Protecting older people from COVID – care homes and hospital-at-home providers needed for important national studies

Adam Gordon is Professor of Care of Older People at the University of Nottingham and President Elect of the British Geriatrics Society; he tweets @adamgordon1978

The second wave of the COVID-19 pandemic in the UK has been even more devastating than the first. In care homes, where measures in place to protect residents have improved substantially following lessons learned during wave one, we have continued to see high infection rates related to SARS-CoV-2, and a number of deaths as a consequence. This is concerning and reflects how difficult the virus is to control, particularly the new variant that has come to prominence during wave 2.

We hope that vaccination will represent a way out of this situation and that this will enable life to return to normal after the spring. There is, however, a possibility that vaccination will not work as well in older people who live with frailty as it will in younger, fitter groups. Very frail older people were not included in the vaccination trials, even when chronologically older people were. Immunosenescence (the deterioration in immune response with ageing) may mean that the vaccine will not generate the same levels of immunity in older populations as it does in younger populations. Many epidemiologists now predict that COVID-19 will become endemic, even once the pandemic is over, and care home outbreaks will become a regular occurrence.

We therefore need to keep developing and evaluating preventative measures and treatments that modify the course of COVID-19 in older people with advanced frailty. In the event of a further wave of infections we need every treatment possible in our armoury to protect this vulnerable group.

Thinking about care homes, when it comes to medications – there are two important ways in which we might make a difference. Firstly, we need to find medications that stop people from catching COVID-19, or that reduce the severity of infection once people catch it. Such preventative treatments could be given before SARS-CoV-2 arrives in a care setting (pre-exposure prophylaxis) or after the virus arrives, to prevent spread (post-exposure prophylaxis). Secondly, we need treatments that can improve outcomes for people who are confirmed as having COVID-19.

In the first category, prevention, it’s exciting to be able to play a leading role in delivering the Prophylactic Therapies in Care Homes (PROTECT) trial, which went live this week. This is a platform trial, where individual therapies selected by the Prophylaxis Oversight Group of the National Institute of Health Research will be tested in a care home setting to see whether they prevent, or reduce the severity of, outbreaks. It will be the largest ever trial conducted in care homes and we need as many care homes as possible to come forward now. To learn more, please visit this website  - where care home owners and managers can sign an expression of interest form to find out more.

In the second category, the AVID-CC study is a randomized controlled trial of adaluminab for older people with frailty who develop COVID-19, considering whether this can reduce disease severity and improve outcomes. Adaluminab is an injectable agent and the study team have chosen to work with Hospital-at-Home providers to deliver the trial. We need more of these to come forward. To learn more and complete an expression of interest, please visit this website. 

As somebody who has been doing research in the care of older people, particularly in care homes, for over a decade, it would have been inconceivable to me prior to the pandemic that two such important and large-scale clinical trials would be taking place in care homes. This is an indicator of how important it is for us to continue to add additional treatments to our toolkit as we manage this devastating infection. We need all the help we can get.  Please sign up for expression of interest.