COVID-19 and sotrovimab: The Moree experience

Jennie Broughton    Brianna Joseph    Sharlene Williams    June Conners    Julie Evans    Mark Loewenthal   
doi: 10.31128/AJGP-COVID-51-6   |    Cite this article    BIBTEX    REFER    RIS


The beginning of November 2021 saw Moree Plains, the traditional country of the Kamilaroi/Gamilaraay/Gomeroi People, have the highest number of COVID-19 cases per 100,000 population in NSW. Moree remained ranked first or second for cases for the next four weeks.1 The double vaccination rate was low, being <80% for the general population and approximately 60% for the Aboriginal and Torres Strait Islander population.2 In November 2021, the only early treatment for non-hospitalised patients with COVID-19 at risk of severe disease was sotrovimab. This is an intravenous monoclonal antibody associated with an 85% relative risk reduction in the likelihood of hospitalisation or death if given within five days of symptom onset.3

Moree District Health Service (MDH) is 665 km northwest of Sydney, servicing a population of 12,750, 20% identifying as Aboriginal or Torres Strait Islander. MDH comprises a general practitioner (GP)-run 33-bed hospital and community health service with visiting non-GP specialists. The hospital can offer maximal respiratory support of short-term ventilation, the nearest intensive care unit (ICU) being 270 km away in Tamworth. Within town there is an Aboriginal Health Service (Pius X), an Aboriginal and Torres Strait Islander youth centre (Miyay Birray Youth Service) and two general practices. During the outbreak, these services helped with testing, vaccination, welfare, accommodation and social support services.

In 2021, direct care of patients with COVID-19 was limited to specific services. For the Moree Plains local government area, this was MDH and COVID Care in the Community (CCitC) in Newcastle. CCitC is a virtual clinician-led (doctors/registered nurses/allied health professionals) service of Hunter New England Local Health District (HNELHD), that assessed and managed all COVID-19 outpatients in the HNELHD. MDH was tasked with the local response to the outbreak, including identifying, locating, isolating, supporting and monitoring patients with COVID-19. They also had to rapidly implement an early treatment program to identify, seek consent from and safely transport people eligible for sotrovimab. Additionally, MDH needed to create mobile and static COVID-19 testing, deliver oximetry/care packages and staff a COVID-19-safe infusion lounge.

The first week saw all but essential MDH acute and community services turn to the COVID-19 outbreak. Staff upskilled to the tasks before them.

Six Aboriginal and Torres Strait Islander Health Workers from MDH were the backbone of locating people within family networks, supplying phones as needed and communicating, in appropriate language, the available treatment options. They offered support both during and out of hours. The fact that these health workers were respected and knowledgeable members in the community was crucial in enabling the rapid response and subsequent high uptake of sotrovimab, which rose further as word spread among community networks of symptom improvement with sotrovimab treatment.

MDH adjusted wards and increased and adapted work hours to suit community needs, with sotrovimab services running from 10:00 am to 6:00 pm. Local services were stretched within a week. HNELHD responded, sending COVID-19-trained staff and transport drivers/vehicles. Private pathology supplied rapid polymerase chain reaction testing equipment. CCitC managed outpatients virtually, assessing risk of severity and treatment and reviewing clinical condition daily until day 14, escalating care as needed.

Sotrovimab eligibility was established daily with morning meetings between MDH clinicians and CCitC doctors. CCitC sought consent from eligible patients with assistance from Aboriginal and Torres Strait Islander Health Workers. Within two days of the initial case being identified, the first sotrovimab infusion was administered. Between 4 November 2021 and 1 December 2021, sotrovimab was administered to 35 people, 34 of whom identified as Aboriginal or Torres Strait Islander.4 During this period, 18.6% of patients with COVID-19 received sotrovimab.4

The outcome of this rapid and coordinated effort was that during this period, there were no deaths from COVID-19, no ICU admissions and only two transfers to Tamworth Hospital, the tertiary referral hospital for this region.4

In late 2021, sotrovimab was known to be effective in preventing progression of COVID-19 Delta variant, but timely administration is essential. In a remote rural setting with high numbers of at-risk patients and limited resources, this requires a coordinated approach on several levels. In this case, MDH, local Aboriginal and Torres Strait Islander Health Workers and the wider networks were tireless and skilful in their engagement with the local community and likely prevented hospitalisations and deaths. Although sotrovimab is no longer the treatment of choice, the pathways developed in Moree illustrate the importance and impact of community ownership and leadership for effective delivery of a public health intervention.

First published 28 November 2022.

Competing interests: None.
Provenance and peer review: Not commissioned, peer reviewed.
Funding: None.
Citation: Broughton J, Joseph B, Williams S, Conners J, Evans J, Loewenthal M. COVID-19 and sotrovimab: The Moree experience. Aust J Gen Pract 2022;51 Suppl 6. doi: 10.31128/AJGP-COVID-51-6.
Correspondence to:
  1. NSW Health. COVID-19 weekly surveillance in NSW. Epidemiological weeks 44 & 45 – Table 5b, Epidemiological week 46 & 47 – Table 7b. St Leonards, NSW: NSW Ministry of Health, 2022. Available at [Accessed 31 May 2022]. Search PubMed
  2. Australian Government, Department of Health and Aged Care. COVID-19 vaccination – Geographic vaccination rates – LGA – Indigenous population. Canberra, ACT: Commonwealth of Australia, Department of Health and Aged Care, 2021. Available at [Accessed 31 May 2022]. Search PubMed
  3. Gupta A, Gonzalez-Rojas Y, Juarez E, et al; COMET-ICE Investigators. Early treatment for Covid-19 with SARS-CoV-2 neutralizing antibody sotrovimab. N Engl J Med 2021;385(21):1941–50. doi: 10.1056/NEJMoa2107934. Search PubMed
  4. Hunter New England Local Health District. Data extracted from HNE Health clinical data base (Authorisation Number AU202205-01). New Lambton, NSW: HNELHD, 2021. Search PubMed

Aboriginal and Torres Strait Islander healthCoronavirusCOVID-19MoreeSotrovimab