U.S. health officials are seeing a staggering lack of demand for COVID-19 drugs that can help keep infected people out of the hospital. These drugs have been brought to the States in the past few weeks as deaths set new records.
Red tape, staff shortages, test delays, and strong skepticism keep many patients and doctors away from these drugs, which deliver antibodies that help the immune system fight the coronavirus. Only 5% to 20% of the federal government allotted doses were used.
Ironically, government advisors met on Wednesday and Thursday to plan the opposite problem: potential future shortages of the drug as COVID-19 cases continue to rise. Many hospitals have set up lottery systems to ration what is likely to be limited supply, also taking into account unused drugs that are still in use.
There are only 337,000 treatment courses available and there are 200,000 new COVID-19 cases per day. “So the supply can certainly not meet the demand,” said Dr. Victor Dzau, President of the National Academy of Medicine, whose panel of experts met on drugs.
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Antibodies are made by the body’s immune system to fight the virus. However, it can take a few weeks after infection for the best to form. The drugs are said to help immediately by delivering concentrated doses of one or two antibodies that work best in laboratory tests. The government provides them for free, but sometimes a fee is charged for the IV needed to administer the medication.
Eli Lilly and Regeneron Pharmaceuticals have an emergency clearance to ship their antibody drugs while studies continue. However, the drugs must be used within 10 days of the onset of symptoms in order to do any good. Confusion about where to find the drugs and delays in coronavirus test results have conspired to keep many away.
“It can take anywhere from two to four days for the results to come back, and that is absolutely precious time,” said Dr. Keith Boell of the Geisinger Health System in Pennsylvania to the panel of experts.
“Our clinics have everything from a bus stop to a buggy stop,” he said, serving large cities and Amish communities with horses. “We really want to get these into anyone they can help,” but it’s hard, he said.
Many states and health centers weren’t ready for the drugs’ sudden availability, said Dr. Ryan Bariola of the University of Pittsburgh’s 30 Hospital System. Finding out if a patient is qualified can be a nightmare for doctors or emergency centers.
“How you do that? Are you calling your local hospital? An infusion center may not be set up. This is very difficult for many independent doctors, ”he said.
The crisis comes when vaccination efforts begin in the United States, monopolizing attention and personnel.
States “didn’t see this coming … and have limited scope” to handle this in addition to vaccine distribution, said Connie Sullivan, president of the National Home Infusion Association.
Many hospitals like the University of Michigan were quick to set up outpatient infusion centers, but a shortage of nurses and other staff was “the biggest problem we had,” said Megan Klatt, a pharmacy resident.
Skepticism also harms use. The evidence that the drugs help is little, several leading medical groups have not endorsed them, and many patients who feel only mildly ill see them as a risk: half of those offered them in the Michigan system refused, said Klatt.
“It doesn’t help if the doctors themselves aren’t completely convinced,” said Mohammad Kharbat, chief pharmacist in a hospital system in Madison, Wisconsin, where half of the patients have also turned it down.
At North Carolina’s Wake Forest Baptist Health System, “we had very little activity, very few referrals,” and little interest from patients or doctors, said Dr. John Sanders.
The University of Utah has seen the interest of patients and has developed a formula to find out who needs the drugs most urgently. However, in order to get the infusion, you need to “go to a website and be notified of your test result … do some of the work yourself” and many people cannot do it, said Dr. Emily Sydnor Spivak.
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“We have to go out and find people” who qualify and offer them the drugs, she said.
So Lance Harbaugh got one. Harbaugh, 58, of Cumberland, Maryland, started feeling sick on Thanksgiving, tested positive for the coronavirus the following Monday, and received Lilly’s drug a few days later at the University of Pittsburgh’s Western Maryland Hospital.
Harbaugh said he was “downcast” with pneumonia, chills, fever and a lot of cough. When the staff suggested the drug, they added, “I was all for it.”
Harbaugh avoided hospitalization but said he still had many symptoms.
“I don’t think I’ll ever be the way I used to be,” he said.
Ohio State University was ready to quickly dispense the drugs as they helped test one of those drugs, said a pharmacy manager, Trisha Jordan. Within an hour of receiving the first dose, the hospital gave it to a patient, Jordan said. She said the university could use more treatment courses than it has already received.
Dr. John Redd of the U.S. Department of Health said he was happy to hear some hospitals want more. “We have never said no to an applicant,” Redd told the National Academy of Medicine panel.
Towards the end of the panel discussion, a Lilly official, Andrew Adams, lamented the hurdles that have prevented healthcare professionals from getting the drugs to the people who need them. He said Lilly had overcome serious obstacles, including a power outage due to a hurricane in the northeast, in order to develop the drugs quickly.
“It just shows the extreme effort we put into making this happen,” said Adams. “It is important to us that all of these efforts have not been in vain.”
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