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. 2024 Feb;25(2):290-295.
doi: 10.1016/j.jamda.2023.10.003. Epub 2023 Nov 6.

Underuse of SARS-CoV-2-Neutralizing Monoclonal Antibodies in Skilled Nursing Facilities

Catharine I Paules  1 , Nicole Osevala  2 , Erik Lehman  3 , Emily S Heilbrunn  4 , Erica Francis  4 , R Ellen Hogentogler  4 , Lan Kong  3 , Jennifer L Kraschnewski  5
Affiliations

Underuse of SARS-CoV-2-Neutralizing Monoclonal Antibodies in Skilled Nursing Facilities

Catharine I Paules et al. J Am Med Dir Assoc. 2024 Feb.

Abstract

Objective: Little is known about deployment of SARS-CoV-2-neutralizing monoclonal antibodies (mab) in skilled nursing facilities (SNFs), a high-risk population for COVID-19-related complications. We assessed the utilization of mabs in SNFs and identified facility characteristics associated with effective use.

Design: Retrospective cohort study assessing the correlation of SNF characteristics with increasing mab use.

Setting and participants: United States SNFs participating in Project ECHO (Extensions for Community Health Outcomes).

Methods: The primary outcome was percentage of total mabs per COVID-19 cases in SNFs. Facilities were divided into 3 groups based on the percentage of the administration of mabs per number of cases: 0%, >0% to 20%, >20%. Ordinal logistic regression was applied to assess whether facility characteristics-study group, state, location, type, size, rating at baseline, weekly average of residents vaccinated, weekly average of staff vaccinated, and total weeks short staffed-correlated with the primary outcome. A multivariable model was used to evaluate the independent effect of predictors.

Results: A total of 130 facilities were included. Between the weeks ending on May 30, 2021, and on May 29, 2022, mean mab use when accounting for the number of COVID-19 cases was 12.96% (±26.71%) and >50% of facilities administered 0 doses of mabs. Facility location was associated with mab use (P value .030), with micropolitan facilities having the highest percentage of facilities administering mabs (30.4% in >0% to 20%, and 39.1% in >20%, respectively). There was a nonsignificant trend toward increased mab use in facilities reporting fewer staffing shortages. When the multivariable ordinal logistic regression model was applied, location in a micropolitan vs metropolitan area was associated with higher odds [3.29 (1.30, 8.32), P value .012] of increasing percentage total mabs per cases.

Conclusions and implications: COVID-19 mabs were underutilized in a high-risk population for COVID-19 hospitalization and death. Understanding the barriers to effective distribution is critical in shaping pandemic preparedness efforts for the future.

Keywords: COVID-19; monoclonal antibodies; skilled nursing facilities.

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Conflict of interest statement

Disclosure The authors declare no conflicts of interest.

Figures

Figure 1:
Figure 1:
Potential Barriers to Monoclonal Antibody Deployment in Skilled Nursing Facilities Abbreviations: Skilled nursing facility (SNF), Monoclonal antibody (mab), Special Projects for Equitable and Efficient Distribution (SPEED), Infectious Diseases (ID)
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