With omicron spike, N.H. health officials make tough decisions about COVID treatment due to limited availability
New Hampshire health officials are telling health care facilities to prioritize effective treatments for the omicron variant of COVID-19. But some of those treatments are much newer, and in shorter supply.
Monoclonal antibodies and antiviral pills are therapies given to patients shortly after COVID symptoms appear. If symptoms are caught quickly, they can help prevent hospitalization and death due to the virus.
But the supply shortage for these treatments means New Hampshire health care facilities will likely have to use them for patients at the highest risk of developing a severe COVID case. It’s a dilemma facing health care facilities across the country.
While COVID treatments are mostly provided through hospitals in New Hampshire, Convenient MD also offers monoclonal antibodies at nine of its locations. A spokesperson for the company says the urgent care centers will have to limit their ability to give the medication.
At Concord Hospital, Dr. Michael McLeod, the hospital’s associate chief clinical officer, says his team is focused on health conditions that put people at a greater risk of a severe case when considering patients for these treatments.
“You do have to put, maybe a 35-year-old person who's overweight and that's their only risk factor up against perhaps the 75-year-old who's immunocompromised with diabetes and hypertension. So, you really do need to look at that clinically,” he explained.
Race and ethnicity, McLeod said, is not a factor the hospital plans to use to determine eligibility. But some conditions listed in interim guidance from the National Institutes of Health, like diabetes and sickle cell disease disproportionately impact people of color – though those demographics were not made explicit in the release. The state of New Hampshire sent providers NIH’s guidelines but hasn’t made state-specific guidelines.
The state health department in New York does recommend facilities consider non-white race and Hispanic/Latino ethnicity a risk factor, “as longstanding systemic health and social inequities have contributed to an increased risk of severe illness and death from COVID-19.”
Federal teams that have come to New Hampshire to help administer monoclonal infusions will now likely be assigned to other tasks, like staffing vaccination sites, because supply of monoclonal treatments is more limited, said Gov. Chris Sununu at a press conference Wednesday.
But McLeod says staffing may still be an issue, as supply remains in question. The infusion process of monoclonal antibodies is time-consuming and labor-intensive. “The actual infusion isn't that long, but you have to monitor folks for an hour afterwards,” McLeod explained.
Additionally, he says, one of the newer options available to Concord Hospital to treat outpatients with COVID requires three consecutive days of infusions rather than one, which is also more time intensive.
Even before the new state guidance, the treatments could be difficult to access for patients who don’t already have a primary care doctor, McLeod says, because recommendations for the treatment often come from a physician.
“It would likely be a challenge for a person without a primary care provider, who did a home test, to try to navigate the system” he said.
Access to timely COVID testing, McLeod said, is another barrier, because treatments have a time limited window when they are most effective.