This week, the Food and Drug Administration revoked Emergency Use Authorization for COVID-19 antibody drugs from Regeneron and Eli Lilly, a regulatory move that was expected because both drug makers have found that the infusion drugs are less able to target omicron due to the strain's mutations.
So what should people who test positive for COVID and are at high risk for severe illness do? Chicago's top doctor says there are options in the city.
"We’ve not been using those two for weeks here in Chicago knowing most of what we had was omicron," said Dr. Allison Arwady, commissioner of Chicago's Department of public Health.
Instead, many Chicago hospitals have started administering Sotrovimab, another monoclonal antibody treatment that has proven effective against the now-dominant omicron strain.
The omicron variant is now believed to be responsible for more than 99% of COVID infections in the city.
"It has to be given intravenously, and it has to be used within the first ten days of symptom onset, so you can have the best benefit and it provides pre-made antibodies to fight the infection," said Dr. Shivanjali Shankaran, an assistant professor of infectious diseases at Rush University Medical Center.
Dr. Shankaran also oversees a new COVID infusion clinic at Rush. The clinic opened last week to provide patients who may have mild or moderate covid infection, but are at high risk for serious illness, opportunities for treatment.
"We are able to see up to nine [patients] a day," said Dr. Shankaran. "The infusion takes about 30 minutes and then patients have to be monitored for an hour after. So the whole [process] takes about two and a half hours."
The hospital also administers Remdesivir, an antiviral and the first FDA approved drug to treat COVID, in the infusion clinic. Similarly to Sotrovimab, Remdesivir is time sensitive and must be administered within ten days of symptom onset, according to experts.
Clinics like the one at Rush are popping up elsewhere, too. AMITA Health has seen a large increase in interest in monoclonal antibodies over the past six weeks, and the health system is currently administering Sotrovimab.
"We’ve probably been doing about 300-to-350 infusions a week due to the surge," said Dr. Ana Gephart, the Chief Medical Officer at AMITA Health St. Joseph Hospital in Elgin. "They’ve been very successful. People have been feeling much better after the treatment. But of course, it’s not a substitute for the actual vaccine."
Health care providers also have new, easier to administer tools in their arsenal, though some treatments are in short supply.
In December, the FDA granted EUA to Pfizer's Paxlovid antiviral pill and Merck's Molnupiravir.
The pills, distributed by the federal government, require a prescription from a doctor and can be picked up at a pharmacy and taken at home, but officials warn that the treatments may be hard to find.
Supply is extremely limited and there is a risk for side effects for some patients, according to experts.
"The paxlovid, the oral one people are most interested in, it has a lot of drug-to-drug interactions. Some of the people on the most medications can’t qualify," Arwady said. "And [Molnupiravir] can’t be taken if someone is pregnant, you have to do some extra testing."
The pills are not currently available to everyone because of supply shortages. For now, many healthcare providers are following guidance from the National Institute of Health to prioritize patients, especially those who are immunocompromised.
"Basically it’s based on risk. The people who are the highest risk, statistically, of having a poor outcome, or getting severely sick, or ending up in the ICU, we give them the first dibs, if you will," said Shankaran. "We’ve also created a scoring system based on multiple other things based on diabetes, vaccination status, heart disease, pregnancy."
Dr. Shankaran says the most important thing to do if you have symptoms is to test early because the oral medications only work in the first five days.
"They have to be given during the multiplication process. That’s why we have to start them in the first five days. Getting tested very, very quickly is going to be essential," she said.
A prescription and positive COVID test are required to receive the treatment. Pharmacies have limited quantities for now, though the hope is to increase access to more patients when supply is more readily available.
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