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Antivirals and military parachuted in as aged care struggles with Omicron


Morgan Liotta


9/02/2022 4:53:55 PM

With more than 40% of residential facilities managing ongoing outbreaks, the military has been deployed and antivirals are being delivered. But how much help will they provide?

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

At least 533 deaths were recorded in the first five weeks of 2022 as a result of COVID-19 outbreaks in residential aged care facilities (RACFs).
 
According to the Department of Health (DoH), outbreaks are still raging across nearly 1200 facilities in every state and territory outside of Western Australia, and more than 9700 residents are currently infected.
 
Complicating the situation further are a myriad of missed infection control spot checks, insufficient supplies of rapid antigen tests, and hundreds of thousands of residents still to receive their vaccine boosters.
 
To help ease the burden, the DoH has moved to pre-place molnupiravir (sold as Lagevrio), a new COVID-19 antiviral oral treatment, into RACFs across Australia.
 
But while there is some uncertainty around the medication’s effectiveness, RACGP President Dr Karen Price said it is important for GPs to ‘get on board quickly’ with their knowledge of the new treatments.
 
‘These new medicines provide a change in the rhythm of the pandemic,’ she said.
 
‘[Their introduction is] a good psychological message to the community of moving forward in how we will treat COVID-19.
 
‘The clinical decisions of weighing up the benefits and harms 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 in a recent DoH primary care information session, which provided an introduction to the antivirals, how they are used, prescribing, storage of medicine, dosage, contraindications, side effects and availability.
 
The webinar revealed that once an RACF resident is assessed and deemed eligible for the antiviral treatments, GPs are requested to prescribe the pre-placed S4 drugs which are then dispensed in line with medical regulations in their state or territory.
 
The provision of Lagevrio in RACFs should allow eligible patients immediate access once the prescription has been issued, but facilities currently experiencing outbreaks are set to be given priority access to the medication.
 
These sites should receive treatment courses starting this week and next, with the allocation of doses determined by the number of residents at each site, what residents would be impacted by the outbreak and the number of residents eligible for the drug.
 
Chair of RACGP Specific Interests Aged Care Dr Khayyam Altaf believes access to antivirals is an important breakthrough for populations at greater risk of severe outcomes from COVID-19, but told newsGP the rollout needs to be carefully monitored.
 
‘As COVID-19 becomes endemic, it cannot be forgotten that aged care residents remain vulnerable to this dangerous disease,’ he said.
 
‘Rapid antigen tests are limited in their accuracy, and infection control checks are not a guarantee to protect RACFs.
 
‘The introduction of antiviral treatment would be welcome, as long as there are adequate studies behind them and they are utilised appropriately.
 
‘[For example], the elderly may be more susceptible to side effects from [these] antivirals, some of which can be more significant than the illness itself.’
 
Situations in which the medicines may be appropriate include if the patient:

  • has tested COVID-positive
  • has mild-to-moderate symptoms and no need for supplemental oxygen
  • can commence treatment quickly and no later than five days after the onset of symptoms
  • meets any other eligibility criteria relating to vaccination and immunosuppressed status.
RACFs can contact GPs via telehealth to make a clinical decision about treatment, the DOH has confirmed, including via normal after-hours medical deputising services working in partnership with the usual GP to determine if treatment is appropriate.
 
However, during the webinar, Deputy Chief Medical Officer Professor Michael Kidd emphasised that the antiviral treatments are not a substitute for vaccines, and indicated vaccination is still the best protection against COVID-19.
 
Currently there is no evidence the drugs are of benefit to people who have received a booster vaccine who are not immunosuppressed.
 
The DoH has said the treatments may eventually be listed on the Pharmaceutical Benefits Scheme (PBS) to enable wider use and access for older and more vulnerable Australians but is yet to announce a date.
 
Boots on the ground
In addition to residents, 6541 staff are also currently infected with COVID, leading to major workforce shortages that have forced military deployments to help manage the situation.
 
But while the aged care sector has broadly welcomed the move to deploy Australian Defence Force (ADF) assistance, Dr Altaf has reservations.
 
‘Without knowing the experience of our defence forces, it needs to be fully understood that aged care residents can have a number of complex medical conditions,’ he said.
 
‘So ADF personnel need to be adequately trained and appropriate support provided to them by experienced aged care staff and medics.’
 
Dr Altaf also believes GPs must remain involved in clinical decision making and be at the ‘forefront’ of all discussions related to managing RACFs.
 
‘GPs remain independent and continue to work with the RACF staff to provide the best care for their patients,’ he said.
 
‘Support will continually be required in order to access services for their patients, in particular there is a lack of pain management, physiotherapy and mental health services that are easily accessible.
 
‘The RACGP and the GP body are best placed to advise based on our experience of frontline management.’
 
In addition to the DoH webinar recording, a factsheet is available that has been issued to all RACFs, as well as an overview of the National COVID-19 Clinical Evidence Taskforce recommendations for the use of Lagevrio.
 
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aged care antivirals COVID-19 infection control RACFs


newsGP weekly poll What are appropriate public health measures should COVID cases spike and the healthcare system be placed under further pressure?
 
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newsGP weekly poll What are appropriate public health measures should COVID cases spike and the healthcare system be placed under further pressure?

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Dr Ian   10/02/2022 11:01:49 AM

The National Institutes of Health in the USA has recommended four treatments for at risk patients to progress to severe disease and death in order of believed effectiveness at this time :Paxlovid is orally administered Sotrovimab which is one IV infusion Remdesivir which has been used in hospitalised patients but now has been recommended to be trialled in the first few days of infection as a IV infusion for 3 consecutive days 200mg day one 100mg day 2 100mg day 3 claiming an 87% reduction in progression to severe disease in one trial by the Pine-tree group - NEJM Jan 2022 - requires the ability to obtain IV insertion - and there are in the USA mobile infusion ambulances and Molnupiravir which is useful because there are less drug interactions and it is oral but benefit is less 30% .
But Molnupiravir is teratogenic NOT for those wanting children ..



It has not been trialled for earlier use that is post exposure but on principles could be more effective in that scenario.