Paxlovid, an antiviral used to treat COVID-19
Credit: Rafmaster/Getty Images
Paxlovid, an antiviral used to treat COVID-19
Credit: Rafmaster/Getty Images

Just 18% of COVID cases in nursing homes were treated with antiviral medications, and the rate increased only slightly after oral treatments were approved, according to new research. 

“Nursing home residents are at elevated risk for severe infection from SARS-Cov-2, making them a priority for antiviral treatment,” study authors wrote. “Although use of oral antivirals was found to be greater in nursing homes than the community, overall take-up has been low and use among nursing home residents may not be commensurate with their elevated risk.”

Lead study author Brian McGarry, PhD, told McKnight’s Long-Term Care News that the most unexpected news was that a huge portion of skilled nursing operators did not use antiviral therapies at all.

“Most surprising, we found that by the end of 2022, 40% of nursing homes reported that they had never used any of the antiviral treatments,” McGarry said. “This is alarming, as almost all nursing home residents meet the current clinical guidelines to be considered for treatment.”

The research, Treatment of SARS-CoV-2 Infection in U.S. Nursing Homes, 2021-2022, was published Friday in JAMA. It also found that nursing homes with significant populations of non-White residents and Medicaid recipients were less likely to administer antiviral treatments for COVID.

McGarry acknowledged that the research raises more questions than it answers. He said he and his colleagues hope it stirs conversation among policy- and other decisionmakers about the effectiveness of treatments and the approach toward COVID long-term, particularly in facilities with large populations of Medicaid patients. 

“It’s an important transition moving away from the state of emergency and assimilating this into how we manage [COVID] in the day-to-day standard of care for nursing home residents,” McGarry told McKnight’s Long-Term Care News on Friday, adding that providers and others should approach COVID similar to how the flu and other respiratory illnesses are managed. 

“They can go into it without the fear and the heavy dose of COVID fatigue.”

Antivirals use a sticky issue

McGarry noted that nursing home residents’ vaccinations rates and indications that fewer residents are getting sick are positive news but suggested that access to prescribers or treatments such as oral antivirals could be outstanding issues. 

There have been approximately 1.7 million confirmed cases of COVID among nursing home residents with 167,183 deaths reported, according to the Centers for Medicare & Medicaid Services. For the week ending July 2, the agency reported that 61.4% of nursing home residents were up-to-date with vaccines. Ninety-five percent of people aged 65 or older in the US reported receiving at least one vaccine dose with 43.4% also receiving a booster as of May 11, according to the Centers for Disease Control. 

Those rates are higher than the population as a whole and significantly higher than for nursing home staff. CMS reports that just 24.9% of facility staff are up-to-date with the vaccine series while 81.4% of the US population has received at least one dose, per the CDC.

There were 763,340 cases of COVID among nursing home residents during the study period, but 136,066 residents — or 17.8% — were treated, according to the research. In 2022, monoclonal antibodies were the dominant treatment for COVID but by the end of the year, oral antivirals such as Paxlovid were becoming more prominent. Still, the authors noted that 41% of facilities reported not using any antiviral treatments by the end of last year. 

The study found seven facility characteristics to be associated with the use of antivirals, including profit status, quality ratings, staffing ratios, vaccination rates, and the presence of an affiliated geriatrician.

“The associations between facility characteristics such as profit-status, affiliation with a geriatrician, and non-White and Medicaid resident shares suggest that structural barriers may be contributing to underuse,” the authors wrote. 
McGarry is affiliated with the Department of Medicine at the University of Rochester. The other researchers are: Benjamin D. Sommers, MD, PhD; and Michael L. Barnett, MD, MS, of the Department of Health Policy and Management at Harvard University’s T.H. Chan School of Public Health; and Andrew D. Wilcock, PhD, and David C. Grabowski, PhD, both of the Department of Health Care Policy at Harvard Medical School.