Unpublished Research Reveals Underutilization of COVID-19 Antiviral Medications in Nursing Facilities
In a recent study published in JAMA, researchers found that antiviral treatments for COVID-19 were significantly underutilized in nursing homes across the United States during the pandemic. The study, authored by Brian McGarry, PhD, and collaborators from the University of Rochester Medical Center and Harvard University, focused on data from the Center for Disease Control and Prevention National Healthcare Safety Network, covering a 19-month period from May 2021 to December 2022.
The study revealed that just 18% of COVID cases in nursing homes received antiviral treatment during the study period. This is particularly alarming considering that nearly all nursing home residents meet clinical guidelines to be considered for treatment. By the end of 2022, 40% of nursing homes reported that they had never used any antiviral treatments.
The researchers found that for-profit and lower quality facilities were less likely to use antivirals, contributing to disparities in COVID hospitalizations and deaths. Additionally, facilities with higher shares of Medicaid and non-white residents were less likely to use these potentially life-saving treatments.
Monoclonal antibodies and oral antiviral drugs were underutilized due to several key factors. Logistical challenges, limited awareness and infrastructure for administration, and complexities in timely diagnosis and treatment posed significant barriers.
Monoclonal antibodies require intravenous infusion in a clinical setting, which posed logistical barriers in nursing homes lacking the staff, equipment, or protocols to administer these treatments safely and promptly. The window for effective use is also narrow—early in infection—which requires rapid testing and diagnosis that was often difficult to achieve in these facilities.
Oral antivirals, while easier to administer, still required timely identification of eligible patients and awareness among healthcare providers of their availability and benefits. Initial limited supply, uncertainty or lack of clear evidence about effectiveness in the elderly population, and the complexity of coordinating treatment within the regulatory and reimbursement frameworks further complicated implementation of these therapeutics.
Staff shortages, high workload, and disrupted healthcare delivery systems in nursing homes further complicated the implementation of these treatments during the pandemic.
The study was supported with funding from the National Institute of Aging. Additional authors of the study include Benjamin Sommers, Andrew Wilcock, David Grabowski, and Michael Barnett with Harvard University.
It's important to note that all nursing home residents are at high risk for adverse outcomes due to COVID and may benefit from antiviral COVID treatments. The study found that monoclonal antibodies and oral antiviral drugs were not used in nursing homes as much as would be expected given the high-risk of resident populations. During the studied period, there were 763,340 reported COVID cases in 15,092 nursing homes in the US.
As we continue to combat COVID-19, it's crucial to address these barriers and ensure that antiviral treatments are made readily available to nursing home residents to reduce severe COVID-19 outcomes.
[1] McGarry, B., Wilcock, A., Sommers, B., Grabowski, D., Barnett, M., & et al. (2023). Underutilization of Antiviral COVID-19 Treatments in U.S. Nursing Homes. JAMA, 329(1), 55-64. doi:10.1001/jama.2022.35456
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