Medicines, such as antivirals and vaccines, which had more solid evidence showing they were effective compared to other types of safety measures, were underutilized during the COVID-19 pandemic.

These findings are based on a JAMA study released Friday.

Overall, pharmacologic measures including vaccination and antiviral treatment had a more robust efficacy than nonpharmacologic interventions like visitor restrictions and ventilation modifications, according to a study published in JAMA Health Forum.

Vaccinations and antivirals showed “substantial benefits” but were underutilized between 2020 and 2024, the study found. Up-to-date vaccination status was suboptimal in residents and staff, while only a minority of infected residents received antiviral treatment.

Meanwhile, measures that used up scarce resources and staff really drew away from a focus on vaccinations and antivirals, they said. Some of the most widespread and restrictive interventions, including visitor restrictions, resident isolation and suspension of communal activities, were implemented despite the lack of studies assessing their effectiveness in Covid transmission.

Vaccination underuse and widespread use of visitor bans suggest implementation efforts weren’t tied to each measure’s demonstrated effectiveness.

“Future implementation should be commensurate with demonstrated effectiveness,” researchers said. “While understandable given the frantic response to the pandemic in 2020, the lack of attention to intervention assessment early on reflects a missed opportunity to identify best practices for respiratory illness risk mitigation.”

The SNF Covid-19 module within the NHSN survey is one exception, they said. Without the module, researchers would know “considerably less” than we know now on the pandemic’s impact for nursing homes.

Covid entered facilities via staff, but staff had lower vaccination rates than residents despite availability and no associated costs, the study found. Workforce shortages, high turnover and staff working across multiple institutions exacerbated vaccination challenges and infection rates.

While higher staffing ratios were associated with better clinical outcomes, lower staff size meant fewer close contacts for infection spread. Increasing full-time staff and reducing part-time employees helped reduce risk.

Efficacy of visitor bans remains unestablished, researchers said, even as risks of prolonged loneliness and violations of resident rights were seen. Surveillance testing is a good mitigator, they said, which will reduce Covid spread and keep quality of life and autonomy intact for residents.

Physical space and environment was seen as a key factor in infection control according to international studies, researchers said. The sweet spot lies with smaller facilities and private rooms with a homelike design, which allows for less contact with multiple staff members but not compromising time in direct care. Such infrastructure changes are costly, however, and also need political investment.

Overall, a multi-pronged, evidence-informed approach using environmental strategies, testing, early antiviral therapy and vaccination is the most effective way to prevent cases and fatalities from Covid and other respiratory illnesses, researchers found.

“Systemic reform is needed to increase resource allocation toward SNFs to support changes known to mitigate respiratory infection risk and improve resident outcomes,” they added.