18% of nursing home residents with COVID-19 received antivirals during the pandemic

Key points to remember:

• Nursing facilities with more nonwhite and Medicaid residents were less likely to administer antivirals to patients with COVID-19.
• More than 40% of nursing homes reported never administering antivirals.

Despite being at higher risk for adverse COVID-19-related outcomes, only one in four nursing home residents with COVID-19 received antiviral therapy from May 31, 2021 through the end of 2022, the researchers found.

Brian E. McGarry, PT, PhD, assistant professor in the department of medicine at the University of Rochester Medical Center, and his colleagues wrote in Open JAMA Network nursing home residents are a priority for antiviral treatment for COVID-19 due to their high risk of serious infection.

“Although use of oral antivirals was found to be higher in nursing homes than in the community, overall usage among nursing home residents was low and may not be proportional to the residents’ elevated risk,” the researchers wrote.

They added that there are several barriers to providing antiviral treatment in nursing homes, “including access to treatment, often modification of authorizations and recommendations on the use of monoclonal antibodiespatient and physician preferences, unfamiliarity with these drugs, and treatment costs.

Using data from the CDC’s National Healthcare Safety Network Nursing Home COVID-19 Database, McGarry and colleagues assessed trends in COVID-19 treatment rates in nursing homes from May 31, 2021 through December 25, 2022.

During the study period, there were 763,340 resident cases of COVID-19 in 15,092 nursing homes, with 136,066 residents treated for COVID-19.

The overall antiviral treatment rate was 17.8% (95% CI, 17.4-18.3) throughout the study period. The mean rate increased to 24.5% (95% CI, 23.2-25.7) over the past 6 weeks. The moving average treatment rate peaked at 32.7% (95% CI, 30.5-34.8) on November 21, 2021.

The researchers noted that 61.1% of treatments in 2022 were Paxlovid (nirmatrelvir-ritonavir, Pfizer) and 18.2% Lagevrio (molnupiravir, Merck).

There has been a steady increase in the percentage of nursing homes that have previously administered antivirals for COVID-19; however, McGarry and colleagues found that 41% still reported no use at the end of 2022.

Several factors were linked to higher odds of facility use of antivirals, including:

• larger bed sizes;
• higher overall quality scores;
• an affiliated geriatrician;
• higher vaccination rates for residents and staff; And
• the average age and acuity of residents are higher.

In contrast, for-profit facilities and those with higher shares of Medicaid and nonwhite residents were less likely to use antivirals.

The study was limited by its observational design which prevented informal interpretation by the researchers. In addition, eligibility for treatment at the resident level could not be determined.

McGarry and his colleagues concluded “that structural barriers can contribute to underutilization and disparities” in COVID-19 antiviral treatment in nursing homes.

The references:

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