As of July 27, 2022, over half of the 342 skilled nursing facilities (SNFs) in LA County are experiencing active COVID-19 outbreaks, which is the highest level of transmission since the surge last winter. All patients in SNFs are at high risk for progressing to severe COVID-19 if infected. Fortunately, there are now outpatient COVID-19 treatments such as oral antivirals that are easy to administer and can reduce the risk of poor outcomes, including hospitalization and death. Despite the wide availability of oral antivirals, they continue to be underutilized in the nursing home population. To close this crucial gap and significantly improve outcomes in this vulnerable population, Los Angeles County Department of Public Health issued an update on July 25, 2022 to the Order of the Health Officer for Control of COVID-19: Prevention of COVID-19 Transmission in Skilled Nursing Facilities requiring all SNF patients with a positive SARS-CoV-2 viral test to be immediately assessed by their healthcare provider for any symptoms of COVID-19. Oral COVID-19 antivirals should be initiated at the facility within 5 days of symptom onset if clinically appropriate, i.e., they have mild or moderate symptoms and there are no contraindications. Please do not transfer residents to hospitals solely for treatment of mild or moderate COVID-19. These residents should be treated at their SNF. Even if you are not practicing in Los Angeles County, CALTCM agrees that all PALTC medical directors, attending physicians and practitioners should evaluate every case of COVID for the potential ordering of therapeutics including Paxlovid.  Please work with SNFs where you provide care to help meet this recommendation and provide optimal care for your patients.

For more resources on oral COVID-19 antivirals, please see the following:

• LAC DPH COVID-19 Outpatient Therapeutics: ph.lacounty.gov/covidtherapeutics   
• IDSA COVID-19 Outpatient Treatment Guidelines: https://www.idsociety.org/covid-19-real-time-learning-network/covid-19-outpatient-treatment--guidelines-roadmap/ 
• Liverpool COVID-19 Drug Interactions website: https://www.covid19-druginteractions.org/ 
• Paxlovid (ritonavir-boosted nirmatrelvir)
• FDA’s Fact sheet for health providers: https://www.fda.gov/media/155050/download 
• FDA’s PAXLOVID Checklist Tool for Prescribers: https://www.fda.gov/media/158165/download 
• LAC DPH’s Paxlovid Prescribing Provider Tool (can be used by pharmacists):http://publichealth.lacounty.gov/acd/ncorona2019/docs/PaxlovidScreeningandAssessmentForm.docx
• Lagevrio (molnupiravir):
• FDA’s Fact sheet for health providers: https://www.fda.gov/media/155054/download
• FDA’s Molnupiravir Checklist Tool for Prescribers: https://www.fda.gov/media/155118/download