LAUSR

Study Objective: Monoclonal antibody therapy (MOAB) has recently emerged as a treatment for mild to moderate COVID-19, potentially preventing those with underlying conditions from progressing to severe illness and hospitalization. While MOAB administration has commonly been restricted to infusion centers or inpatient settings, the infection prevention needs of patients with acute COVID-19 and the ambulatory nature of the therapy make the emergency department (ED) a useful setting to offer this treatment. Further, as EDs are the primary point of health care access for many at-risk individuals, offering MOAB in the ED may increase availability of treatment options for patients from traditionally underserved communities. Methods: A retrospective chart review was conducted of patients 12 years and above who received treatment in our urban, academic, community hospital. A multidisciplinary group comprised of stakeholders in emergency medicine, pediatrics, infectious disease, nursing, informatics, and pharmacy developed a comprehensive ED-based MOAB program. Patients 12 years and older were screened for eligibility during ED visits or during follow-up calls providing positive test results. Staff was trained on specific consent, infusion, monitoring, and documentation procedures adherent to MOAB administration under the Emergency Use Authorization. Patients were contacted following MOAB and queried regarding symptom resolution and health care utilization. Data regarding patient demographics, ED course, and 7-day unscheduled visits were collected. Results: In this ongoing quality improvement initiative, from December 2020 to March 2021, there were 26,229 patient encounters at the pilot ED site. 84 patients were provided MOAB, 87% Bamlanivimab and 13% Bamlanivimab/Etesevimab. Patients had a mean age of 52.3 years (SD 24.4);21% were 12-17 years of age and 37% were >65 years old. 52% were male. 33% self-reported as Caucasian, 19% Black, 18% Asian/Pacific Islander, 21% as other, and 9% were unknown. 17% identified as Latinx. 19% of patients were insured by Medicaid, 36% Medicare, 39% commercially insured, and 6% were uninsured. Patients had symptoms a median of 3 days prior to MOAB. After age (46%), the most commonly reported eligibility criteria was obesity (20%), followed by hypertension (11%) and immunocompromised state (11%). 74% of infusions were administered during nights and weekends. No infusion reactions occurred. 8% returned to an ED within 7 days of MOAB, 5% were hospitalized. No patients required ICU admission or died. Conclusion: ED-based MOAB has been safely implemented and may be an effective treatment for patients with mild to moderate COVID-19. Health-system-wide expansion of this program may provide opportunities to offer this life-saving therapy to underserved populations with poor access to care.