Start-up of a high-risk COVID unit: The experience from a general hospital

Introduction

COVID-19, a disease caused by SARS-CoV-2, was identified in December 2019 and rapidly progressed to a global pandemic. Age and some comorbidities, such as obesity, cardiovascular disease and diabetes mellitus, were described in our setting as predictors of poor outcome and increased the risk of hospitalisation and death in the first 2 waves of the pandemic, before vaccination.¹ In addition, patients with haemato-oncological disease, lung cancer, or neoplasms in disseminated stages had a worse prognosis.^2,3 Patients with haematological malignancies undergoing chemotherapy were also described as having a higher risk of mortality associated with a COVID-19 admission (OR 2.09; 95% CI 1: 1.09–4.08; p = 0.028).⁴ Lastly, lymphopenia, a very common finding in patients receiving chemotherapy or biologic drugs, was also defined as a poor prognostic factor in SARS-CoV-2 disease.⁵

Treatments were modified throughout the pandemic according to the knowledge gained. Initially the indication for specific treatment was restricted to severe infection requiring hospital admission. Due to the emergence of the different variants of SARS-CoV-2 and the implementation of vaccination, which exceeded 80% of the population in Catalonia,⁶ the indication of specific treatments for mild–moderate disease in patients at risk of progression, including immunocompromised patients, was approved at the beginning of 2022.

The challenge now is for clinicians to adapt to this new scenario: indication of treatment in the early phase of the disease, generally within the first 5 days of the onset of symptoms of infection and single-dose intravenous outpatient administration (sotromivab), 3 doses (remdesivir) or even oral antivirals (nirmatrelvir/ritonavir). In this context, the existence of agreed protocols and pathways aimed at prevention, early detection of infection and treatment in indicated cases with the best available drug can contribute to improve the management of these patients. To this end, it seems essential to create a multidisciplinary group to integrate knowledge of diseases or treatments that may cause immunosuppression, the updating of treatment indications in these high-risk patients, the peculiarities of SARS-CoV-2 infection and knowledge of the response to vaccination in these patients.

A new scenario in the COVID pandemic

The development and widespread administration of COVID-19 vaccines by the end of 2021 has helped protect vulnerable patients. At the same time, the emergence of the omicron variant of SARS-CoV-2, which is more transmissible but less severe, has progressively reduced the number of hospitalisations for severe infection and has virtually eliminated admissions to intensive care units (ICU). The ratio of ICU admissions to hospitalisations has fallen below 5% for the first time in this pandemic in April 2022 (week 14),⁷ as shown in Fig. 1.

Fig. 1.

Hospital and intensive care unit admissions in Catalonia during the COVID pandemic.

Hospital admissions and ICU admissions during the 6 waves of the COVID pandemic are shown. The percentage of ICU admissions relative to hospital admissions is shown, which is below 5% as of April 2022 (week 14).

ICU: intensive care unit.

Thus, since the sixth wave of the pandemic, there has been a change in control strategies at European level, from a reduction in virus circulation in the community (use of masks, hand washing, social distance, restrictions or lockdowns) to free circulation in the community with protection strategies for vulnerable patients, or those at risk of progression (booster vaccination, early diagnosis and treatment for vulnerable patients, and even pre-exposure treatment).

However, while there is high vaccination coverage in the general population, data on the response to vaccines in vulnerable patients are limited. A systematic review of 57 studies looked at seroconversion in patients with haematological malignancies and found a response to the vaccine between 38.1% and 99%, with a higher response in myeloproliferative diseases and a lower response in patients with B-cell chronic lymphocytic leukaemia (CLL). Response to vaccine administration was also assessed according to treatments received, with lower seroconversion observed in B-cell depletion treatments compared to the other treatments, especially if this treatment was administered within the last 12 months.⁸ Other preliminary data also point to a low response in older patients with myeloma.⁹ A lower vaccine response has also been reported in patients with solid organ neoplasm, although to a lesser extent than in haematological diseases. In this same review, some of the factors that are related to a lower response to vaccine administration are: age >65 years, haematological malignancies, cytotoxic chemotherapy, monoclonal antibodies (anti-CD20, anti-CD38), immunomodulatory drugs, targeted therapies (BCL2, BTK, JAK1/JAK2 inhibitors), active or disseminated neoplasms, and lymphopenia.¹⁰

In our setting, the most prevalent group is that of patients treated with anti-CD20 drugs, especially rituximab. Rituximab is a genetically engineered chimeric monoclonal antibody that depletes CD20+ B cells, causing their destruction through cellular cytotoxicity, complement activation and induction of B cell apoptosis directly by drug binding.¹¹ It is currently approved by the European Medicines Association for the treatment of non-Hodgkin’s lymphoma, chronic lymphocytic leukaemia, rheumatoid arthritis, multiple sclerosis, granulomatosis with polyangiitis and microscopic polyangiitis.¹²

After rituximab treatment, B-cells usually recover within 6 months, reaching normal blood levels at 12 months. Less than 20% of patients treated with monoclonal antibodies have a decrease in serum immunoglobulin (IgG or IgM) concentrations below reference values 5–11 months after rituximab administration. This hypogammaglobulinaemia, together with lymphopenia, could explain the lower response to SARS-CoV-2 vaccination, especially if this treatment has been given within the last 12 months.¹³

Thus, although vaccination in the general population has protected immunocompetent individuals from severe infection, for patients with factors leading to lower seroconversion, strategies should be adopted to minimise the risk of progression to severe disease: increasing vaccination coverage (heterologous vaccination, booster vaccination), considering the use of pharmacological treatments (monoclonal antibodies, convalescent plasma) or non-pharmacological treatments (social distance, use of masks). And, at the same time, ensure the dissemination of information and prevention advice to vulnerable patients to avoid SARS-CoV-2 infection and assess post-vaccination antibody determination to evaluate serostatus, which will determine treatment selection in case of infection. Other strategies would be to withhold immunosuppressive therapy at the time of immunisation depending on patient profile, associated disease and treatments administered.¹⁴

New specific treatments for SARS-CoV-2

In the Catalan health system, there are treatment recommendations within the pharmacotherapeutic harmonisation programme, according to the protocol for pharmacological treatment of SARS-CoV-2 infection of the Catalan Health Service,¹⁵ which are supported by the indications of the Spanish Agency of Medicines and Medical Devices.¹⁶ During the course of the COVID pandemic, these treatments have changed according to the evidence. The 26 January 2022 version of the protocol indicated specific treatment for mild–moderate infection, but with risk factors for progression, and later added the indication for treatment with monoclonal antibodies in the pre-exposure phase.

Pre-exposure treatment with monoclonal antibodies in patients at risk of progression without evidence of seroconversion (antibody titre below 260 BAU/ml after a complete vaccination regimen or with contraindication to vaccination due to anaphylaxis) is recommended with the combination of tixagevimab/cilgavimab, which is administered consecutively intramuscularly (2 doses of 150 mg, one in each buttock). A pre-publication of the clinical trial involving 1417 hospitalised patients with confirmed SARS-CoV-2 infection which showed differences in 90-day mortality is available as of 22 April 2022.¹⁷

In order of priority and according to availability, the treatments proposed for mild–moderate infection in patients with risk factors for progression are: orally administered nirmatrelvir/ritonavir combination, remdesivir (indicated in patients with a vaccine response) and the monoclonal antibodies casirivimab/imdevimab (no vaccine response and infection caused by a variant other than omicron) and sotromivab (no vaccine response and infection with the omicron variant).

Currently, due to its efficacy, ease of access and use, it is considered that the first recommended therapeutic option is nirmatrelvir/ritonavir in a 5-day regimen. The combination of nirmatrelvir/ritonavir is administered orally, with 2 tablets of 150 mg of nirmatrelvir and 1 tablet of 100 mg ritonavir every 12 h. Nirmatrelvir inhibits the main protease of SARS-CoV-2 and reduces the replication capacity of the virus, while ritonavir acts as an enhancer, since it inhibits the metabolism of nirmatrelvir and increases plasma concentrations. In Catalonia, the drug is accessed through the usual electronic prescription system. The dose must be adjusted according to renal function and interactions with other drugs must be evaluated. Treatment should be started within the first 5 days of symptoms. Efficacy data from the EPIC-HR clinical trial,¹⁸ which included unvaccinated outpatients who had mild or moderate disease caused predominantly by the delta variant and at least one risk factor for progression. From a total of 2085 patients, the risk of a combined endpoint including hospitalisation for COVID-19 or death from any cause within 28 days was reduced compared to placebo (0.77% vs. 6.31%; p < 0.001; NNT = 18 [14–25]).

Remdesivir is a nucleotide analogue that exhibits in vitro activity against SARS-CoV-2 by inhibiting RNA replication. A phase 3 trial (SIMPLE trial) showed that treatment with this drug for 5 or 10 days decreased recovery time in patients requiring hospital admission for COVID-19.¹⁹ In December 2020, after reviewing all available efficacy and safety data, its authorization for use was limited to patients with low-flow, high-flow or non-invasive ventilation oxygen requirements, while patients with invasive ventilation or ECMO were excluded. Recently, an 87% reduction in hospitalisation or death was demonstrated in early phase outpatient treatment with a short course of 3 days in patients with mild SARS-CoV-2 infection and risk factors for progression.²⁰

Casirivimab/imdevimab is a combination of 2 monoclonal antibodies against the spike protein of SARS-CoV-2 that has demonstrated a reduction in viral load, a decrease in the duration of symptoms and in the need for healthcare in patients with mild symptoms at an early stage of the disease (<7 days of symptoms) and with negative serology for SARS-CoV-2.²¹ In addition, efficacy has also been demonstrated with subcutaneous administration.²²

Finally, sotromivab is a monoclonal antibody against SARS-CoV-2 that has demonstrated a reduction in hospitalisation and death in 85% of patients with early SARS-CoV-2 infection (<5 days) and high risk of progression based on age (>55 years) and comorbidities, such as diabetes, obesity, chronic kidney disease, heart failure, chronic obstructive pulmonary disease and severe-moderate asthma.²³

The use of monoclonal antibodies requires an assessment of the patient’s serological status (response to SARS-CoV-2 vaccination) and analysis of the current variants of SARS-CoV-2, since the different monoclonal antibodies have different sensitivities according to the variants. Casirivimab/imdevimab has low activity against the different omicron variants and sotrovimab is active against the omicron BA.1 variants, but has lower activity against the BA.2 and BA.4/5²⁴ variants, with the latter being currently the most common in our setting.

High-risk patients with COVID

One of the main problems in healthcare 2 years after the start of the COVID pandemic is the risk of infection in vulnerable patients, especially those with immunodeficiencies and lack of response to vaccination.

In patients under active treatment for neoplasms, especially haematological malignancies, increased severity has been observed in cases of SARS-CoV-2 infection, probably due to lymphopenia and hypogammaglobulinaemia, secondary to the underlying disease or the treatments administered. A particular case is patients requiring anti-CD20 treatment, with secondary lymphopenia and hypogammaglobulinaemia, in which a lack of response to the vaccine has been described.

When the availability of new therapeutic alternatives for SARS-CoV-2 infection is limited, criteria for prioritising early access to them need to be established.

As was the case during the national vaccination programme, progression risk groups have been defined. At the end of January, patients with immunosuppression mainly due to haematological treatments were included. Later, patients with cytotoxic chemotherapy or with lymphopenia or neutropenia were added and, gradually, risk groups have been added on the basis of the immunosuppression caused by the drugs. This group of patients makes up group 1. Groups 2–4 have been recently added according to age, vaccination status and comorbidity. Table 1 describes the population groups at risk of progression in case of mild–moderate SARS-CoV-2 infection.

Table 1.

Prioritized high-risk situations for the treatment of mild–moderate SARS-CoV-2 infection.

Group 1. Immunocompromised and other high-risk individuals, regardless of vaccination status:

• Haematopoietic stem cell transplant or CAR-T recipients, within 2 years after transplantation/treatment, on immunosuppressive therapy or who have graft-versus-host disease regardless of the time since haematopoietic stem cell transplantation

• Solid organ transplant recipients (less than 2 years or on immunosuppressive treatment for rejection related events)

• Renal replacement therapy (haemodialysis and peritoneal dialysis)

• Primary immunodeficiencies: combined and B-cell immunodeficiencies in which absence of vaccine response has been demonstrated

• Active treatment with myelotoxic chemotherapy for oncological or haematological diseases. The use of hormone therapy, immune checkpoint inhibitors or other treatments that do not cause an increase in the risk of infection (for example, non-myelotoxic anti-target monoclonal antibodies) is excluded

• Patients with non-cytotoxic haemato-oncological treatments with neutropenia (<500 neutrophils/mcL) or lymphopenia (<1000 lymphocytes/mcL) at time of infection

• HIV infection with ≤200 cells/ml (blood test within the last 6 months)

• Cystic fibrosis

• Down’s syndrome aged 40 or older (born in 1981 or before)

Immunosuppressive treatment with high-dose or prolonged oral glucocorticoids and certain non-biological immunomodulators:

• Treatment with continuous high-dose oral glucocorticoids (equivalent to ≥20 mg/day of prednisolone for 10 or more consecutive days in the previous 30 days)

• Prolonged treatment with moderate dose oral glucocorticoids (equivalent to ≥10 mg/day of prednisolone for more than 4 consecutive weeks in the previous 30 days)

• High doses of oral glucocorticoids (equivalent to >40 mg/day of prednisolone for more than one week) for any reason in the previous 30 days

• Treatment in the previous 3 months with any of the following non-biological immunomodulatory drugs: methotrexate (>20 mg/wk or >15 mg/m^2/wk, oral or subcutaneous), leflunomide, 6 mercaptopurine (>1.5 mg/kg daily) or azathioprine (>3 mg/kg daily), cyclosporine, mycophenolate, tacrolimus (oral formulations), sirolimus and everolimus in the previous 3 months.

• Immunosuppressive treatment with biological immunomodulators: individuals who have received in the preceding 3 months (6 months in case of anti-CD20) specific therapy with any of the drugs of the following groups:

• Anti-CD20 monoclonal antibodies: rituximab, ocrelizumab, obinutuzumab, ibritumomab tiuxetan

• Inhibitors of B cell proliferation: ibrutinib, acalabrutinib

• T-cell suppressor fusion proteins: abatacept

• Interleukin-1 (IL-1) inhibitors: anakinra, canakinumab

• Anti-CD52 monoclonal antibodies: alemtuzumab

• Sphingosine-1-phosphate receptor modulators: fingolimod, siponimod.

• Protein kinase inhibitors: afatinib, axintinb, crizotinib, dabrafenib, dasatinib, erlotinib, everolimus, gefitinib, imatinib, lapatinib, nilotinib, pazopanib, ruxolitinib, sorafenib, sunitinib, temsirolimus, vandetinib, etc.

• Janus kinase (JAK) family inhibitors: tofacitinib, baricitinib, upadacitinib, filgotinib

Group 2. Unvaccinated individuals^a aged >80 years

Group 3. Unvaccinated individuals^a aged >65 and with at least one risk factor for progression^b

Group 4. Vaccinated individuals (>6 months) aged >80 years and with at least one risk factor for progression^b.

a

Unvaccinated individuals are persons who have not received the full vaccination schedule (including booster doses) and have not had the disease within the last 3 months.

b

The risk factors for progression are considered to be:

Structure and operation of the high-risk COVID Unit

The one in Mataró is a general hospital, a reference hospital in the Maresme Central region, in the province of Barcelona, with a population of 275,000 inhabitants. As care resources we have a day hospital with a full-time infection nurse and a hospital at home (HaH) service that covers the entire area of influence. Our tertiary level and reference centre is the Hospital Universitari Germans Trias i Pujol (HUGTiP) in Badalona, 20 km away. The Institut Català d’Oncologia (ICO) of Haematology, where hematopoietic transplants are performed, and the Nephrology Department, a centre with renal transplants (there is no nephrology department at Mataró hospital), are reference services at this centre.

High risk COVID Unit

In view of the creation of a high-risk COVID Unit (HR COVID Unit) in our care setting, we assume that the profile of the patient candidate for specific early treatment for a mild–moderate SARS-CoV-2 infection is the one under treatment with anti-CD20 drugs (especially rituximab and ocrelizumab) and the one undergoing chemotherapy. Together with the Pharmacy Service and the prescribing departments, the treatments carried out in our centre in the last 6 months with anti-CD20 drugs (around 80 treatments) were analysed. All prescribing departments (Haematology, Pneumology, Internal Medicine, Neurology and Rheumatology), together with the Oncology department, were invited to the first meeting concerning the creation of the HR COVID Unit at the beginning of March 2022.

One of the challenges in the care of these patients was the existence of an anti-spike antibody test to assess the vaccine response (as this is necessary to decide on the indication of specific treatment) and the early detection of SARS-CoV-2 infection (indication of treatment within 5 days of symptom onset). It was decided to fill in an information sheet for high-risk patients (treatment with anti-CD20 drugs and treatment with chemotherapy), indicating the need for a blood sample to assess the humoral response to the administered vaccines. It included 2 telephones numbers of the Internal Medicine Department to contact in case of SARS-CoV-2 infection (one during working hours and one at all times).

It was agreed that all patients on active treatment with anti-CD20 drugs and chemotherapy should receive the information sheet and undergo serology for anti-spike antibodies against SARS-CoV-2. Those who had received treatment in the last 6 months were identified in the subgroup of patients with anti-CD20 drugs.

To facilitate the request for serologies, a specific analytical profile (HR COVID) was created and SARS-CoV-2 serology was also included in the profile used for screening at the start of chemotherapy in cancer patients.

Specific treatment protocol for mild–moderate SARS-CoV-2 infection in patients at risk of progression

One of the objectives of the multidisciplinary working groups is to promote standardised clinical practice in the different specialties and to reduce variability in patient management. The agreed protocols are a practical support available on the hospital’s intranet.

Once patients at high risk of progression were identified, the serology request process initiated and the early detection channels established, the hospital’s Infection Committee approved the protocol for the specific treatment of mild–moderate infection in vulnerable patients. This protocol specified the treatment criteria and the indication of the different drugs. Case reporting mechanisms were established and the care resources were made available according to the treatment indicated, as well as the subsequent monitoring of the progress by the HR COVID Unit.

In summary, upon a report of SARS-CoV-2 infection, the Unit’s referring physician reviews the patient’s medical records and contacts the patient by telephone to corroborate the diagnostic information (the day of the diagnostic test), as well as the days of symptoms. It assesses the serological status and, based on these data, decides on the indication for treatment and the prioritised drug according to current protocols.

If the patient consents, the drug is requested from the hospital pharmacy (in the case of oral treatment, for validation of the prescription). If intravenous administration is required, the appropriate care provider is informed: HaH for treatment with remdesivir (3 days) or Day Hospital for the administration of sotromivab (single dose). If the patient is identified in the Emergency Department, the indicated treatment is started and, if further doses are required, the patient is subsequently admitted to HaH. The start of treatment is also assessed in patients admitted to hospital.

Once the treatment has been administered, the referring doctor at the unit carries out a weekly telephone follow-up for 4 weeks and, after a month, schedules a face-to-face visit with laboratory and radiological control.

If treatment is not indicated due to detection of infection within >5 days of symptoms (in the case of nirmatrelvir/ritonavir or sotromivab) or >7 days (in the case of remdesivir), the patient is informed and a weekly telephone follow-up is also conducted to rule out clinical worsening up to one month of follow-up.

If the patient requires admission to HaH, he/she must give consent and accept the admission criteria (have a contact telephone number and ensure a caregiver at home 24 h during the course of the admission).

Care for at-risk patients within the territorial reference area of the centre

With the introduction of oral nirmatrelvir/ritonavir treatment, a protocol was agreed between primary and specialised care. In summary, in risk group 1, treatment was indicated through the HR COVID Unit, while in groups 2–4 the indication came from primary care physicians or from the hospital emergency department. Likewise, the Unit also offered telephone contact for possible consultations when patients from any risk group were identified at any level of care (outpatient, inpatient or emergency).

Fig. 2 shows the care pathway for the patient with high-risk mild–moderate SARS-CoV-2 infection.

Fig. 2.

Care pathway for patients with mild–moderate SARS-CoV-2 infection with risk factors for progression.

HR (high risk) COVID Unit.

Dissemination of the HR COVID Unit’s initiatives and ongoing training

The proposals, programmes, actions and recommendations of the HR COVID Unit would have little impact if they were not accompanied by a programme of dissemination and ongoing medical training aimed at the different levels of care. Various strategies include the dissemination of protocols via the hospital's intranet, recommendation sheets, training sessions, dissemination of inpatient and outpatient content, and dissemination of results at scientific society meetings and congresses.

One of the main objectives is the involvement of specialised nurses caring for patients at risk of progression. The health education they provide to the patient at the beginning and during treatment and the direct access of patients to report any adverse events makes them an additional referral specialist.

Promoting research in the field of SARS-CoV-2 infection in high-risk patients

Finally, the record of the HR Unit’s activity and its results must enable research projects led by members of the Unit to improve care for vulnerable patients in relation to prognostic factors for treatment response and the scheduling of vaccination programmes, among others.

Impact of mild–moderate SARS-CoV-2 infection in high-risk patients in actual clinical practice

Since the approval of the treatment of mild or moderate infection, a total of 31 patients have been treated at Mataró Hospital, the first 6 without the HR COVID Unit setup. Since the implementation of the HR COVID Unit, a high percentage of serology determinations have been achieved, allowing early indication of treatment. No specific treatment was indicated in 8 patients as they were off-period (>5 or 7 days).

Table 2 shows the patients treated, the underlying disease and the immunosuppressive treatment, as well as the indication for specific treatment and the site of administration.

Table 2.

Patients treated at the Hospital de Mataró following the indication of treatment for mild–moderate SARS-CoV-2 infection with risk factors for progression.

Patient	Disease	Treatment	Serology	Drug	Site
1	NHL	Rituximab	?	Remdesivir	HaH
2	NHL	Rituximab	Unknown	Remdesivir	HaH
3	NHL	Rituximab	?	–	>7 days
4	Lymphoma	Rituximab	?	Remdesivir	HaH
5	Lymphoma	Rituximab	?	–	>7 days
6	MS	Rituximab	?	Remdesivir	Hospitalisation
7	Lymphoma	Rituximab	Negative	–	>7 days
8	CLL	Obinutuzumab	?	Remdesivir	Day hospital
9	Colorectal cancer	Folfox	Unknown	Remdesivir	HaH
10	Lung cancer	Osimertinib	Unknown	Remdesivir	HaH
11	SLE	Rituximab	Unknown	Remdesivir	HaH
12	Lymphoma	Rituximab	Negative	Sotromivab	Day hospital
13	Kidney transplant	Tacrolimus	?	Remdesivir	HaH
14	MM	ASCT	Unknown	N/R	OPC
15	Lymphoma	Rituximab	Negative	Sotromivab	Emergency Dpt
16	Lymphoma	Rituximab	Negative	–	>5 days
17	Colorectal cancer	Capox	Unknown	Remdesivir	HaH
16	Lymphoma	Rituximab	Negative	Sotromivab	Day hospital
17	Leukaemia	Azacitidine + Venetoclax	Unknown	Remdesivir	Hospitalisation
18	Cholangiocarcinoma	Gemcitabine	Unknown	–	GFR<30
19	Heart transplant	Tacrolimus	?	Remdesivir	HaH
20	Breast cancer	Paclitaxel	Unknown	–	>7 days
21	Lymphoma	Rituximab	Negative	–	>7 days
22	Ovarian cancer	Niraparib	Unknown	Remdesivir	Emergency Dpt/HaH
23	NHL	Rituximab	Unknown	Sotromivab	Day hospital
24	Undifferentiated sarcoma	VAC	Unknown	Remdesivir	Emergency Dpt
25	Haemolytic anaemia	Rituximab	Unknown	N/R	OPC
26	MS	Ocrelizumab	Negative	Sotromivab	Day hospital
27	Malignant mesothelioma	Carboplatin	Positive	N/R	OPC
28	Cholangiocarcinoma	Gemcitabine	Unknown	–	>7 days
29	Gastroesophageal cancer	Radiotherapy	Negative	Sotromivab	Hospitalisation
30	Carcinoma of unknown origin	Folfox	Negative	Sotromivab	Hospitalisation
31	Breast cancer	Eribulin	Unknown	–	>7 days

Capox: capecitabine/oxaliplatin; OPC: outpatient clinic; MS: multiple sclerosis; GFR: glomerular filtration rate; Folfox: calcium leucovorin/fluorouracil/oxaliplatin; HaH: hospital at home; SLE: systemic lupus erythematosus; CLL: chronic lymphatic leukaemia; NHL: non-Hodgkin’s lymphoma; MM: multiple myeloma; N/R: nirmatrelvir/ritonavir; ASCT: autologous stem cell transplantation; VAC: vincristine/dactinomycin/cyclophosphamide.?: unknown serology at the time of treatment indication; subsequently, negative serologies.

As an indicator of the HR COVID Unit outpatient activity, during the months of May and June 2022, 2 months with an increase in hospital admissions due to SARS-CoV-2 infection (seventh wave), 183 patients with COVID-19 were admitted to the Hospital de Mataró, 24 of whom required specific treatment with antivirals. In the same time period, 14 outpatient antiviral treatments were administered in the HR COVID Unit.

Conclusions

The creation of a multidisciplinary group, the HR COVID Unit, with all professionals involved in the care of patients at risk of progression in case of mild–moderate SARS-CoV-2 infection, has meant a qualitative change in the management and care of these patients. From an initial phase of dissemination about the new treatment protocols and the need for serology for SARS-CoV-2 and the early identification of cases of infection, the protocols have been approved at both hospital and regional level, which has enabled an effective and rapid response in this new approach to the pandemic. The consolidation of the working group, from a personal and professional perspective, has also led to the creation of an efficient collaborative network and the implementation of clinical and research projects.

Funding

None.

Conflict of interests

The authors declare that they have no financial relationship that could give rise to a conflict of interest in relation to this paper.

Ramon Boixeda has received grants for lectures, scientific collaborations or congress attendance from Astra-Zeneca, Bayer, Boheringer-Ingelheim, Chiesi, Esteve, Ferrer, Gilead, GSK, Menarini, Novartis, Pfizer and Rovi.

Alba Palau has received grants for conference attendance from Gilead and GSK.

Montserrat García has received grants for lectures, scientific collaborations or attendance at conferences from Boheringer-Ingelheim, Janssen, Novartis, Rovi and Pfizer.

Esther Plensa has received grants for lectures, scientific collaborations or attendance at conferences from Boheringer-Ingelheim, Janssen, Novartis, Leo Pharma, Bristol Myers Squibb and Pfizer.