We, a group of medical professionals, researchers, patient representatives, and politicians, call for the UK government to commit to a reversal

Abstract Background Limited data and resources drove collaboration among healthcare providers treating COVID-19. In July 2021 a multi-disciplinary committee representing all facilities in Veterans Integrated Service Network (VISN) 9 developed COVID-19 guidelines for bacterial co-infection in hospitalized COVID-19 patients. We assessed the impact of these guidelines on appropriate antibiotic utilization (AU) in admissions for COVID-19. Methods AU in COVID-19 admissions to VISN 9 facilities from 08/01/20 to 08/31/21 (pre-guidelines) were reviewed and compared to 11/01/21 to 11/30/22 (post-guidelines). COVID-19 positivity, hospitalization, and AU data were pulled from the Corporate Data Warehouse. COVID-19-specific antibiotic stewardship (AS) interventions and guideline distribution plans were collected for each facility. A weighted random sample of patients from each facility who received antibiotics was chart reviewed for appropriateness of AU. AU for non-respiratory indications were excluded from analysis (Table 1). AU was considered appropriate if at least one guideline criteria was met (Table 2). Antibiotic appropriateness was compared before and after guideline distribution for each site using t-test. The odds of appropriate antibiotic prescribing in the VISN after guidance distribution was determined by logistic regression adjusted for site. Results Initial rates of antibiotic use varied among facilities both pre and post guideline distribution (Table 1). Facility-specific interventions and guideline distribution also varied (Table 3). There was no significant change in the frequency of appropriateness for any individual site. Similarly, the odds of AU appropriateness for the VISN was not significantly changed in the post-guideline period (p=0.7) (Table 4). Conclusion AU appropriateness did not change significantly after guidance distribution, likely due to a myriad of reasons. Reprioritization of AS programs’ focus in the post-guidance period may have shifted resources away from initiatives targeting AU in COVID-19 patients. Additionally, guidance was distributed mid-2021 potentially missing the window for largest impact. Collaboration can fill in gaps for many ASPs; but the success of any intervention is multifactorial. Disclosures Milner Staub, MD, MPH, Gilead: Stocks/Bonds|Johnson & Johnson: Stocks/Bonds

In simple view, the universe consists of coherent, organizational sentience that we can call Intelligence. This builds organizationally from sub-quantum through the cosmos. An axiom rather than a theory — this a priori millenia-old assumption provides fruitful means for fundamental advance in all scientific investigation. We re-posit and reinvigorate it, as a prelude to further work, with extensive consequences.