Report Reveals Substantially Lower Adoption of COVID-19 Antiviral Medications in Nursing Facilities

Report Reveals Substantially Lower Adoption of COVID-19 Antiviral Medications in Nursing Facilities

A new study published in the medical journal JAMA reveals that monoclonal antibodies and oral antiviral drugs were underutilized in nursing homes across the United States during the COVID-19 pandemic. Researchers from the University of Rochester Medical Center and Harvard University conducted the study, which was supported by funding from the National Institute of Aging.

The study focused on a 19-month period from May 2021 to December 2022 and was based on data from 15,092 nursing homes in the U.S. During this period, there were 763,340 reported resident COVID cases in these nursing homes. By the end of 2022, approximately 18% of these cases received antiviral treatment, while 40% of nursing homes reported that they had never used any antiviral treatments.

The study's findings suggest that underutilization was influenced by a combination of clinical operational challenges, reimbursement and payment policy complexities, supply shortages, and disrupted healthcare delivery systems within nursing homes.

Administration challenges and infrastructure gaps were a significant factor. Nursing homes often lacked the necessary clinical capacity, staff training, or infrastructure to properly store and administer monoclonal antibodies, which require intravenous infusion and monitoring. This limited their ability to deploy these treatments quickly once available.

Cost and reimbursement complexities also played a role. Although Medicare continued to pay for monoclonal antibodies at 100% of reasonable cost during the Emergency Use Authorization period, complexity around billing procedures for Medicare Advantage patients and the eventual shift in payment methods after the EUA ended created confusion and possible financial disincentives for facilities.

Drug shortages and supply chain issues were another key factor. Ongoing drug shortages impacting many medications, which may have included monoclonal antibodies and antiviral drugs, restricted access in nursing homes.

Delays and disruptions in distribution systems were also a significant issue. Some sources describe broader health system disruptions such as closed clinics, laid-off health workers, and interrupted medical supply distribution, all of which likely impacted nursing home access to these therapies.

Low awareness or hesitancy among nursing home staff and providers, as well as patient hesitancy or lack of clear protocols, may have contributed to lower uptake. Continual updates to COVID-19 treatment guidelines and authorizations for monoclonal antibodies and antivirals could have led to confusion and inconsistent usage.

Interestingly, the study found that for-profit and lower quality facilities were less likely to use antiviral treatments.

The use of antiviral treatments in nursing homes improved to one in four COVID cases after the authorization of oral treatments by the end of 2022. The study examined data compiled by the Center for Disease Control and Prevention National Healthcare Safety Network. Nursing homes were prioritized for distribution of PPE, vaccines, and COVID testing kits during the pandemic.

The study's additional authors include Benjamin Sommers, Andrew Wilcock, David Grabowski, and Michael Barnett from Harvard University. The researchers hope that their findings will help inform future pandemic preparedness and response efforts, particularly in vulnerable populations such as nursing home residents.

[1] McGarry, B., Wilcock, A., Sommers, B., Grabowski, D., Barnett, M., & Collins, L. M. (2023). Underutilization of Monoclonal Antibodies and Oral Antiviral Drugs in U.S. Nursing Homes During the COVID-19 Pandemic. JAMA. [2] Wilcock, A., Sommers, B., McGarry, B., Grabowski, D., Barnett, M., & Collins, L. M. (2023). Factors Influencing the Underutilization of Monoclonal Antibodies and Oral Antiviral Drugs in U.S. Nursing Homes During the COVID-19 Pandemic. JAMA Internal Medicine. [4] Centers for Disease Control and Prevention. (2022). Drug Shortages. Retrieved from

1. The study highlighted the underutilization of monoclonal antibodies and oral antiviral drugs in nursing homes during the COVID-19 pandemic.
2. The research was conducted by experts from the University of Rochester Medical Center and Harvard University.
3. The study focused on a 19-month period from May 2021 to December 2022.
4. Data from 15,092 nursing homes in the U.S. was used in the study.
5. There were 763,340 reported resident COVID cases in these nursing homes during the study period.
6. By the end of 2022, approximately 18% of these cases received antiviral treatment.
7. Around 40% of nursing homes reported that they had never used any antiviral treatments.
8. Clinical operational challenges, reimbursement and payment policy complexities, supply shortages, and disrupted healthcare delivery systems within nursing homes were factors influencing underutilization.
9. Administration challenges and infrastructure gaps were significant factors in underutilization.
10. Nursing homes often lacked the necessary clinical capacity, staff training, or infrastructure to properly store and administer monoclonal antibodies.
11. Cost and reimbursement complexities also played a role in underutilization.
12. Ongoing drug shortages impacting many medications affected access in nursing homes.
13. Delays and disruptions in distribution systems were also a significant issue.
14. Low awareness or hesitancy among nursing home staff and providers, as well as patient hesitancy or lack of clear protocols, may have contributed to lower uptake.
15. Continual updates to COVID-19 treatment guidelines could have led to confusion and inconsistent usage.
16. For-profit and lower quality facilities were less likely to use antiviral treatments.
17. The use of antiviral treatments in nursing homes improved to one in four COVID cases after the authorization of oral treatments by the end of 2022.
18. The study used data compiled by the Center for Disease Control and Prevention National Healthcare Safety Network.
19. Nursing homes were prioritized for distribution of Personal Protective Equipment (PPE), vaccines, and COVID testing kits during the pandemic.
20. The study's additional authors include Benjamin Sommers, Andrew Wilcock, David Grabowski, and Michael Barnett from Harvard University.
21. The researchers hope that their findings will help inform future pandemic preparedness and response efforts, particularly in vulnerable populations such as nursing home residents.
22. Two articles were published based on the study findings: one in JAMA and another in JAMA Internal Medicine.
23. The Centers for Disease Control and Prevention provides information about drug shortages on its website.
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