ABSTRACT
Aim: The PINETREE study showed benefit of remdesivir in non-hospitalised COVID patients. This became the evidence base for the NHSE policy on antivirals use in hospital-onset COVID patients. However, there are differences between PINETREE inclusion criteria and NHSE policy eligibility criteria, and PINETREE was conducted when Delta was dominant. We describe attributes, risk stratification and outcomes in hospital-onset COVID patients when Omicron is dominant. Method(s): A retrospective analysis of patients testing COVID +ve post-admission over 30 days at two district hospitals, collecting risk factors as defined by the QCovid model, and outcomes including days on/off oxygen, survival/discharge at 28 days, and whether antivirals were considered/given. Result(s): 68 eligible cases were identified. CV followed by respiratory diseases were the commonest risk factors. In the 28 days after a +ve test, 31% required supplemental oxygen and 16% died. Being male, and having CV disease, active solid malignancy and recent chemo/radiotherapy were over-represented in patients who died. Supplemental oxygen was associated with significantly higher 28-day mortality risk (43% v 4.3%). Average age of those who died was higher than the overall cohort (84 v 75y). 28-day mortality rates for those who received 1, 2 and 3 COVID vaccines were 60%, 21% and 5% respectively. 18 patients met criteria for highest risk group and were eligible for antivirals. Only 11% were considered for antivirals. Conclusion(s): Despite the milder omicron variant and high vaccination rate, hospital-onset COVID is associated with worse outcomes compared to community clinical trials. The lack of antivirals use according to NHSE criteria should push MDTs to consider a validated risk model for antivirals use.