The highly contagious Omicron variant is about to become the dominant coronavirus strain in Vermont, but the leading treatment for high-risk patients with the disease is in short supply, health officials said Tuesday.
Monoclonal antibodies can keep high-risk patients with Covid-19 from getting seriously ill. Only one of the available treatments, however, works against Omicron.
The federal government this week allocated Vermont roughly 300 monoclonal antibody infusions. Of these, fewer than 80 are sotrovimab, the drug that is effective against both Omicron and Delta.
Cases of Omicron are climbing, and there is no easy way to know which version of the virus each patient has. It could mean that some high-risk patients with Omicron would receive a drug that would not help them fight off the infection.
“We still probably have more Delta than Omicron. Any of the monoclonal antibodies would be good treatment for patients that walk in the door,” Health Commissioner Health Mark Levine said at a press conference on Tuesday.
In the meantime, Levine said, providers should choose whichever drug is available and base their decisions on the information they have. Patients with confirmed Omicron infections should be prioritized for sotrovimab infusions, Levine said.
It’s unclear exactly how many doses are still available from previous federal allocations, but Levine said the state has limited amounts of drugs from previous shipments.
The state is slated to receive a small batch of the newly approved antiviral medications that people could use at home, but the bulk of these pills likely won’t make it to Vermont in time for much of the surge.
“We’re in a little bit of a race because there isn’t much (medication supply) at all since they’ve all been approved very, very recently,” Levine said.
Vermont health authorities thus far have confirmed a handful of Omicron cases in swabs from mid-December, but the Centers for Disease Control and Prevention estimate the new variant already accounts for roughly 44% of cases in New England.
Levine projected that Vermont’s new Omicron infections would eclipse Delta cases within days, but most of the doses in the most recent federal shipment are Regeneron and Eli Lilly infusions that do not work against the new variant.
[Looking for data on breakthrough cases? See our reporting on the latest available statistics.]
A pillar of the state’s Covid-19 mitigation strategy, monoclonal antibody infusions can help keep patients from becoming seriously ill as hospital beds fill up.
Typically, the drug is administered at a hospital as an infusion with patients spending roughly two to three hours at the hospital on the day of the treatment, said Josh White, chief medical officer at Gifford Medical Center in Randolph.
“The three hours’ worth of effort now is a whole lot easier than trying to manage an ICU patient later,” White said. “So if we could get it done now we absolutely will.”
So far, the Omicron variant has caused fewer hospitalizations than previous variants of Covid-19, but even a modest increase could overload Vermont’s already strained health care system.
The state’s current guidelines suggest giving monoclonal antibodies to Vermonters who are 12 and older and are at “substantially increased risk” for severe disease. Infusions work best when given to patients no later than 10 days after symptoms begin.
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