Organ transplant recipients respond suboptimally to SARS-CoV-2 vaccination and remain at risk for severe COVID-19 infections. During community surges with the Delta (September to November 2021) and Omicron BA.1 (December 2021 to February 2022) variants in Singapore, we systematically offered Sotrovimab to kidney transplant recipients (KTRs) who reported a positive antigen rapid test with diagnosis subsequently confirmed by SARS-CoV-2 PCR. Inclusion criteria were presentation within 6 days of symptom onset, were unvaccinated, or vaccinated with spike antibody <100 U/ml, (SpAb, Roche Cobas SARS-CoV-2-S assay) and not requiring oxygen.We herein report outcomes among 51 SARS-CoV-2-infected KTRs administered 500 mg intravenous Sotrovimab. Note that 80.4% of the study population had received two or three doses of SARS-CoV-2 mRNA vaccine (Table 1A). Antimetabolite doses were halved upon COVID-19 diagnosis and discontinued with progression; calcineurin inhibitors and mTOR inhibitors were reduced or discontinued with progression and COVID-19 therapeutics administered as per NIH guidelines. 1 The association of independent variables with the outcomes of acute kidney injury (AKI), requirement for supplemental oxygen (SuppO2), intensive care unit (ICU), and mortality at 60 days follow-up were evaluated.Overall, 15 (29.4%) had AKI, 11 (21.6%) required SuppO2, nine (17.6%) required ICU, and five (9.8%) died. On multivariable analysis, baseline estimated estimated glomerular filtration rate (eGFR) ≤30 ml/min/1.73m 2 was the only variable significantly associated with AKI and mortality (Table 1B). BMI, lung infiltrates on admission, and interval to Sotrovimab ≥4 days were independently associated with SuppO2 requirement, while BMI, eGFR, and lung infiltrates were independently associated with ICU stay.Our retrospective study, although limited by small numbers, demonstrates that despite Sotrovimab, 21.6% of KTRs progressed to severe disease, in contrast to only 1% progression in the COMET-ICE trial, which included unvaccinated, nonimmunosuppressed individuals. 2 Nevertheless, early Sotrovimab modified disease progression: 14.

Objectives: The infection prevention team (IPT) was tasked with providing technical guidance for the construction and setup of a community treatment facility in 3 weeks at a Formula 1 (F1) racing pit to house elderly SARS-CoV-2–positive cases. Methods: The facility was setup with 737 beds including an isolation unit and a resuscitation bay. The multidisciplinary team decided on zone segregation (ie, green and hot zones) and discussed the clean–dirty workflow. IPC measures were revisited, especially regarding the layout of the donning and doffing station, as the facility expanded to accommodate patients with more comorbidities and those who needed dialysis. IPC training for nominated infection control liaison officers (ICLOs) was conducted using a “train the trainer” approach for mask fitting, hand hygiene, donning and doffing of personal protective equipment (PPE). Enhanced IPC measures, including weekly audit and staff surveillance, were mandatory, and monitoring was performed according to MOH guidelines. Linen and waste management and the cleaning and disinfection process were established at the beginning of the project. Results: Construction was completed within 3 weeks. The setup was completed in November 2021 for 737 beds. There were 758 admissions during the 4-month operation. In total, 12 trained ICLOs oversaw the training of 200 healthcare workers. They conducted 12 IPC audits and provided feedback to all staff. Compliance with PPE practices was inconsistent, and findings were shared during daily after-action reviews for improvement. The greatest challenges were converting the F1 facility to a healthcare facility, training staff with no IPC knowledge, and monitoring IPC on the ground. The trained ICLOs were successful in implementing, practicing, and monitoring IPC measures with minimal assistance from the infection prevention team. Conclusions: Operation began on November 5, 2021, and ceased on March 9, 2022. The community treatment facility construction, setup, and operations were completed within a short timeframe due to the efforts of various stakeholders. We faced many challenges, but we managed to implement and uphold IPC standards from beginning to end.

Objectives: COVID-19 cases continue to climb in the community from the SARS-CoV-2 δ (delta) variant wave. To prepare for cases that may be nosocomial or detected late, the infection prevention team constructed a ‘hot ward’ tool kit to guide implementation of infection control measures. Methods: We engaged the NUH Facilities Management ventilation engineers to understand every ward’s mechanical ventilation setup. With this information, we created of “green” and “hot” zones within ward. After conducting assessments on individual wards, we created the “hot ward” tool kit: (1) 38 ward floor plans indicating ventilation setup, “green” zones, and “hot” zones; (2) a risk matrix to guide ward actions based on cycle threshold (Ct) value and duration of exposure; and (3) “hot ward” checklists. The tool kit was presented to infectious disease clinicians on the infection prevention team and senior nursing leaders for input and guidance. To ensure that these plans were practical, we conducted numerous site walks with HOD and ward nurse managers (ie, for the ICUs and psychiatric units). Finally, the tool kit was shared in a meeting with key stakeholders and senior leaders. It was also uploaded to the NUH COVID-19 quick-reference intranet page for easy staff access. Results: The tool kit was used by 2 general wards when cases of confirmed COVID-19 were detected among patients. Overall, the tool kit helped HOD and nurse managers with the immediate actions required and it provides useful guidance for the infection prevention team to assess and guide decisions regarding whether a ward lockdown is necessary. Conclusions: Although the guidance was useful, from the site walk we learned that the mechanical ventilation system of some wards is shared, making it challenging to prevent cross contamination between wards because any shared ventilation between unmasked areas can be pose a risk for both patients and staff. Additional measures were instituted to mitigate this risk.

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