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A Network of Sharing: How Community Collaboration Allowed for Flexible and Timely Administration of Monoclonal Antibodies for COVID-19 in Skilled Nursing Facilities

      Introduction

      Monoclonal antibody treatment for COVID-19 transitioned to an allocation per state by dictate by hospitalization rate in state by HHS. A nursing home needs to request doses needed for the next week by Monday. However, the unpredictable nature and small numbers of an individual nursing home’s outbreaks make accurate ordering difficult. In this series, we describe how a local collaboration among skilled nursing facilities in the Rochester, NY region allowed for rapid delivery of mAb doses to residents positive for or exposed to COVID-19.

      Case Description

      A team was developed within the UR Medicine Geriatrics Group and the Hurlbut Care Communities Corporation to oversee distribution and administration of mAb to regional nursing homes. The team includes a medical director, RN and RN nursing home administrator. Doses were delivered and held centrally at facility A. Participating facilities, 7 of which are within 1 corporate entity and an additional 3 of which operate independently, procured mAbs through the team. Data regarding case details, vaccination status, indication, doses given, and outcomes is tracked centrally by an RN at facility A. A protocol was shared with facilities, including instructions for subcutaneous administration and monitoring, indications, and standardized consent, progress notes, and flow sheet. Doses were administered by corporate nurses, facility nurses and medical providers depending on availability and need. In total, across 10 facilities, 219 doses were given. The number of treated residents in each facility varied from 1 to 34. The smallest participating facility is home to 34 residents, a total of whom 15 were treated: 7 positive cases and 8 exposures. To date there have been no deaths in treated patients in this group and 1 hospitalization for those receiving treatment as post-exposure prophylaxis. Additionally, the large majority of residents receiving post exposure prophylaxis remained asymptomatic and negative for COVID-19.

      Discussion

      This case series highlights how 219 symptomatic and exposed residents in nursing homes achieved favorable outcomes through community collaboration to improve access to monoclonal antibody treatment despite the more restrictive allocation plan. The interdisciplinary team-based approach and standardization of protocols allowed for real time distribution of mAb doses according to need to facilities that may have not otherwise been able to feasibly procure and administer doses independently. This supports the value of collaboration among skilled nursing facilities to improve the community outcomes.

      Disclosures

      All authors have stated there are no financial disclosures to be made that are pertinent to this abstract.