Pandemic: States ration best treatment against worst COVID cases
By staff and wire reports
At the onset of the coronavirus pandemic in 2020, scarce ventilators and protective equipment faced strict rationing. Today, as the pandemic rages into its third year, another precious category of products is coming under tight controls: treatments to stave off severe COVID-19.
There is a greater menu of COVID- 19 pills and infusions now than at any point in the pandemic. The problem is that the supplies of those that work against the omicron variant are extremely limited.
That has forced state health officials and doctors nationwide into the fraught position of deciding which patients get potentially lifesaving treatments and which don’t. Some people at high risk of severe COVID-19 are being turned away because they are vaccinated.
Some hospitals have run out of certain drugs; others report having only a few dozen treatment courses on hand. Staffs are dispensing vitamins in lieu of authorized drugs. Others are scrambling to develop algorithms to decide who gets treatments.
“There is simply not enough to meet the needs of everyone who is going to have COVID in the upcoming weeks and be at risk of severe complications,” said Dr. Natasha Bagdasarian, Michigan’s chief medical executive. “I don’t think there is a way to make sure it gets to all the right people right now.”
At Family Health Centers of San Diego, a network of clinics for low-income patients, the staff has had to turn away about 90% of the hundreds of people who are calling daily and are eligible for COVID-19 treatments.
“It makes me nauseous going home at night because it makes me feel like I’m deciding, with this limited resource, who should get it,” said Dr. Christian Ramers, an infectious disease specialist there. A plentiful supply of effective treatments would be a powerful weapon as the virus again surges across the United States. Fueled by the highly contagious omicron variant, COVID-19 cases have soared to record highs, and the number of hospitalized patients also has increased sharply, although omicron tends to cause milder illness than other variants.
For most of the pandemic, monoclonal antibodies — a treatment generally administered intravenously at hospitals or clinics — have been the primary option for recently infected patients. But the two most common types of the antibodies don’t appear to work against the omicron variant, which is quickly becoming the world’s dominant version of the coronavirus.
There is a third antibody treatment, made by GlaxoSmithKline and Vir Biotechnology, that is potent against omicron. But the federal government has ordered only about 450,000 treatment courses, many of which have already been used or have not yet been delivered to states.
The Food and Drug Administration two weeks ago authorized the use of a new antiviral pill, developed by Pfizer, that shows great promise at fighting COVID- 19 in general and omicron cases in particular.
The federal government is providing the pill, known as Paxlovid, to states, whose health officials decide where to send the pills and how to advise doctors to use them.
Supplies are already being depleted. New York City, for example, received about 1,300 treatment courses of Paxlovid in late December, which it used up within a week, according to a spokesperson for Alto Pharmacy, which is distributing the city’s supply. New York City currently does not have any Paxlovid in stock.
On Tuesday, the U.S. government doubled its order for Paxlovid, although supplies won’t be plentiful until April.
State and local officials say the goal is to get Paxlovid to as many of the most vulnerable people as possible, with a particular focus on those with weakened immune systems or who are unvaccinated.
Unvaccinated people are at far greater risk of hospitalization or death from COVID-19. But giving them priority access to treatments leaves people feeling “like you are rewarding intransigence,” said Dr. Matthew K. Wynia, the director of the Center for Bioethics and Humanities at the University of Colorado, who has advised the state on how to ration COVID-19 treatments.
Only some states, like Ohio and Nevada, have sent Paxlovid to pharmacies that serve nursing homes, whose residents are especially
vulnerable to COVID-19. Many states, including Virginia, Pennsylvania and Arizona, have sent most or all of their initial Paxlovid supplies to pharmacy chains like Walgreens and Rite Aid.
The World Health Organization said Thursday that a record 9.5 million COVID- 19 cases were tallied over the last week as the omicron variant of the coronavirus swept the planet, a 71% increase from the previous 7-day period that the U.N. health agency likened to a “tsunami.” However, the number of weekly recorded deaths declined.
“Last week, the highest number of COVID-19 cases were reported so far in the pandemic,” WHO Director-General Tedros Adhanom Ghebreyesus said. He said the WHO was certain that was an underestimate because of a backlog in testing around the year-end holidays.
In its weekly report on the pandemic, the agency said the weekly count amounted to 9,520,488 new cases — with 41,178 deaths recorded last week compared to 44 680 in the week before that.
WHO officials have long cited a lag between case counts and deaths, with changes in the death counts often trailing about two weeks behind the evolution of case counts. But they have also noted that for several reasons — including rising vaccination rates in some places, and signs that omicron affects the nose and throat more than the lungs — omicron has not appeared as deadly as the delta variant that preceded it.
Any rise in hospitalizations or deaths in the wake of the latest surge in cases isn’t likely to show up for about two weeks.
While omicron seems less severe than delta, especially among people who have been vaccinated, the WHO chief cautioned: “It does not mean it should be categorized as mild. Just like previous variants, omicron is hospitalizing people, and it’s killing people.”
“In fact, the tsunami of cases is so huge and quick that it is overwhelming health systems around the world,” the WHO chief told a regular news briefing. The New York Times and The Associated Press contributed to this report.
People queue outside the Sunflower Rural Health Clinic in Ruleville, Miss., on Thursday. The clinic operator said it had not received any antibody treatments since Dec. 24, and it isn’t among the hospitals that were initially picked to receive supplies of Paxlovid. WHITTEN SABBATINI — THE NEW YORK TIMES
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