ABSTRACT
Background and aims: In humanitarian settings, access to specialists is limited or absent. The MSF telemedicine store and forward network provides a space for online discussion with different specialists. Complemented with specific planned sessions, real-time discussion can occur among all parties involved, facili-tating the resolution of complex cases. Method Since 2018, case discussion sessions for paediatric cases have been estab-lished between MSF and the paediatric hospital at the University Hospitals of Geneva (HUG). Cases are sent in advance via the telemedicine platform to the fellows who collect information, contact relevant specialists and prepare the summary. Results and discussion Close to 40 sessions have been held. Most cases have been resolved pos-itively for the patient despite their complexity and the lack of diagnos-tic/therapeutic means. The focus of the sessions remains to improve the patient condition. None-theless, they allow senior and junior doctors and medical students to be confronted with new or rare medical situations. They learn skills to pro-vide adapted medical advice for resource-limited and humanitarian set-tings. For some of them, it is a source of motivation to work in humanitar-ian contexts. From the project medical team's perspective: they become more efficient presenting and discussing clinical cases, which in turn helps their critical thinking during their clinical activities. A summary of recom-mendations is sent back to the project medical team after each discussion. Due to COVID-19, the sessions take place virtually. This change has al-lowed much wider and easier access to MSF medical staff in HQ, and in particular the project medical teams, but also to specialists from all over the world. Conclusion This model allows for the focused management of complex cases and has multiple benefits for patients, project medical teams, specialists and med-ical trainees. This model could be replicated in other areas of the HUG for other types of patients depending on project needs and requests.
ABSTRACT
OBJECTIVES: To evaluate longitudinally the persistence of humoral immunity for up to 6 months in a cohort of hospital employees with mild coronavirus disease 2019 (COVID-19). METHODS: We measured anti-RBD (receptor binding domain of viral spike protein), anti-N (viral nucleoprotein) and neutralizing antibodies at 1, 3 and 6 months after mostly mild COVID-19 in 200 hospital workers using commercial ELISAs and a surrogate virus neutralization assay. RESULTS: Antibodies specific for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) persisted in all participants for up to 6 months. Anti-RBD geometric mean concentrations (GMCs) progressively increased between months 1 (74.2 U/mL, 95%CI: 62.7-87.8), 3 (103.2 U/mL, 95%CI: 87.9-121.2;p < 0.001), and 6 (123.3 U/mL, 95%CI: 103.4-147.0;p < 0.001) in the whole cohort. Anti-N antibodies were detectable in >97% at all times. Neutralizing antibodies were detectable in 99.5% of participants (195/196) at 6 months post infection. Their GMC progressively decreased between months 1 (20.1 AU/mL, 95%CI: 16.9-24.0), 3 (15.2 AU/mL, 95%CI: 13.2-17.6;p < 0.001) and 6 (9.4 AU/mL, 95%CI: 7.7-11.4;p < 0.001). RBD-ACE2-inhibiting antibody titres and anti-RBD antibody concentrations strongly correlated at each timepoint (all r > 0.86, p < 0.001). Disease severity was associated with higher initial anti-RBD and RBD-ACE2-inhibiting antibody titres, but not with their kinetics. CONCLUSIONS: Neutralizing antibodies persisted at 6 months in almost all participants, indicating more durability than initially feared. Anti-RBD antibodies persisted better and even increased over time, possibly related to the preferential detection of progressively higher-affinity antibodies.