COVID-19 remains prevalent in many communities and continues to pose major risks for those living in residential aged care. Frail older people are especially vulnerable to severe illness, hospitalisation or death from COVID-19 even when vaccinated. There is now compelling evidence that rapid access to oral antiviral medication can materially reduce the impact of COVID-19 on residents. Of all the treatment measures available to people in the community and in nursing homes, rapid access to oral antivirals could make the biggest difference to older people if they become infected with COVID-19.
Lagevrio® and Paxlovid® are oral antiviral treatments which can be used for residents in nursing homes who have tested positive to COVID-19 infection. Both medications are Schedule 4 Prescription Only Medicine, which means they have to be prescribed by a doctor. That is because they can have some serious side effects and can interact with other medicines.
In line with the latest evidence, people aged 70 years or older can be prescribed COVID-19 antiviral treatments when they test positive, regardless of whether they have other risk factors or even have any symptoms. People aged 50 years or older can also access these treatments when they reside in residential aged care. Medical assessment by a doctor is a prerequisite for any prescription of an antiviral medication.
Where clinically appropriate, the antiviral treatment should be offered to every resident within 24 hours of a positive test for COVID-19. The treatment should be commenced as soon as possible after a diagnosis of COVID-19 and at latest within 5 days of the onset of symptoms or a diagnosis.
People receiving oral antiviral treatments should be closely monitored for medication side effects.
While substantial advice has been provided to the aged care providers on proactive steps that a provider should take to ensure their readiness to respond to a COVID-19 outbreak, the Aged Care Quality and Safety Commission continues to find services that are underprepared. Among other negative impacts, this is compromising rapid access to treatment for affected residents.
It is imperative that any barriers to COVID-positive residents accessing oral antivirals as quickly as possible are identified and addressed by individual residential aged care providers without delay. Preparatory steps that providers should be taking now include:
- seeking advance consent from residents or their representatives for antiviral treatment in the event of contracting COVID-19
- lining up General Practitioners to assess positive residents at short notice for the purposes of prescribing an antiviral oral treatment
- confirming there is a supply of oral antivirals held at the service
The Aged Care Quality and Safety Commission has produced a Fact Sheet, on which this article is based. It sets out provider obligations in relation to facilitating early access to antiviral treatment for COVID-positive residents. The Fact Sheet is available at https://www.agedcarequality.gov.au/resources/covid-19-oral-antiviral-treatments-residential-aged-care-services . Use it to discuss your nursing home’s preparedness if they have not already advised you.