This commentary is by Darcie L. Johnston of Essex, who was intergovernmental affairs director for the U.S. Department of Health and Human Services from January 2017 to January of this year.
In November 2020, the first early treatments for Covid-19 infections — monoclonal antibodies — were allocated on a weekly basis to all U.S. States and Territories with guidance to implement them.
As the intergovernmental affairs director at the U.S. Department of Health and Human Services, I notified the states about the weekly allocations of these treatments, the vaccines and conducted strategy sessions with the governors.
At the start, implementing this treatment was difficult. Infected patients must be treated as outpatients and isolated from non-Covid-19 patients. In addition, health care staff shortages made it difficult to dedicate staff to administer the infusion 24/7. Also, hospitals were not compensated as much for early treatments as they are for hospital stays under the Covid-19 Relief or CARES Act legislation.
Despite those early challenges, many states developed monoclonal antibody treatment plans. Strike teams were sent into nursing homes to address outbreaks; infusion centers were set up at the community level and managed by county health departments or the National Guard. Pharmacists, under the PREP Act, are allowed to administer monoclonal antibody treatment.
In Alaska, pharmacists are administering monoclonal antibody treatment subcutaneously in peoples’ cars. Governors who prioritized early treatment in conjunction with vaccine efforts saved lives, kept hospitalizations down and reduced the need for ICU beds.
Vermont did not take this approach, relying almost exclusively on vaccines and hospital care.
During a briefing Aug. 24, 2021, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, encouraged hospitals and physicians to make greater use of the therapy.
“We want people out there, including physicians as well as potential patients, to realize the advantage of this very effective way of treating early infection,” Dr. Fauci said. “Clinical trials have demonstrated that early treatment with anti-SARS-CoV-2 monoclonal antibodies can reduce the risk of Covid-19 hospitalization or death by 70 to 85 percent. … Bottom line is this is a very effective intervention for Covid-19. It is underutilized, and we recommend strongly that we utilize this to its fullest.”
Because Vermont has been slow to adopt monoclonal antibody treatment, many have died who could have survived, or at the very least avoided a hospital stay. Of the 591 doses of bamlanivimab the state received from Nov. 9, 2020, through March 2, 2021, and the 94 doses of REGEN-COV the state received from Nov. 24, 2020, through Feb. 2, 2021, it is unknown how many of those doses may have gone unused.
Fortunately, the FDA has extended the shelf-life and these treatments have not expired and could be used today.
In total, from Sept. 13, 2021, through Dec. 12, 2021, the state of Vermont has received well over 1,704 doses of monoclonal antibody treatments directly allocated from the Department of Health and Human Services. HHS now requires states to report utilization of product and stock on hand weekly.
Vermont primary care doctors, and the public, do not generally seem to be informed about the treatment, when it should be used, and where it can be obtained.
The Vermont media has not asked the tough questions, for months, about why Vermont was not doing more to promote and aggressively implement the treatment.
A patient who receives monoclonal antibody treatment has a strong immune response that can last up to eight months. People who are obese, pregnant, have chronic conditions or are age 65 or older can benefit from the therapy, and it is also authorized for use in preventing infection in people exposed to the virus, even if they are not symptomatic (as a prophylactic measure).
It is long past time for Vermont to establish an aggressive monoclonal antibody treatment plan, starting with informing the public and the medical community about availability.
