Top 5 Takeaways

  1. Significant Underutilization of Antivirals: Review of 110 immunosuppressed Veterans Health Administration patients with nonsevere COVID-19 showed 80% were not offered antiviral drugs, primarily due to mild symptoms.
  2. Reasons for Not Offering Treatment: Besides mild symptoms, reasons included symptom duration >5 days (22.7%), lack of symptoms (22.7%), and drug interaction concerns (5.7%).
  3. Missed Opportunities for Treatment: One-fifth of patients were offered antivirals but declined, indicating a gap in patient education and potential for increased usage.
  4. Education as a Key Intervention: Enhancing education for providers, patients, and staff could increase antiviral use, especially with plans in place at the time of testing.
  5. Study Limitations: Findings may not apply to non-VA systems or to women and minorities due to the study’s veteran-centric, male-dominant sample.

Original Article Author and Citation

Corresponding Author

Paul A. Monach, MD, PhD, Email:

Suggested Citation

Monach PA, Anand ST, Fillmore NR, La J, Branch-Elliman W. Underuse of Antiviral Drugs to Prevent Progression to Severe COVID-19 — Veterans Health Administration, March–September 2022. MMWR Morb Mortal Wkly Rep 2024;73:57–61. DOI:


This report highlights the underuse of antiviral medications among high-risk patients within the Veterans Health Administration, revealing that a significant proportion of patients were not offered treatment mainly due to mild symptoms or were offered but declined. Education for providers, patients, and staff, alongside advance planning for antiviral treatment, is suggested to improve utilization rates.


The study analyzed data from the VA COVID-19 Shared Data Resource and electronic medical records, focusing on a cohort of patients with conditions like organ transplantation or hematologic malignancies who did not receive an antiviral drug despite being at high risk for COVID-19 progression.


The findings indicate a substantial gap in the provision of antiviral treatments, underpinned by reasons such as symptom duration, drug interaction concerns, and patient refusal. The underestimation of antiviral usage due to limitations in electronic medical record data suggests that actual usage rates may be slightly higher, though still insufficient.


To combat underutilization, the study recommends enhancing education around antiviral treatments for both healthcare providers and patients, ensuring that individuals at high risk are aware of and offered necessary treatments promptly.


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