Antivirals and the military parachuted into a crisis-ridden elderly care sector

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With over 40% of residential facilities dealing with ongoing outbreaks, the military has been deployed and antivirals are being delivered. But will it be enough?

Australian Defense Force medical staff assess needs at an aged care facility in Frankston, Victoria. (Image: AAP)


At least 533 deaths have been recorded in the first five weeks of 2022 as a result of COVID-19 outbreaks in aged care facilities (RACFs).


According to the Department of Health (DoH), outbreaks are still raging in nearly 1,200 facilities in every state and territory outside Western Australia, and more than 9,700 residents are currently infected.


Complicating the situation further are a myriad of missed infection control spot checks, an insufficient supply of rapid antigen tests, and hundreds of thousands of residents who still haven’t received their vaccine boosters.


To help ease the burden, the DoH decided to pre-place molnupiravir (sold as Lagevrio), a new oral COVID-19 antiviral treatment, in RACFs across Australia.


But although there is some uncertainty about the effectiveness of the drug, RACGP chair Dr Karen Price said it was important that GPs ‘swiftly mobilized’ with their knowledge of new treatments .


“These new drugs help change the pace of the pandemic,” she said.


‘[Their introduction is] a good psychological message to the community to move forward in how we will deal with COVID-19.


‘Clinical decisions to weigh the pros and cons and who is most at risk of deterioration [from COVID-19] requires our leadership as GPs, to make the right decision and protect them as much as possible.


Dr. Price made the comments during a recent DoH Primary Care Information Session, which provided an introduction to antivirals, their use, prescribing, drug storage, dosage, contraindications. -indications, side effects and availability.


The webinar revealed that once a RACF resident is assessed and deemed eligible for antiviral treatments, GPs are asked to prescribe the pre-placed S4 drugs which are then dispensed in accordance with the medical regulations in their area. state or territory.


Provision of Lagevrio in RACFs should allow eligible patients immediate access once the prescription is issued, but facilities currently experiencing outbreaks should be given priority access to the drug.


These sites are expected to receive treatment courses starting this week and the following week, with the allocation of doses determined by the number of residents at each site, the residents who would be affected by the epidemic and the number of eligible residents. to the drug.


Chair of RACGP Care of the Elderly Special Interests, Dr. Khayyam Altaf believes that access to antivirals is an important breakthrough for populations most at risk of serious consequences from COVID-19, but said newsGP deployment should be carefully monitored.


“As COVID-19 becomes rampant, it cannot be forgotten that elderly residents remain vulnerable to this dangerous disease,” he said.


“Rapid antigen tests are limited in their accuracy and infection control controls do not guarantee protection from RACF.


“The introduction of antiviral treatment would be welcome, as long as there are adequate studies behind it and it is used appropriately.


‘[For example]older people may be more susceptible to the side effects of [these] antivirals, some of which may be more important than the disease itself.


Recommendations for ordering medication administration include if the patient:

  • has tested COVID-positive
  • has mild to moderate symptoms and does not need supplemental oxygen
  • can start treatment quickly and no later than five days after the onset of symptoms
  • meets any other eligibility criteria relating to vaccination and immunocompromised status.

The RACF then follows the normal processes and procedures it has in place for contacting the patient’s usual GP or after-hours department for a prescription.

RACFs can contact GPs via telehealth to make a clinical decision about treatment, the DOH confirmed, including via normal after-hours locum medical services working in partnership with the regular GP to determine if the treatment is appropriate.

However, during the webinar, Deputy Chief Medical Officer Professor Michael Kidd stressed that antiviral treatments are not a substitute for vaccines and advised that vaccination remains the best protection against COVID-19.

Currently, there is no evidence that the drugs are beneficial for people who have received a booster shot who are not immunocompromised.

The DoH has said the treatments could eventually be listed on the Pharmaceutical Benefits Scheme (PBS) to allow wider use and access for older and more vulnerable Australians, but has not yet announced a date.

Ground boots

In addition to residents, 6,541 staff members are also currently infected with COVID, leading to significant labor shortages that have forced military deployments to help manage the situation.

But while the aged care sector has widely welcomed the decision to deploy Australian Defense Force (ADF) aid, Dr Altaf has reservations.

“Without knowing the experience of our defense forces, it must be understood that elderly residents may have a number of complex medical conditions,” he said.

“Thus, ADF staff should be properly trained and appropriate support should be provided to them by senior care staff and experienced doctors.”

Dr Altaf also believes that GPs should remain involved in clinical decision-making and be at the forefront of all discussions related to the management of RACF.

“GPs remain independent and continue to work with RACF staff to provide the best care for their patients,” he said.

“Support will be continually needed to access services for their patients, in particular there is a lack of easily accessible pain management, physiotherapy and mental health services.

“The RACGP and the GP body are best placed to advise based on our frontline management experience.”

In addition to the DoH online seminar registration, a fact sheet is available which has been distributed to all RACFs, together with an overview of the Recommendations from the National COVID-19 Clinical Evidence Task Force for using Lagevrio.

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