Study Finds Elderly Nursing Home Residents Lacked Access to Antiviral Treatments for COVID-19

Elderly and frail residents in nursing homes, who were at high risk for severe COVID-19 symptoms, did not receive adequate access to antiviral treatments, according to a study conducted by researchers at the University of Rochester and Harvard University. The study, published in JAMA and supported by funding from the National Institutes of Health and the National Institute on Aging, analyzed prescribing data reported to Medicare by nursing homes under special pandemic regulations.

The data revealed that only about 25 percent of nursing home residents with COVID-19 were prescribed any antiviral medication between May 2021 and December 2022. While the highly effective Paxlovid pill from Pfizer was readily available during this time, nursing homes fell short in administering the treatment to their patients. The researchers emphasized that nursing homes could have done better in providing the treatments, especially since the Paxlovid pill became widely available in the second quarter of 2022.

The study pointed out that earlier available monoclonal antibody treatments required more challenging administration methods, such as transfusions into the bloodstream. In comparison, Paxlovid, an antiviral tablet, proved to be more accessible yet highly effective, unlike another authorized antiviral tablet called Lagevrio from Merck.

“The massive underuse of Paxlovid, particularly in nursing homes, almost certainly led to a lot of avoidable mortality,” stated Michael Barnett, a clinician and professor of health management and policy at Harvard School of Public Health. In December 2021, when the FDA authorized Paxlovid, a key clinical trial demonstrated that the drug reduced the risk of hospitalization and death by 88 percent for individuals with high-risk factors, including the elderly and those with underlying medical conditions.

A more recent study, analyzing outcomes in a Veterans Affairs database, further supported Paxlovid’s efficacy, showing a 47 percent reduction in the risk of death and a 24 percent reduction in the risk of hospitalization. The study’s researchers also acknowledged that some clinicians may have been unfamiliar with antiviral treatments during the study period, while patients may have been discouraged by reports of COVID-19 “rebound” following initial treatment.

The nursing home industry trade association acknowledged that facilities faced challenges concerning supply and physician guidance for prescribing these medications. David Gifford, chief medical officer for the American Health Care Association and National Center for Assisted Living, emphasized the need for clear guidance from public health officials and urged prioritization of the nation’s most vulnerable, especially the elderly.

Paxlovid was authorized by the FDA for individuals at high risk of severe COVID-19 symptoms, including the elderly and those with obesity, diabetes, and other serious conditions. The treatment requires a three-pill dose taken twice a day for five days, starting within five days of symptom onset. Although there are some downsides, such as pills that are large and leave a metallic taste in the mouth, and common side effects like diarrhea, the researchers argued that temporarily pausing blood thinners for a few days during a course of Paxlovid could significantly reduce the risk of death or hospitalization from COVID-19.

The study also found that facilities with affiliated geriatricians and nonprofit organizations performed better in administering antiviral treatments to infected residents, indicating a potential knowledge gap in certain locations. Additionally, residents on Medicaid and non-White residents received the drugs at lower rates. The analysis further revealed that 40 percent of nursing homes reported that none of their residents received antiviral medications, highlighting the need for clinicians to stay up-to-date with guidelines and addressing disparities in accessing high-quality providers.

Overall, the study shed light on the inadequate access to antiviral treatments for elderly nursing home residents with COVID-19. The researchers emphasized the importance of prioritizing the vulnerable population and providing clear guidance to healthcare professionals during a pandemic like COVID-19. Efforts to improve access to effective treatments like Paxlovid could potentially save lives and reduce the burden of severe illness in nursing homes.