Failing grade

There are two apparently effective treatments for early, moderately severe Covid-19, namely monoclonal antibody infusions of the sort received by Trump, Giuliani and Christie in November and December. The point is to use these antibody infusions early in the disease in patients who are at home, in order to head off clinical deterioration and prevent hospitalization and bad outcomes.

One treatment is Regeneron’s dual-antibody “cocktail” which includes casirivimab and imdevimab. The other is Lilly’s almost unpronounceable bamlanivimab. Both intravenous infusion treatments target the spike protein of the SARS-CoV-2 virus. And both were approved under emergency use authorizations (EUAs) by the FDA in November. They appear effective to date, although formal controlled trials have not been completed.

Two hours of calling to no avail

Antibody infusion supplies are publicly said to be plentiful. But right now, even if plentiful, they are really not available. The Washington Post just wrote about this, and I found the same thing yesterday.

Despite two hours of calling to two teaching hospitals, one community hospital, and one designated infusion company on, I could not arrange an antibody infusion this weekend for a member sick with Covid-19 who meets criteria for its use as an outpatient. This is immensely concerning to me.

I am on staff at the two teaching hospitals. In each, ER staff indicated they rarely if ever give the antibody infusions, and the infusion units were closed on the weekend. At the third hospital, where the sick patient works, I spoke to a nursing supervisor who indicated she thought they don’t do antibody infusions, the infusion centers are closed, and that employee health didn’t play a role.

Last I called the CVS/Coram specialty infusion centers, where Partners physicians were referred for access to outpatient antibody infusions. That may be true, but not on weekends. Only an answering machine and no callbacks. I’ll be curious if I hear on Monday. Unfortunately, Covid-19 doesn’t take long weekends.

What’s the message? Failure.

We are entering what is likely to be the worst several months of the pandemic, with a new more transmissible strain becoming prevalent and hospitals coming under increasing strain. Meanwhile, our Massachusetts vaccination programs are barely getting started and Dr. Sobel and I still don’t know when we will have vaccine to give to our oldest and most vulnerable members. By contrast, in Florida many older adults have already had their first shots (we know from some of our patients who winter in Florida).

Now, at long last, we at least have an apparently effective treatment that can mitigate and perhaps stop moderately severe Covid-19 infections and help prevent hospitalizations and probably some deaths. But we actually don’t have ready access to the antibody treatment! Just like we have struggled and still do struggle to get supposedly available PPE, especially N95 masks.

Why do our medical and governmental systems fail to provide us in a timely fashion with the critical tools to help our patients? We are supposed to be more capable than this. We clearly are not.

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4 Responses to Why Do We Fail With Covid-19? Antibody Infusions Not Realistically Available

  1. Andrew Ostrom says:

    You’re right on point. If politicians spent less time trying to blame each other and posturing about meaningless and ineffective policies and more worrying about their constituencies we’d be a lot better off.

    Another example is that (according to the Massachusetts Covid Vaccination web site update on 12/29)by 12/29 Massachusetts had received 285,050 doses of vaccine, but only administered 78,643 doses. Somewhere there were 210,000+ doses sitting in freezers doing nothing, and I’m sure many more than that now.

    I don’t know whether it’s incompetence or intentional foot-dragging, but it’s inexcusable. I keep hearing how the state needs time to prepare their vaccination program — well, we’ve KNOWN FOR MONTHS that a vaccine would be arriving by the end of the year. What have all the public health department officials been doing all year? Why wasn’t there a plan in place ready to be activated at a moment’s notice? Why wasn’t the National Guard (if needed) all set to deliver the vaccine to waiting administration sites that were already staffed and equipped to vaccinate the population?

    If a for-profit business was run this way either heads would roll, or they’d be put out of business. It’s maddening and disgusting.

    (https://www.mass.gov/doc/weekly-covid-19-vaccination-report-december-31-2020/download)

  2. David Goldsmith says:

    Hi Everyone,

    I’m a nerdy, retired economist and investment manager and I’ve spent many hours researching the Covid-19 pandemic.

    Dr. Kanner could not be more right, both about early infusion of monoclonal antibodies and about the importance of vaccinating older Americans. But as you might imagine, I am disheartened about the slow progress in delivering these medical miracles to patients. Speedy development and manufacturing is a tremendous achievement, but it is obviously not enough.

    It is also not a coincidence that Massachusetts lags Florida with respect to immunizing older Americans. Massachusetts, following CDC guidelines, prioritizes people over 75, while Florida prioritizes people over 65.

    Maybe, I have some implicit bias because I’m 68 years old, but I think Florida got it right in terms of rational public policy. The infection fatality rate for males 65-69 is roughly 9x that of males 45-49 and 85x that of males 25-29.

    One can argue that we should be maximizing years of life saved rather than lives saved, which is probably right, but even using this metric, we should be vaccinating older Americans first, as these mortality ratios swamp the remaining years of life ratios that go in the opposite direction.

    I usually don’t pay too much attention to what politicians have to say, but I think Tulsi Gabbard got this one right: “Heartless, arrogant, unelected CDC bureaucrats have decided that the lives of elderly Americans don’t count. They’re recommending 100 million ‘essential workers’ (i.e. healthy people working at liquor stores or phone companies) can get the vaccine before our grandparents.”

    By the way, Gabbard’s examples of non-medical, essential workers are not particularly representative, but I think her point remains valid.

    Perhaps, it’s time for an Older Lives Matter movement?

    David

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