All the weak points of American health care — testing delays, communication breakdowns, inequity — are working against this potential treatment.
This headline and article in today’s New York Times puts the spotlight on the situation which this site is dedicated to changing. Alas, these issues are all too real, and indeed barriers to efficient access to and distribution of these important medicines to the local healthcare providers managing the ground level response to COVID-19. And, of course, the supply itself needs focus, resources and attention to be massively scaled.
Supply Will Be Extremely Limited at First, Then Expand in Q1 21
As the article points out:
Supply will be extremely limited at first, even though the pool of patients who might benefit is vast, raising messy questions about who should be first in line for treatment. The drugs are believed to work best in people who have recently been infected and are not yet very sick.New York Times: Trump’s Antibody ‘Cure’ Will Be in Short Supply
Therefore, the focus and any availability will and must initially be on:
- front line workers who face exposure risk in their daily duties; and
- population groups that are particularly vulnerable to severe disease: the elderly and those with pre-existing health conditions.
But even though production is expected to ramp up quickly:
If the antibody treatments prove effective, they are expected to become more widely available by early next year. Regeneron has said it will be able to produce about 250,000 doses a month in partnership with Roche. Eli Lilly has said it will also be able to ramp up production. Another company, AstraZeneca, is also developing an antibody treatment that is earlier in its development, and it has a deal with the federal government to supply up to 100,000 doses by the end of December.New York Times: Trump’s Antibody ‘Cure’ Will Be in Short Supply
Unless there is a major change in the funding and prioritization of these medicines, demand – or at least need – will still outstrip supply for some time to come.
What Can Your Community or Organization Do?
This section of the article is key for business and community leaders that have responsibility and concern for these kinds of people.
Dr. Douglas B. White, a medical ethicist and professor of critical care medicine at the University of Pittsburgh School of Medicine, said he hoped hospitals would apply the lessons they had learned when another experimental Covid-19 drug, remdesivir, was initially scarce. Then, too, the federal government asked states to take responsibility for how the drug was allocated. Dr. White wrote guidelines that were adopted by Pennsylvania that recommended giving priority to people from economically disadvantaged communities, who are at higher risk of dying from Covid-19. The same rules should apply to the antibody treatments, if they are in short supply, he said. “There needs to be clear guidelines, and there needs to be efforts to mitigate the inequitable outcomes across groups in society,” he said.
Dr. Plescia, of the state health officials group, said he believed that most states had worked out the kinks that occurred with remdesivir. Now, he said, “I think there’s a distribution chain in place that could be adapted to this.”New York Times: Trump’s Antibody ‘Cure’ Will Be in Short Supply
So, how does that translate into actual actions that you can take? This is where you can start.
1. Engage with your state Department of Public Health
Most states have been very active in working closely organizations with vulnerable populations – in particular assisted living facilities and nursing homes for the elderly, handicapped and cognitively challenged. They also have programs dedicated to front line workers. So start there.
2. Find out about existing policies and ‘distribution’ processes they have in place for Remdesiver and other COVID-19 Treatments
If your state is similar to Pennsylvania, these may be what is applied to formulate the rules, processes and flow of new antibody-based drugs.
3. Get on the Radar
At the very least, if you do steps 1 and 2, then you may be able to actively lobby for and get on to some type of preferred access program, hotline access, or another way to ensure that lines for rapid communication and coordination are in place.
4. Test, Test, Test
Putting aside the prevention use case for now – which can only come with much greater production and supply – your immediate focus should be on early detection and treatment, which are the keys to successful outcomes. To achieve that, you need to have rapid – and frequent testing – in place. If you can detect early, and have lines of communication and coordination open with the right public health agencies and healthcare providers, then you will be able to respond quickly to apply these medicines after infections are detected to reduce the severity of disease, as well as to prevent infection for known exposures established through contact tracing.
Despite all the effort and money that has been put into testing, alas, it is still far too hard and slow to obtain tests and results for most individuals and organizations. This varies greatly by state, however, so once again start with steps 1, 2 and 3. If you don’t already have it in place, you should be able to get support from state & local public health officials to do so.
But if that is not working, take matters into your own hands for your organization and community. Engage with your local healthcare providers to get the right testing programs in place. There are also many different rapid tests available for direct order, but these need to be carefully evaluated. We will work to create a resource directory and information on some of the best options here. In the meantime, here are a few resources.
5. Volunteer for a Clinical Trial
This is somewhat like a lottery ticket, alas – these are very limited in their participation. But if you qualify and are able to participate, you will:
- make an important contribution to the battle against COVID-19; and
- get access to protection and treatment.
Of course, no one wants to get the placebo – and you cannot know which you will receive. But it is likely that participating in a trial would have benefits of repeated testing and rapid access to treatments – most especially mABs. It is also often common in such trials that if the data is very positive, that there can be an early termination and all of the recipients of the placebo would be given the actual vaccine or treatment. That’s not usual, but there is nothing usual about the circumstances we are in!
- NYT: Is Your State Doing Enough Testing?
- FDA: Information on Labs and Manufactures for COVID-19 Testing
- CDC: Overview of Testing for SARS-CoV-2 (COVID-19)