563. Experience of a Private Hospital in the Treatment of COVID-19 Pneumonia in Veracruz, Mexico

Abstract Background Large mortality rates have been reported in the Mexican public health system, however in the experiences of private hospitals that have resources and infrastructure this is lower compared to the national average. Methods Descriptive and retrospective study. Adult patients treated for pneumonia due COVID-19 from April to December 2020 are entered into the study. Its general characteristics such as gender and age, comorbidities, influenza vaccination history, clinical characterization, laboratory and tomographic diagnosis of sars cov2 pneumonia are studied, as well as the drug and oxygen therapy treatments received and finally, its evolution and clinical outcome. Results 132 patients were studied, of which 51% were female. The main age groups affected were 65 and over (43.9%), 50-59 years (20.4%) and 25-44 years (16.6%). The main comorbidities found were: arterial hypertension (43.9%), Diabetes mellitus 2 (33.3%), heart disease (11.3%) and obesity (10.6%). 95.4% of the patients were not vaccinated against influenza. The main symptoms reported were: fever (92%), cough (87%), dyspnea (76%) and headache (52%). The diagnosis was confirmed with RT-PCR in 63%, reporting negative RT-PCR in 36%; the antigen test was positive in 1%. Regarding the findings of the chest computed tomography, CORADS 5 was reported in 30%, CORADS 6 in 3% and CORADS 4 in 20%. The main treatments used in patients with severe inflammatory pneumonia were: steroids (98%), enoxaparin (100%), tocilizumab (20%), baricitinib (60%), direct oral anticoagulants (10%), fibroquel (5%). 60% were treated with a combination of two or more drugs. The main oxygenation contributions were: 20% nasal tips - mask/reservoir, 60% high flow nasal cannula, 20% mechanical ventilation. In 95% the prone position was indicated. Regarding the clinical evolution, 65.1% were towards improvement, 17.4% died, 12.1% requested transfer to another unit and 5.3% requested voluntary discharge. Overall mortality was 17%. Medications in ICU Ventilation strategies Conclusion A hospital strategy that has the necessary resources and infrastructure as well as openness to the use of medication with emergency approvals for its use or off-label indications, can help limit morbidity and mortality in vulnerable populations and manifest risk factors such as Mexican population Disclosures All Authors: No reported disclosures


Session: P-24. COVID-19 Treatment
Background. Tocilizumab is an interleukin-6 monoclonal antibody with widespread use in rheumatologic conditions. Observational studies have shown a promising role of Tocilizumab in severe COVID-19 patients with cytokine storm syndrome. Data about tocilizumab use in pregnant patients is limited. We report two outcomes of two pregnant patients with COVID-19 in the second trimester who received tocilizumab Methods. A 24-year-old 20 weeks pregnant lady with a history of asthma and gestational diabetes mellitus presented with three days history of fever, cough and shortness of breath ( Figure 1). She was clinically stable but later developed ARDS and developed increased oxygen demand up to 10 liters/min. She received Tocilizumab on. Patient was observed in a high dependency unit but did not require mechanical ventilation. Patient was discharged home with full recovery and later delivered a healthy baby. Timeline of medicines used during hospital ( Figure 2). Case 2: 39-year-old 23 weeks pregnant lady presented with seven days history of fever cough and shortness of breath ( Figure 1). On presentation, she had progressive worsening hypoxic respiratory failure and was intubated. Patient had her nasopharyngeal swab for CODI-19 RT PCR was positive. The patient had severe ARDS requiring ECMO (extracorporeal membrane oxygenation) for respiratory support. Tocilizumab 400 mg was given on the presentation, along with other medications (Figure 3). Patient had regular monitoring of fetus; however, she had intrauterine fetal demise on day 14. Patient It is unclear if IUFD was due to using of tocilizumab or severity of COVID19 itself. The patient stayed in ICU for 20 days and was discharged after full recovery. Results. Learning points: Tocilizumab use in pregnant patients with severe COVID-19 pneumonia during the second trimester improved maternal outcomes in our cases. Tocilizumab use may be associated with worse fetal outcomes, including intrauterine fetal demise (IUFD). Conclusion. The pharmacological management of pregnant patients with severe COVID-19 pneumonia poses significant challenges. The use of Tocilizumab may improve maternal outcomes but may also increase the risk of worse fetal outcomes. Caution should be exercised in using this agent, and risks and benefits should be discussed with the patients.
Disclosures. All Authors: No reported disclosures

Session: P-24. COVID-19 Treatment
Background. Large mortality rates have been reported in the Mexican public health system, however in the experiences of private hospitals that have resources and infrastructure this is lower compared to the national average.
Methods. Descriptive and retrospective study. Adult patients treated for pneumonia due COVID-19 from April to December 2020 are entered into the study. Its general characteristics such as gender and age, comorbidities, influenza vaccination history, clinical characterization, laboratory and tomographic diagnosis of sars cov2 pneumonia are studied, as well as the drug and oxygen therapy treatments received and finally, its evolution and clinical outcome.
Medications in ICU Ventilation strategies

Conclusion.
A hospital strategy that has the necessary resources and infrastructure as well as openness to the use of medication with emergency approvals for its use or off-label indications, can help limit morbidity and mortality in vulnerable populations and manifest risk factors such as Mexican population Disclosures. Background. The zoonotic emergence of SARS-CoV-2 quickly developed into a global pandemic. Multiple vaccine platforms have been advanced to clinical trials and emergency use authorization. The recent emergence of SARS-CoV-2 virus variants with Spike receptor-binding domain (RBD) and N-terminal domain (NTD) mutations, highlights the need for next-generation vaccines that can elicit immune responses that are resilient against Spike mutations.
Methods. Using a structure-based vaccine design approach, we developed multiple optimized SARS-CoV-2 nanoparticle immunogens that recapitulate the structural and antigenic profile of the SARS-CoV-2 prefusion spike. We assessed these immunogens in murine immunogenicity studies and in a K18-hACE2 transgenic mouse model with a SARS-CoV-2 challenge. Immune sera from vaccinated mice were assessed for SARS-CoV-2 binding, and neutralization against SARS-CoV-2, variants of concern, and the heterologous SARS-CoV-1 virus.
Conclusion. These observations highlight the importance of SARS-CoV-2 neutralizing antibody levels in providing protection against emerging SARS-like coronaviruses and provide a robust platform for pandemic preparedness.
Structure-based design enables development of a SARS-CoV-2 nanoparticle immunogen. Methods. Our academic medical center with 11,785 HCWs on its Jackson campus initiated non-mandatory CoVac among HCWs with BNT162b2 on December 16, 2020. Individuals ≥ 2 weeks after 1st dose of vaccine were defined as partially vaccinated and those ≥2 weeks from 2nd dose of vaccine were defined as fully vaccinated. Per facility policy, all symptomatic HCWs (irrespective of vaccination status) were recommended to undergo SARS-CoV-2 RT-PCR testing. Asymptomatic HCWs were also tested upon household exposure, however, this policy was changed on March 9 th 2021 to allow fully vaccinated asymptomatic HCWs to work without need for quarantine or testing. Universal masking policy among HCWs remained effective at our center during study period.

Risk of COVID-19 Among Healthcare Workers After Launch of Vaccination Campaign at an Academic Medical Center
Results. Between the launch of COVID-19 vaccination on December 16, 2020 and April 30, 2021, 5,855 HCWs received one dose of vaccine, and 5,687 received both doses. A total of 1,329 unique HCWs underwent COVID-19 testing between January 4, 2021 and April 30, 2021. Of those, 217 (16.3%) tested positive for SARS-CoV-2 infection; 204 were unvaccinated, 7 were partially vaccinated, and 6 were fully vaccinated (figure 1). Of the 6 fully vaccinated employees, 1 was asymptomatic (testing for travel purposes), 4 had mild symptoms, and one elderly employee required hospitalization with oxygen supplementation and had a complete recovery. No facility outbreaks were reported related to asymptomatic, work exposed, fully vaccinated HCWs.