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.