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EDMUND G. BROWN JR.
Governor

State of California—Health and Human Services Agency
California Department of Public Health


AFL 22-20
September 12, 2022


TO:
Skilled Nursing Facilities

SUBJECT:
Coronavirus Disease 2019 (COVID-19) Treatment Resources for Skilled Nursing Facilities (SNFs)


​All Facilities Letter (AFL) Summary

  • This AFL provides guidance recommending that all SNF residents with symptomatic COVID-19 be evaluated by a prescribing clinician to be considered for COVID-19 therapeutics.
  • In addition, SNFs should evaluate all residents for any oral COVID-19 therapeutics drug-drug interaction risk, renal and hepatic impairment in advance of a COVID-19 diagnosis and indicate such information in charts to facilitate access to appropriate therapeutics when a COVID-19 diagnosis is made.
  • This AFL also provides information regarding available guidance and resources for evaluating, prescribing, and obtaining COVID-19 therapeutics for SNF residents.
  • This AFL encourages SNFs to provide information for healthcare personnel (HCP) who test positive for COVID-19 to obtain treatment with appropriate therapeutics.

​SNF residents are at high risk of severe illness, hospitalization and death from COVID-19, and COVID-19 therapeutics can substantially reduce these risks. All SNF residents should be considered eligible to receive treatment for mild-to-moderate COVID-19 and should be evaluated by a prescribing clinician for consideration of COVID-19 therapeutics. This AFL provides information to SNF medical directors and other prescribing clinicians regarding available guidance and resources for evaluating, prescribing, and obtaining COVID-19 therapeutics for SNF residents.

The products currently authorized for treating mild-to-moderately ill COVID-19 patients include:

DrugTypeInformation
PaxlovidOral pillsEUA for patients ≥12 y/o; highly effective in reducing deaths/hospitalizations; drug-drug interaction risk; not recommended for severe renal or hepatic impairment; "rebound" with positive antigen test and symptom recurrence is possible upon completion of therapy.
MolnupiravirOral pillsEUA for patients ≥18 y/o; moderately effective in reducing deaths/hospitalizations; may cause fetal harm for pregnant individuals
RemdesivirIVFDA-approved for patients ≥12 years; EUA in patients younger than 12; highly effective in reducing deaths/hospitalizations; multi-day treatment
BebtelovimabIVEUA for patients ≥12 y/o; moderately effective; given in single dose
EvusheldInjectionIndicated for immunocompromised individuals who cannot mount an immune response to COVID-19 vaccinations; taken before getting sick or exposed

 

These medications are no longer in short supply and should be prescribed whenever clinically appropriate. These products must be administered within 5-7 days of symptom onset, depending on the specific product. To facilitate therapeutic decisions, SNFs should evaluate all residents for oral COVID-19 therapeutics drug-drug interaction risk, renal and hepatic impairment in advance of a COVID-19 diagnosis and indicate such information in charts to facilitate access to appropriate therapeutics when a COVID-19 diagnosis is made. Additional information about these products, clinical decision-making, and prescribing and dispensing regulations can be found in the California Department of Public Health's (CDPH) COVID-19 Test-to-Treat Playbook (PDF). Individuals can sign up for CDPH therapeutics updates using the Sign Up for CDPH Therapeutics Updates survey link.

SNFs should communicate with their pharmacy to ensure oral antiviral therapeutics are readily available. If the partnered pharmacy or SNF has difficulty obtaining supply, please contact CDPH at CDPHTherapeutics@cdph.ca.gov for assistance in obtaining supply.

In addition, SNFs should provide information for their HCP who test positive for COVID-19 to obtain treatment with appropriate therapeutics. SNF HCP may seek care from their regular provider or at Test to Treat Locations.

 

Sincerely,

Original signed by Cassie Dunham

Cassie Dunham

Deputy Director


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