Authors (including presenting author) :
Lam CY (1), Kong HL (1), Woo S (1), Wong CK (1), Choy YL (1), Fu WK (1), Leung D (1), Chan K (3), Chan YF (3), Leung PK (3), Tsang KY (3), Siu TS (1), Po MMY (2), Kng C (1)
Affiliation :
(1) Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu Kin Hospital (2) Community Healthcare Services, Hong Kong East Cluster (3) Community Geriatric Assessment Team, Hong Kong East Cluster
Introduction :
Covid clinic in Hong Kong East Cluster (HKEC) was started from 19 Feb 2022, amid the fifth wave of covid-19 in HK, when the public health care system and testing capacity were overwhelmed. It involved tele-consultation provided by geriatricians and geriatric nurses to the covid-19 positive patients residing in residential care homes for elderly (RCHE) in HKEC catchment area, and was part of the service of the Community Geriatric Assessment Team (CGAT) of the Hospital Authority (HA). The covid clinic aimed at providing tele-medical support to covid-positive patients residing in RCHE, and to triage patients for hospital care. In Hong Kong, oral antiviral therapies, molnupiravir, became available after 4 March, 2022, and nirmatrelvir/ritonavir after 16 March, 2022.
Objectives :
Our study aimed to report in-depth details regarding the situation in RCHE and the use of oral antiviral drugs in tele-consultation setting for RCHE patients during the fifth wave of covid-19 of Hong Kong.
Methodology :
We collected data from covid clinic from 19 February, 2022 to 26 April, 2022. The demographic and clinical parameters, including age, gender, medical history, and the outcome variables, including death within 28 days and 90 days, as well as hospital admission within 7, 14 and 21 days of covid clinic visit, were retrieved through Clinical Data Analysis and Reporting System (CDARS) of the HA. Statistical analysis was carried out by Statistical Package for the Social Sciences (SPSS) version 26. Statistical significance was taken as p<0.05.
Result & Outcome :
During the study period, 2965 tele-consultations were conducted to 2392 patients. The mean age was 86.4 ± 9.74 (age range: 22-112) and 61% were female. Hospital admission within 7, 14 and 21 days of clinical visit were 9.2%, 14.8% and 19.8% respectively. Mortality within 28 and 90 days of clinical visit were 5.9% and 9.7% respectively. Of the 921 patients prescribed with oral antiviral, 837 were given molnupiravir and 84 were given nirmatrelvir/ritonavir. Those taken oral antiviral medication within first 5 days of covid infection were associated with significantly reduced risk of admission within 7 days, death within 21 days and death within 90 days of clinic visit. When comparing molnupiravir, nirmatrelvir/ritonavir and no oral anti-viral groups, the nirmatrelvir/ritonavir group was associated with the best outcome in terms of hospital admission and mortality. Conclusions: Tele-consultation by CGAT has provided medical support to covid-positive patients in RCHE during fifth wave of covid-19 in Hong Kong, and has improved the outcome of these group of patients by early consultation and timely prescription of oral antiviral treatment.
