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US Treatment shortages, packed hospitals: Why at-risk adults should be on COVID alert

18:20  13 january  2022
18:20  13 january  2022 Source:   usatoday.com

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As the coronavirus tears across America, it is a particularly bad time for high-risk people to catch COVID-19.

And that means a lot of Americans are vulnerable. Nearly 40% of U.S. adults are considered at high risk for a serious infection because they're over 65, are carrying extra pounds or have certain medical conditions.

"It's a tough time, a challenging time," said Dr. Ali Khan, a chief medical officer with Oak Street Health, a national network of primary care centers specializing in vulnerable patients.

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Khan, who is based in Chicago, said he'd like to be keeping more of his patients out of emergency rooms, but he simply doesn't have the tools right now. In Illinois, one of 20 states his network serves, they have access to just 100 courses of one of the two antivirals, he said.

At the same time, hospitals are nearly overwhelmed with patients, including those with COVID-19 as well as other ailments.

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And while there are good treatments to prevent infected people from needing hospital care, including two recently approved, they are almost totally unavailable across the country.

Two of the three monoclonal antibodies shown to help prevent hospitalizations don't work against the omicron variant that now accounts for more than 95% of cases nationwide. Many hospitals have stopped offering those entirely.

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"Right now, we've got nothing else to treat ambulatory patients with COVID," said Dr. Jeanne Marrazzo, who directs the division of infectious diseases at the University of Alabama at Birmingham. "We have no monoclonals right now. We don't have the oral drugs yet and we don't have any other options – so it's really really important to try to protect yourself."

The one monoclonal antibody that's still effective against omicron, called sotrovimab, is also the one that's least available.

GlaxoSmithKline and Vir Biotechnology announced Tuesday that they'd sold an additional 600,000 doses of sotrovimab to the U.S. government to be delivered by March 2022, bringing the total doses bought by the government to 1 million.

But the country reported more than 1.3 million cases of COVID-19 on Monday alone, so even those additional doses will go fast.

"There's clearly a huge mismatch between the demand because of the sheer number of cases of omicron and the supply of this one simple monoclonal antibody," said Dr. Joshua Barocas, an infectious disease expert at the University of Colorado School of Medicine Anschutz.

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Marrazzo said her facility had just 16 doses of sotrovimab available last week. "We don't have anything," she said in a Tuesday media call with Barocas, set up by the Infectious Disease Society of America.

Antiviral pills that were authorized by the Food and Drug Administration last month and are expected to transform treatment for COVID-19 are just becoming available. Marrazzo and Barocas said their institutions have not yet received any doses.

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At Massachusetts General Hospital, the situation is much the same, with monoclonal antibodies being reserved for those most at risk, said Dr. Richelle Charles, an infectious disease physician who joined a Tuesday media briefing by the Massachusetts Consortium on Pathogen Readiness.

In the fall, anyone who was even a little overweight or over 50 years old would be immediately given monoclonal antibodies to prevent their infection from getting worse, said Dr. Dorry Segev, a transplant surgeon and epidemiologist at Johns Hopkins University.

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"Now, you have to be incredibly high risk and it's only for treatment (not prevention), because we have so little supply," he said.

When one of his transplant patients comes down with omicron he has been "desperately" trying to find a dose of sotrovimab to give them. "It's critical for them," he said, because many transplant recipients don't get good protection from vaccines.

More doses to come

Hopefully, the shortage will be short-lived, Segev and others said.

"It's starting to get better but it's not there yet," said Dr. Daniel Griffin, an infectious disease specialist at Northwell Health on Long Island.

Griffin said there are about 3,000 doses of antivirals available a week for all of New York state – and they could probably use 300,000.

He predicts the situation will change by March, when more drugs will be available, cases will have fallen and physicians and pharmacists will understand which patients will most benefit from which treatment.

"I think it's going to get better," he said. "I can't imagine it getting worse."

More drugs are also in the pipeline.

The federal government is currently funding a trial of another monoclonal antibody designed to keep people out of the hospital, Dr. Tony Fauci, a presidential COVID advisor said in a Wednesday briefing.

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The government has also been increasing its orders for drugs like sotrovimab and the antivirals.

Remdesivir, an antiviral that has been used for hospitalized patients, is also being made available to those earlier in the course of their disease. A three-day course has been shown to prevent hospitalizations. But it's not yet widely available, either, and has to be delivered by infusion, so either in the person's home or to someone who can come back to a facility three days in a row.

"We would love to be connecting our patients to outpatient remdesivir," Khan said. "That has not been readily available across most of our 20 states."

Even though the best tools for preventing disease are in short supply, Barocas said he feels like medical care is in a totally different place now than it was in March 2020.

"I felt helpless," he said of that time. "I felt that absolutely all I was doing was shuffling deck chairs and trying to keep a boat afloat at the same time."

Now, there are preventive measures and treatments and viral surveillance to help understand where infections are headed, he said.

"I can go to the hospital, and no matter how overwhelmed and how exhausted we all are, it's a vastly different landscape."

Contact Karen Weintraub at kweintraub@usatoday.com.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

This article originally appeared on USA TODAY: Treatment shortages, packed hospitals: Why at-risk adults should be on COVID alert

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