung transplants on a COVID-19 pa- tient, the Chicago-based health system said in March. Surgeons performed the transplant on an Illinois man in his 60s using lungs from a donor who recovered from a mild to moderate case of COVID-19. The donor died from causes unrelated to COVID-19 and did not have any lung damage from the virus. The recipient was diagnosed with COVID-19 last May, placed on a ventilator and experienced permanent lung damage. He had the double-lung transplant in February. "This is a milestone for lung transplantation," Ankit Bharat, MD, chief of tho- racic surgery and surgical director of Northwestern's lung transplant pro- gram, said in a March 19 news release. "To date, 30 million Americans have had COVID-19, and many of them are registered organ donors. If we say 'no' to them just because they had COVID-19 in the past, we will drastically reduce the donor pool, and there's already a big supply and demand gap." Northwestern became the first health system in the U.S. to complete a dou- ble-lung transplant on a COVID-19 patient last June. As of March 19, 14 pa- tients had undergone the procedure at the health system, and all were expect- ed to make a full recovery. n Nearly 30% of hospitalized COVID-19 patients in UK readmitted, study finds By Erica Carbajal N early one-third of hospitalized COVID-19 patients in the U.K. were readmitted, and they experienced multiorgan dysfunction at higher rates than those without COVID-19, according to research published March 31 in The BMJ. Out of 47,780 people hospitalized with COVID-19 in the U.K. and discharged by Aug. 31, 2020, 14,060 people, or nearly 30 percent, were readmitted, re- searchers found. Findings also showed 5,875 people died after discharge. Readmission and death occurred at rates four and eight times greater, respec- tively, compared to the control group. Additionally, people discharged from the hospital after COVID-19 experienced higher rates of diabetes, major adverse cardiovascular events, chronic kidney disease and chronic liver disease. Compared to expected rates from the general population, the risk of death, readmission and multiorgan dysfunction after hospital discharge was higher among people under 70 and ethnic minorities. "Our findings across organ systems suggest that the diagnosis, treatment and prevention of post-covid syndrome requires integrated rather than organ or disease specific approaches," the report said, adding that "urgent research is needed to establish the risk factors." n

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