COVID antiviral treatments underused in nursing homes, study finds

Nursing homes were a key battleground during the COVID pandemic and prioritized for distribution of PPE, vaccines, and COVID testing kits. However, new research shows that monoclonal antibodies and oral antiviral drugs were not used in these facilities as much as would be expected given the high-risk of resident populations.

Brian McGarry, PhD, with the University of Rochester Medical Center, and collaborators at Harvard University, authored the new study, which appears today in JAMA. The authors examined data compiled by the Center for Disease Control and Prevention National Healthcare Safety Network, focusing on the 19-month period from May 2021 to December 2022, during which there were 763,340 reported resident COVID cases in 15,092 nursing homes in the US.

The authors note that all nursing home residents are at high risk for adverse outcomes due to COVID and may benefit from antiviral COVID treatments. However, the use of these drugs in nursing homes was low, a finding the researchers found particularly alarming as almost all nursing home residents meet current clinical guidelines to be considered for treatment. Specifically, the researchers found that:

• Just 18 percent of COVID cases in nursing homes received an antiviral treatment during the study period.
• Treatment rates only improved to 1 in 4 COVID cases after the authorization of oral treatments, which are much easier to administer and were widely available by the end of 2022.
• By the end of 2022, 40 percent of nursing homes reported that they had never used any of the antiviral treatments.
• Facilities with higher shares of Medicaid and non-white residents were less likely to use potentially life-saving antivirals, as were for-profit and lower quality facilities, likely contributing to disparities in COVID hospitalizations and deaths.

Additional co-authors include Benjamin Sommers, Andrew Wilcock, David Grabowski, and Michael Barnett with Harvard University. The study was supported with funding from the National Institute of Aging.