The White House is urging nursing home clinicians to make COVID-19 prevention and treatment drugs a more routine part of clinical care, as older adults continue to face an outsized risk for severe disease, and nursing homes are increasingly the place of COVID-19 death.
Although COVID-19 mortality has fallen overall, older adults make up an increasing share of deaths, with rates growing from 24% in January to 40% in September among those aged 65 and older. Currently that group accounts for 90% of all deaths, and adults aged 75 and older account for 70% of all deaths.
In addition, inpatient hospital deaths have fallen from 62% in 2021 to 53% in 2022 in adults aged 75 years and older. At the same time, more of these deaths have shifted from hospitals to nursing homes, decedent’s homes and hospices, according to Thomas Tsai, MD, MPH, Senior Policy Advisor for the White House COVID-19 Response Team.
“Nursing homes are on the front lines of not just preventing COVID, but also increasingly of treating COVID-19 as well,” said Tsai, in a Centers for Medicare & Medicaid Services stakeholder call late last week.
Clinician awareness
To help curtail these trends and prepare for an expected uptick of COVID-19 this winter, federal officials want to increase awareness among nursing homes’ clinical leaders on the availability of treatments that can significantly halt the progression of the disease in those most at risk of severe symptoms. Officials are encouraging the use of the antiviral pills Paxlovid (nirmatrelvir/ritonavir) and Lagevrio (molnupiravir), which can cut the risk for severe disease if administered within a five days of symptom onset.
The administration and the COVID Response Team is launching a broad effort across the U.S. government to increase clinical awareness of the latest data Paxlovid’s efficacy, updated data showing that rebound symptoms do not lead to any severe outcomes and of potential drug-drug interactions, he said.
“Our job is to make access to these treatments such as Paxlovid and Lagevrio no longer extraordinary, but part of ordinary, routine high-quality clinical care that is delivered every day in nursing home facilities and long-term care settings,” he said.
Tsai encouraged clinicians to treat COVID-19 patients based on risk factors and treatment indications, without delay, to prevent hospitalization and severe symptoms.
Supplies of antivirals, antibodies
There is an ample supply of authorized and approved COVID-19 therapeutics and preventive drugs in pharmacies nationwide, added Meg Sullivan, chief medical officer, of the Administration for Strategic Preparedness and Response (ASPR).
“We want to have healthcare providers to feel confident in talking to patients about them,” Sullivan said.
In addition to Paxlovid and Lagevrio, the antibody bebtelovimab, indicated for patients with mild-to-moderate disease, remains readily available, even as it transitions to the commercial market, Sullivan said. The preventive antibody Evusheld is plentiful as well, she added. It is recommended for immunocompromised patients and those who have had adverse reactions to vaccines, although it may not work well against the newest omicron variant, which recently accounted for more than 13% of cases.
Health officials are meanwhile working to build awareness among patients about the effectiveness and availability of Paxlovid, through advocates such as the AARP, Tsai said.
“We are in a different place this year, because we have [better] access to treatments. We have to use those treatments and our vaccines effectively” to care for COVID-19 patients and save lives, he said.
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