Quantifying Population Immunity to Covid-19 in Washington State and Oregon

Background: Since early 2020, the novel SARS-CoV-2 virus has spread rapidly throughout the globe. Subsequently many individuals have developed some form of immunity due to either a prior infection, one or more vaccinations, or a combination of the two. Using local epidemic data and mathematical modeling, we enumerate the various immune populations in Washington State and Oregon and quantify the level of protection against infection and hospitalization. Method(s): We developed a compartmental model of ordinary differential equations, which stratifies the population by age (0-17 years, 18-49 years, 50-64 years, and 65+ years), region, type of immunity (naive, infectionderived, vaccine-derived, booster-derived, hybrid immunity, etc), and recency of immune conferring event (recent and waned). To track the number of individuals in each category we combine 1) literature-based estimates of susceptibility to infection and severe disease by age, immune status, and variant, 2) calibration to the number of severe infections (hospitalizations and deaths) and number of vaccinations and 3) validation with serological surveys of the population. Result(s): We estimate that by mid-April 2022 more than 95% of the populations of both Washington and Oregon had some immunity against COVID-19 infection and hospitalization. Younger age groups tended to have much higher rates of natural or hybrid immunity with 96% of 0-17-year-olds and 83% of 18-49-year-olds protected due to past infections. Overall, the population-level immunity against the Omicron variant reduced risk of infection by 59% (95% Credible Interval 54% - 62%) and risk of hospitalization by 79% (95% CI 77% - 81%) in Washington and 62% (95% CI 57% -66%) and 83% (95% CI 82% - 85%), respectively, in Oregon. There was similar population-level protection against Delta at the start of the Omicron wave in early December 2021, which reduced risk of infection by 60% (95% CI 56% - 63%) and risk of hospitalization 79% (95% CI 78% - 80%) in Washington and 66% (95%CI 63% - 70%) and 82% (81% - 83%), respectively, in Oregon. Conclusion(s): Very large waves of new infections throughout 2021 and early 2022, in addition to high levels of vaccination and boosting among the older age groups in Washington and Oregon have greatly reduced population susceptibility to currently circulating strains. However even very high population immunity has allowed for emergence of novel variants that escape existing immunity, highlighting the need for continued develop of new variantspecific boosters.

Public Awareness of and Support for the Use of Wastewater for SARS-CoV-2 Monitoring: A Community Survey in Louisville, Kentucky

The majority of sewer systems in the United States and other countries are operated by public utilities. In the absence of any regulation, the public perception of wastewater monitoring for population health biomarkers is an important consideration for a public utility commission when allocating resources for this purpose. We conducted a survey in August 2021 as part of an ongoing COVID-19 community prevalence study in Louisville/Jefferson County, KY, US. The survey comprised seven questions about wastewater awareness and privacy concerns and was sent to approximately 35 000 households randomly distributed within the county. A total of 1220 adults were involved in the probability sample, and data from 981 respondents were used in the analysis. A total of 2444 adults additionally responded to the convenience sample, and data from 1751 respondents were used in the analysis. The samples were weighted to obtain estimates representative of all adults in the county. Public awareness of tracking the virus that causes COVID-19 in sewers was low. Opinions strongly support the public disclosure of monitoring results. Responses showed that people more strongly supported measurements in the largest areas (>50 000 households), typically representing population levels found in a large community wastewater treatment plant. Those with a history of COVID-19 infection were more likely to support highly localized monitoring. Understanding wastewater surveillance strategies and privacy concern thresholds requires an in-depth and comprehensive analysis of public opinion for continued success and effective public health monitoring.

Lessons from the COVID-19 pandemic: insights into effective training strategies for physical development in football

Professional soccer players typically perform regular training sessions and match play for most of the yearly macrocycle with limited time focused on solely developing physical development. The COVID-19 outbreak in 2020 caused mass disruption to professional soccer but provided an opportunity for an alternative approach to training in attempt to develop professional soccer players physical fitness levels. In a non-randomised and non-controlled study, we aimed to assess the effectiveness of a 13-week remote based physical training programme on physical fitness levels in elite professional soccer players from Scottish Premier League club. Twenty professional soccer players undertook body composition assessments, a countermovement jump (CMJ) test, eccentric hamstring strength test and a submaximal 30-15 intermittent fitness test (IFT) pre- and post-remote based training programme. Body mass (79.3 +or- 6.7 vs. 80.0 +or- 7.3 kg), skinfold thickness (54.1 +or- 14.8 vs. 56.7 +or- 15.2 mm), maximum CMJ height (38.4 +or- 3.4 vs. 40.9 +or- 4.1 cm), eccentric hamstring strength (1035 +or- 158 vs. 1009 +or- 140 n) and percentage max heart rate reached in submaximal 30-15 IFT (81.3 +or- 5.2 vs. 82.3 +or- 7.3%) were maintained (all P > 0.05) from pre- to post training programme, respectively. Although team-based soccer specific training load was removed, and the training programmes prescribed had an increased physical focus, fitness levels were maintained. This suggests that alternative modes of training can potentially be used in instances where team-based soccer specific training load isn't required or is unavailable, without negatively impacting physical development.

Facing Adversity Together: Toward a Genre of Organization- Stakeholder Resilience Discourse

Organizations, such as universities, face a variety of adversities, challenges, or disruptions that call for resilience to be enacted. Resilience is an important communicative process that relies on organizations and their stakeholders to collaboratively make sense of and respond to a given adversity, such as the COVID-19 pandemic. In order to identify the shared characteristics that organizations use in their communication surrounding adversity, we completed a genre analysis of the messages created by Big 10 Universities to welcome stakeholders to the 2020–2021 academic year. Through our analysis we uncovered commonalities that make organization-stakeholder resilience discourse distinct—(1) defining a shared relationship, (2) detailing steps to regain a sense of normalcy, and (3) describing the outcome of enacting resilience. Based on these findings, we propose a genre of organization-stakeholder resilience by highlighting the role of communication in cultivating resilience through the emphasis on discursive relationships that exist between organizations and stakeholders. © The Author(s) 2022.

Post-COVID-19 superior mesenteric artery and jejunal branches thromboembolism.

The World Health Organization has declared the novel coronavirus disease 2019 (COVID-19) a global public health emergency. Despite the predominating respiratory symptoms occurring in COVID-19, thrombosis can occur in some patients, with morbidity and mortality increase due to the respiratory worsening. This article reports the case of a 62-year-old man with a flu-like illness that was diagnosed as COVID-19 by RT-PCR of SARS-CoV-2. After three weeks, he subsequently developed abdominal pain in addition to bloating, nausea, and vomiting. He underwent exploratory laparotomy after imaging tests suggested mesenteric ischemia. Intestinal ischemia was evident, due to the absence of flow in the superior mesenteric artery and jejunal branches. Embolectomy and enterectomy were performed and they resulted in a favorable outcome, with clinical improvement. This case adds data to the limited literature on extrapulmonary complications of COVID-19, notably those related to thromboembolic events.

La Organización Mundial de la Salud ha declarado la enfermedad del nuevo coronavirus 2019 (COVID-19) una emergencia de salud pública mundial. A pesar de los síntomas respiratorios predominantes en COVID-19, la trombosis puede ocurrir en algunos pacientes, con un aumento de la morbimortalidad debido al empeoramiento respiratorio. Presentamos el caso de un hombre de 62 años con enfermedad similar a la gripe que fue diagnosticada como COVID-19 por RT-PCR de SARS-CoV-2. Después de tres semanas, desarrolló dolor abdominal además de hinchazón, náuseas y vómitos. Fue sometido a laparotomía exploradora luego de que las pruebas de imagen sugirieran isquemia mesentérica. Se evidenció isquemia intestinal por ausencia de flujo en la arteria mesentérica superior y ramas yeyunales. Se realizó embolectomía y enterectomía con evolución favorable, con mejoría clínica. Este caso añade datos a la limitada literatura sobre las complicaciones extrapulmonares del COVID-19, en particular las relacionadas con eventos tromboembólicos.

RAPID, CAPILARY-DRIVEN IMMUNOASSAY FOR SARS-CoV-2 DETECTION

A rapid home-diagnostic test for SARS-CoV-2 was developed that automates the reagent delivery and washing steps required for an enzyme-linked immunosorbent assay (ELISA). The device is made of inexpensive polyethylene film and double-sided adhesive that is patterned, cut, and laminated together to create hollow channels. After sample is added, sample, reagents, and washing buffer are sequentially delivered to and washed from a detection zone on a nitrocellulose test strip, giving the end-user a visual readout in <15 minutes. A smartphone camera was used to capture images, and an analytical limit of detection of 35 PFU/mL was determined. When 22 untrained end-users were asked to visually identify a positive result, 95% correctly identified 150 PFU/mL and above as positive. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.

ELECTROCHEMICAL CAPILLARY-FLOW DRIVEN IMMUNOASSAY FOR DETECTION OF SARS-COV-2 NUCLEOCAPSID PROTEIN

As the COVID-19 pandemic continues, there remains a need for fast, accurate and low-cost diagnostic tests to prevent outbreaks. We have developed an electrochemical capillary-flow driven immunoassay (eCaDI) capable of detecting SARS-CoV-2 nucleocapsid (N) protein in self-administered nasal samples at the point of care (POC). The low-cost device is made of polyester and adhesive films and provides sequential delivery of sample and reagents to a detection zone integrating a screen-printed carbon electrode (SPCE) modified with anti-N protein antibodies from a single addition of sample, automating the steps of an ELISA. The modified electrodes are highly sensitive and selective for COVID-19 N protein and were successfully applied to test clinical samples. The novelty of this work resides in the integration of sensitive electrochemical detection with pump-free capillary-flow assay, providing accuracy at the POC. Previously reported systems are slow and/or require multiple user steps reducing the utility for POC applications relative to the system reported here. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.

Age-stratified utility of NT-proBNP testing as part of a blind Emergency Department shortness of breath orderset (Jan-Dec 2019)

Background: NT-proBNP was added to our emergency department (ED) triage blind 'shortness of breath (SOB) orderset' for presenters aged >70. Evidence-based thresholds for acute heart failure (HF) diagnosis are >900/1800 pg/ml for ages 50-75/>75 respectively (1.2);their utility in contemporary practice is uncertain. Purpose: To assess the relation between blind NT-proBNP testing in this setting and (1) coded discharge diagnosis stratified by age, and (2) all-cause mortality at medium-term follow-up. Methods:We retrieved all ED 'SOB' blood ordersets (1.1.2019-31.12.2019), including NT-proBNP, Hb, electrolytes, creatinine, troponin, CRP, d-dimer, and coded discharge diagnoses. Multivariate logistic regression models for all-cause survival (at 9.9.2021) were assessed. Results: There were 638 presentations (median age 76.1), unexpectedly including 198 <70 years. Modal and median lengths of stay were 0 and 1 day respectively. Stratified by age (<60, 60-69, 70-74, 75-79, 80-84, ≥85y), the proportion with HF coded as primary discharge diagnosis (5, 7, 9, 17, 18, 25% respectively) and all-comer all-cause mortality at 2.2±0.3 years (13, 42, 40, 48, 48, 49%) steadily increased (Table;orderset variables presented as median (inter-quartile range)). Median NT-proBNP was 3672, 2667, and 321 pg/ml when HF was in the primary, secondary, or neither coded discharge diagnosis field respectively;2.2-year-all-cause mortality was 54%, 60%, and 35%. In those with a primary HF discharge code, 77% of 349 presenters ≥75y and 88% of 231 aged 50-74 had NT-proBNP >1800/900 pg/ml respectively. In those without an HF code, 26% in both age cohorts had NT-proBNP >1800/900 pg/ml (dotted lines in Figure, panels A/B, respectively represent NT-proBNP thresholds). Independent predictors of all-cause mortality for patients with a primary or secondary HF code were ln(NT-proBNP) (OR 1.26, 95% CI 1-1.59) and serum Na+ (OR 0.93, 0.88-0.99);for patients without an HF code, these were serum K+ (1.87, 1.21-2.88), ln(NT-proBNP) (1.35, 1.15-1.58), ln(CRP) (1.18, 1.02-1.36), length of stay (1.08, 1.03-1.12), and age (1.03, 1.01-1.06). (Figure Presented) Conclusion: HF detection with NT-proBNP in a blind SOB orderset showed increasing sensitivity with age with the best specificity >75 years. Most presenters stayed ≤1 day, so blind testing at triage facilitates HF detection. NT-proBNP independently predicted 2.2-year-all-cause mortality irrespective of discharge HF coding. This is notable as the commonest non-HF causes of acute SOB are prognostically important at >70 years and follow-up occurred through the Covid-19 pandemic. The findings may reflect disease severity in patients without HF, but also suggest that discharge HF coding status does not identify all those with prognostically relevant HF.

Comparing the Psychosocial Impacts of the COVID-19 Pandemic Between Haematological Cancer and Myeloma Patients: Findings From an Online Survey

Haematological cancer is a risk factor for severe COVID-19, and multiple myeloma (MM) patients may have further risk due to older age and susceptibility to infections. This study aims to understand the pandemic's psychosocial impact on people with haematological cancers, and investigate whether MM patients experience extra stress compared to non-MM patients. The IMPaCCT survey was an international, longitudinal online survey, open to cancer patients. The first survey captured the period April-July 2020 and used quantitative and qualitative measures of quality of life (QoL), including validated tools (WHOQOL-BREF and EQ-5D-5L). Overall, 944 blood cancer patients responded (173 MM, 93 leukaemia, 117 lymphoma, 561 myeloproliferative neoplasm). Most were female, resided in the United Kingdom and did not live alone. Patients with MM were older ( p < 0.001), and more of them had received their cancer diagnosis within the last 5 years ( p < 0.001) than non-MM patients. Only three participants had a COVID diagnosis and none of them had MM. In both MM and non-MM groups, most participants said they would be less concerned about COVID if they did not have cancer. Although 70% of respondents reported their QoL as good/ very good, QoL scores on WHOQOL-BREF were lower in the physical, psychological and social domains than healthy prepandemic UK norms 7 . Respondents reported more satisfaction with environmental factors, such as living arrangements and access to services, however, than prepandemic norms. In both groups there were high rates of anxiety/depression (67%, severe in 5%). MM patients reported more issues with pain and mobility than non-MM patients. Overall 84% of the respondents reported COVID had changed their lives, and 63% of them found this hard to manage. Patients' most trusted sources for information about COVID-19 were healthcare providers and scientists for MM and non-MM participants (90% and 86% with high levels of trust respectively). MM patients had more trust in their friends and family for COVID information than non-MM patients (58% with high level of trust vs. 41%;p < 0.001). Regarding services, 43% of participants had used telemedicine, with more MM than non-MM patients using this service (61% of MM vs. 39% of non-MM). Most reported it was a positive experience. Most participants experienced a changed format for their health appointments, particularly MM patients (69% of MM vs. 52% of non-MM). Appointments with oncologists or haematologists were most often affected. Thirty-four per cent of MM patients reported their treatments were changed or delayed, compared to 11% of non-MM blood cancer patients. This study summarises the self-reported impact of COVID on psychosocial health and care access during the early pandemic in vulnerable patient groups. Results indicate that MM patients are especially vulnerable. Better understanding the needs of these patients will enable healthcare providers to properly support them..

Burden of Respiratory Syncytial Virus (RSV) Infection among Hospitalized Older Adults and Those with Underlying Chronic Obstructive Pulmonary Disease (COPD) or Congestive Heart Failure (CHF)

Background. The burden of Respiratory Syncytial Virus (RSV)-associated hospitalization in adults is incompletely understood. The COVID-19 pandemic has resulted in multiple public health measures (e.g., social distancing, handwashing, masking) to decrease SARS-CoV-2 transmission, which could impact RSV-associated hospitalizations. We sought to compare RSV-associated hospitalizations from 2 pre- and one mid-COVID-19 winter viral respiratory seasons. Methods. We conducted an IRB-approved prospective surveillance at two Atlanta-area hospitals during the winter respiratory viral seasons from Oct 2018-Apr 2021 for adults ≥ 50 years of age admitted with acute respiratory infections (ARI) and adults of any age with COPD or CHF-related admissions. Adults were eligible if they were residents of an 8 county region surrounding Atlanta, Georgia. Those with symptoms > 14 days were excluded. Standard of care test results were included. Asymptomatic adults ≥ 50 years of age were enrolled as controls in Seasons 1 and 2. Nasopharyngeal swabs from cases and controls were tested for RSV using BioFireR FilmArrayR Respiratory Viral Panel (RVP). We compared the demographic features and outcomes of RSV+ cases and controls. Results. RSV was detected in 71/2,728 (2.6%) hospitalized adults with ARI, CHF, or COPD and 4/466 (0.9%) controls. In Season 1, RSV occurred in 5.9% (35/596 patients), in Season 2 3.6% (35/970 patients), but in only 0.09% (1/1,162 patients) in Season 3 (P < 0.001 for both seasons). RSV detection in Season 3 was similar to RSV detection among controls during Seasons 1 and 2 (P=0.6). Median age of cases and controls was 67 years (Table 1). Of cases with RSV 11% were admitted to the ICU and two required mechanical ventilation. The majority of hospitalized patients were discharged home (95.8%) with a median length of hospitalization of three days (IQR 2-7). Conclusion. Over 3 seasons, RSV was detected in 2.6% of adults admitted to the hospital with ARI, CHF or COPD. The rate of RSV dramatically declined during the 2020-21 winter respiratory viral season, likely due to public health measures implemented in response to COVID-19.

Outcomes among Influenza and SARS-CoV-2 Infection in Hospitalized Adults Age ≥ 50 Years and with Underlying Chronic Obstructive Pulmonary Disease (COPD) or Congestive Heart Failure (CHF)

Background. A significant burden of disease exists for adults infected with influenza (flu) and SARS-CoV-2, which causes COVID-19. However, data are limited comparing outcomes between hospitalized adults infected with these viruses. Methods. Over the course of 3 consecutive winter respiratory viral seasons, adults ≥ 50 years of age admitted with acute respiratory tract infections (ARI) and adults of any age with COPD or CHF-related admissions were enrolled from 2 Atlanta area hospitals. For the 2018-19 and 2019-20 seasons, participants were approached in the hospital. If the participant enrolled, nasopharyngeal (NP) and oropharyngeal (OP) swabs were collected and tested using BioFire® FilmArray® respiratory panel. Due to the COVID-19 pandemic in 2020-21 and limitations involving participant contact, only NP standard of care (SOC) swabs were collected. A comprehensive medical chart review was completed for each subject which encompassed data on their hospitalization, past medical history, and vaccination history. Co-infected patients were excluded from the analyses. Results. Of the eligible participants, 118 were flu positive (three RSV-influenza co-infections were excluded) and 527 were COVID-19 positive. Median age was lower for the flu cohort at 62 (IQR 56-71) than those with COVID-19 (67, IQR 59-77) (p < 0.0001). Length of stay (LOS) was shorter in flu-infected patients (median 3 d, IQR 2-6), but was longer for COVID-19 patients (median 5 d, IQR 3-10). ICU admission occurred in 20% of those with flu, and among those admitted to the ICU mechanical ventilation (MV) occurred in 12.5%. ICU admission and MV was significantly higher for those with COVID-19, with 28% of patients admitted to the ICU and 47% of those requiring MV. Among patients with COVID-19, 8.9% died. This was significantly higher than that of flu (3.4%) (p=0.008). Hospital discharge occurred more frequently to a nursing home or LTCF with COVID-19 (10.3%) than with flu (0%) (p< 0.0001). Table 1. Breakdown of age, hospitalization course, and discharge disposition for participants diagnosed with influenza or COVID-19 during hospitalization. Conclusion. COVID-19 resulted in a longer hospital admission, a greater chance of ICU admission and MV as compared to flu. Additionally, COVID-19 participants had a high rate of discharge to a nursing home/LTCF and a significantly higher risk of death. While the clinical course was not as severe as COVID-19, influenza contributed a significant burden.

The Burden of Influenza and Rhinovirus among Hospitalized Adults Post the COVID-19 Pandemic

Background. Acute respiratory tract infections (ARIs) are a significant cause of morbidity in adults. Influenza is associated with about 490,600 hospitalizations and 34,200 deaths in the US in the 2018-2019 season. The burden of rhinovirus among adults hospitalized with ARI is less well known. We compared the burden of influenza and rhinovirus from 2 consecutive winter respiratory viral seasons in hospitalized adults and healthy controls pre-COVID-19 and one season mid-COVID-19 to determine the impact of rhinovirus as a pathogen. Methods. From Oct 2018 to Apr 2021, prospective surveillance of adults ≥50 years old admitted with ARI or COPD/CHF exacerbations at any age was conducted at two Atlanta hospitals. Adults were eligible if they lived within an eightcounty region around Atlanta and if their symptom duration was < 14 days. In the seasons from Oct 2018 to Mar 2020, asymptomatic adults ≥50 years old were enrolled as controls. Standard of care test results were included and those enrolled contributed nasopharyngeal swabs that were tested for respiratory pathogens using BioFire® FilmArray® Respiratory Viral Panel (RVP). Results. During the first two seasons, 1566 hospitalized adults were enrolled. Rhinovirus was detected in 7.5% (118) and influenza was detected in 7.7% (121). Rhinovirus was also detected in 2.2% of 466 healthy adult controls while influenza was detected in 0%. During Season 3, the peak of the COVID-19 pandemic, influenza declined to 0% of ARI hospitalizations. Rhinovirus also declined (p=0.01) but still accounted for 5.1% of all ARIs screened (Figure 1). Rhinovirus was detected at a greater rate in Season 3 than in asymptomatic controls in the first 2 seasons (p=0.008). In the first two seasons, Influenza was detected in 8.6% (24/276) of those admitted to the ICU. Rhinovirus was detected in 6.1% (17/276) of those admitted to the ICU but declined to 3.1% (8/258) in Season 3. Conclusion. Dramatic declines occurred in influenza in adults hospitalized with ARI, CHF, or COPD in Atlanta during the COVID-19 pandemic and with enhanced public health measures. Although rhinovirus declined during the COVID-19 pandemic, it continued to be identified at a rate higher than in historical controls. Additional data are needed to understand the role of rhinovirus in adult ARI, CHF, and COPD exacerbations.

Physical and social distancing measures and child health behaviours during COVID-19: A cohort study

BACKGROUND: Various studies have examined the general impact of the COVID-19 outbreak on children's health behaviours. The impact of public health measures practised by children during COVID-19 is relatively unknown. OBJECTIVES: The primary objective was to determine the association between physical and social distancing measures and children's outdoor time, sleep duration, and screen time during COVID-19. DESIGN/METHODS: A longitudinal study using repeated measures of exposures and outcomes was conducted in healthy children (0 to 10 years) between April 14 and July 15, 2020. Parents were asked to complete questionnaires about isolation, physical distancing practices, and children's health behaviours. The primary exposure was the average number of days that children practised physical and social distancing measures per week. The three outcomes were children's outdoor time, total screen time, and sleep duration during COVID-19. Linear mixed effects models were fitted using repeated measures of primary exposure and outcomes. RESULTS: This study included 554 observations from 265 children. Physical and social distancing measures were associated with shorter outdoor time (-17.2;95% CI-22.07,-12.40;p < 0.001) and longer total screen time (11.3;95% CI 3.88, 18.79;p = 0.003) during COVID-19. The association with outdoor time was stronger in younger children (< 5 years), and the associations with total screen time were stronger in females and in older children (= 5 years). CONCLUSION: Physical and social distancing measures during COVID-19 have resulted in negative impacts on the health behaviours of Canadian children living in a large metropolitan area.

Venetoclax with Azacitidine or Low Dose Cytarabine As an Alternative to Intensive Chemotherapy in Fit Adults during the COVID19 Pandemic: Real World Data from the UK National Health Service

Background Based on early evidence of a high rate of coronavirus mortality in patients with acute myeloid leukaemia (AML) undergoing intensive chemotherapy (IC), the national health service (NHS) in the United Kingdom temporarily made venetoclax available as an alternative therapy, with the aim of reducing both mortality and healthcare resource use. From late April 2020, venetoclax was available to patients aged >16y with NPM1 mutation without FLT3 internal tandem duplication (ITD), patients aged >50y with NPM1, IDH1 or IDH2 mutations (regardless of FLT3 status) and patients aged >60y without favourable-risk cytogenetics. Venetoclax could be given with either azacitidine or low-dose cytarabine (LDAC), with the latter recommended mainly for patients with NPM1 mutation. We report a health-system-wide real world data collection for toxicity and patient outcomes across 65 NHS Hospitals. Methods Each patient was registered on a central NHS database. Clinicians certified that their patient met the above criteria, had not received previous AML treatment, and was fit for induction chemotherapy. Anonymised data were retrospectively collected by treating physicians. Venetoclax dose, duration and toxicity information was requested for the first 4 cycles of therapy. Response definitions were as per European Leukaemia Network (ELN) guidelines. A total of 870 patients have been registered on the scheme, with outcomes reported here for those with follow-up information at a data cut on 1st August 2021. Results There were 301 patients, median age 72y (range 34 - 90) with 62% male. The majority (81%) had an ECOG performance status of 0-1. AML was secondary to a previous haematological disorder in 33%, therapy-related in 10% and de novo in the remaining 57%. MRC cytogenetic risk was intermediate in 70% and adverse in 27%. NPM1 mutations were detected in 28% and FLT3-ITD in 12%. Next-generation sequencing results were available in 86% of patients, which detected mutations in IDH1 or IDH2 in 28%, ASXL1 in 20%, RUNX1 in 17% and TP53 in 12%. The ELN risk was favourable for 23%, intermediate for 30% and adverse for 44%. A majority received venetoclax in combination with azacitidine (85%), with the remaining 15% receiving LDAC. The LDAC cohort was enriched for de novo AML (76% vs 54%) and NPM1-mutated disease (56% vs 23%). Most patients (81%) followed the recommended initial schedule of venetoclax 100mg daily for 28 days in combination with posaconazole or voriconazole. Patients spent a median 14 days in hospital in cycle 1, then a median of 0 days for cycles 2-4. In cycles 1, 2, 3 and 4, the median number of days for recovery of neutrophils to >0.5x10 9/L was 33, 25, 24 and 14 respectively, and the median number of days to recovery of platelets to >50x10 9/L was 22, 3, 0 (no drop below 50) and 0. The composite complete remission (CR) / CR with incomplete haematological recovery (CRi) rate was 70%. MRD data is being collected. The best response was morphological leukaemia free state (MLFS) in 2%, partial remission in 7% and refractory disease in 11%. CR/CRi was higher in de novo (78%) compared to secondary AML (57%, p=0.02);NPM1 mutated (78% vs 67%, p=0.02) and IDH1/IDH2 mutated disease (85% vs 62%, p=0.02). ELN favourable risk patients had the highest CR/CRi rate (85%, intermediate 71%, adverse 60%, p=0.01). Median follow-up was 8.2 months (95%CI 7.8 - 9.0) with median overall survival (OS) 12.8 months (95%CI 10.9 - not reached). Mortality at day 30 was 5.7% and day 60 was 8.4%. 12-month overall survival was 51%, increasing to 71% in those who achieved CR/CRi. Survival was poorer in secondary (HR 1.9, p <0.01) and therapy-related AML (HR 2.1, p=0.02), better in NPM1 mutated (HR 0.6, p=0.02) and IDH mutated (HR 0.5, p=0.02) disease and poorer with TP53 mutation (HR 2.0, p=0.01). Overall survival did not differ for patients treated with LDAC compared to azacitidine (HR 1.1, p=0.7). Conclusion This large real-world study demonstrates CR/CRi and survival rates comparable to those reported in prospective clinical trials. Importantly, during t e COVID-19 pandemic, the adoption of venetoclax regimens permitted the great majority of treatment to be delivered as an outpatient with significant resource saving at a time of critically constrained inpatient resources. The data support prospective comparisons of venetoclax-based regimens to IC in fit adults with AML particularly in older patients with de novo AML, NPM1-mutated and IDH-mutated disease. [Formula presented] Disclosures: Belsham: Celgene: Other: meeting attendance;Abbvie: Other: meeting attendance. Khan: Abbvie: Honoraria;Astellas: Honoraria;Takeda: Honoraria;Jazz: Honoraria;Gilead: Honoraria;Novartis: Honoraria. Khwaja: Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Astellas: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Abbvie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Latif: Kite: Consultancy, Honoraria, Speakers Bureau;Jazz: Consultancy, Honoraria;Daiichi Sankyo: Consultancy, Honoraria;Novartis: Consultancy, Honoraria;Amgen: Consultancy, Honoraria;Abbvie: Consultancy, Honoraria;Astellas: Consultancy, Honoraria, Speakers Bureau;Takeda UK: Speakers Bureau. Loke: Pfizer: Honoraria;Amgen: Honoraria;Janssen: Honoraria;Novartis: Other: Travel;Daichi Sankyo: Other: Travel. Murthy: Abbvie: Other: support to attend educational conferences. Smith: ARIAD: Honoraria;Pfizer: Speakers Bureau;Daiichi Sankyo: Speakers Bureau. Whitmill: Daiichi-sankyo: Other: travel fees;EHA in stockholm: Other: conference support. Craddock: Novartis Pharmaceuticals: Other: Advisory Board;Celgene/BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding. Dillon: Shattuck Labs: Membership on an entity's Board of Directors or advisory committees;Jazz: Other: Education events;Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: educational events;Novartis: Membership on an entity's Board of Directors or advisory committees, Other: Session chair (paid to institution), Speakers Bureau;Menarini: Membership on an entity's Board of Directors or advisory committees;Astellas: Consultancy, Other: Educational Events, Speakers Bureau;Amgen: Other: Research support (paid to institution);Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Research Support, Educational Events.