Happy Nice Mall

At the start of the coronavirus pandemic in 2020, scarce ventilators and protective equipment faced a strict rationing. Today, as the pandemic enters its third year, another category of valuable products comes under tight control: treatments to fend off the severe Covid-19.

There is now a larger menu of Covid pills and infusions than at any point in the pandemic. The problem is that the resources working against the Omicron variant are extremely limited.

This has forced government health officials and doctors across the country into an anxious position of deciding which patients will receive potentially life-saving treatments and which will not. Some people at high risk of severe Covid are turned away because they have been vaccinated.

Some hospitals have run out of some medicines; others report having only a few dozen treatment courses. Staff distribute vitamins instead of licensed drugs. Others are trying to develop algorithms to decide who gets treatment.

Michigan’s chief medical officer, Dr. “There is not enough to meet the needs of everyone who will catch Covid in the coming weeks and be at risk of serious complications,” said Natasha Bagdasarian. “I don’t think there is a way to make sure it reaches all the right people right now.”

At the San Diego Family Health Centers, a network of clinics for low-income patients, staff have had to turn down nearly 90 percent of the hundreds of people who call every day and are available for Covid treatments.

Infectious disease specialist Dr. “Going home at night makes me nauseous because with this limited resource it feels like I’m deciding who should buy it,” Christian Ramers said.

As the virus rises again in the United States, an abundant supply of effective treatments will be a powerful weapon. Fueled by the highly contagious Omicron variant, Covid cases have soared to record levels, and the number of hospitalized patients has soared. increased sharply, however, Omicron tends to cause milder disease than other variants.

For most of the pandemic, monoclonal antibodies – a treatment usually administered intravenously in hospitals or clinics – have been the primary choice for recently infected patients. But the two most common types of antibodies don’t seem to work against the rapidly emerging variant of Omicron. being The dominant version of the coronavirus in the world.

There is a third antibody therapy made by GlaxoSmithKline and Vir Biotechnology that is potent against Omicron. But the federal government has ordered only 450,000 treatment courses, most of which have already been used or have not yet been delivered to the states.

Food and Drug Administration two weeks ago official The use of a new antiviral pill developed by Pfizer that shows great promise in tackling cases of Covid in general and Omicron in particular.

The federal government supplies the pill, known as Paxlovid, to states where health officials decide where to send the pills and how to advise doctors to use them.

Consumables are already running out. New York City, for example, took about 1,300 Paxlovid treatment courses at the end of December and consumed it within a week, according to a spokesperson for Alto Pharmacy, which is distributing the city’s supply. New York right now none any Paxlovid in stock.

US government on Tuesday doubled his order For Paxlovid, however, supplies will not be plentiful until April.

State and local officials say the goal is to get Paxlovid to as many vulnerable people as possible, with a particular focus on those who are immunocompromised or unvaccinated.

Unvaccinated people have a much higher risk of hospitalization or death from Covid. Director of the Center for Bioethics and Humanities at the University of Colorado, Dr. Matthew K. Wynia gave advice on how to ration the state. Covid treatments.

Only some states, such as Ohio and Nevada, have sent Paxlovid to pharmacies serving nursing homes whose residents are particularly vulnerable to Covid. Many states including Virginia, Pennsylvania, and Arizona sent most or all of their initial Paxlovid supplies to drugstore chains like Walgreens and Rite Aid.

This was to make the pills as widely available as possible. But the system rewards patients who have the time, energy, and understanding to pursue treatments.

Patrick Creighton, 48, a sports radio host in Katy, Texas, woke up with a sore throat on New Year’s Eve. He was vaccinated but tested positive later that day. Worried that diabetes was increasing her risk of getting seriously ill, she decided to call Paxlovid, which she had read about.

The next day, a telemedicine doctor wrote him a prescription. Now he needed to find a pharmacy that had Paxlovid in stock. He said he called 18 pharmacies within driving distance: one Brookshire Brothers, four Krogers, four HE-B, three Walgreens, three CVS stores and three Walmarts. None of them had pills.

His 19th call was the winner: A nearby Walmart had Paxlovid in stock. The ordeal wasn’t over yet. He was mistakenly told that he might have to pay $500 for free treatment. He later had to see a second telemedicine doctor due to an issue with the way his prescription was sent. Then his wife had to take a second trip to Walmart to get the pills. But at the end of the evening of January 2, she took the first three tablets of the 30 pill regimen.

Mr Creighton said he was worried about patients like him who couldn’t get over the barriers. “It should be readily available to everyone.”

GlaxoSmithKline antibody therapy is similarly difficult.

Staff at the University of Pittsburgh Medical Center administer 400 to 800 antibody treatments each week, down from 2,000 to 3,000 before Omicron finished Both products are useless. Demand has grown rapidly, but the hospital no longer has enough resources.

“It’s devastating to tell these patients, ‘Sorry, we can’t do anything for you, we only need to save this drug for our most severely immunocompromised patients,'” said Erin McCreary, infectious diseases pharmacist at the hospital.

Miami retiree Louis Shantzek tried but failed to receive an infusion of antibodies last week after testing positive for the virus. 72 years old and has diabetes and heart disease – all factors normally make it fit to receive an antibody therapy.

Mr. Shantzek’s symptoms included aches, fatigue and a bad cough. When her adult daughter called two nearby hospitals, she was told she had received three doses of the vaccine and was therefore unable to receive an infusion of antibodies, as she was considered to be at relatively low risk.

“It’s like being told, ‘You’re doing everything you have to do, and yet we’re not going to help you,'” said Mr Shantzek, whose symptoms have since eased.

This is not the first time that scarce resources have forced hospitals and doctors to make painful treatment decisions during the pandemic. Remdesivir, an early intravenous treatment, became so popular that hospitals had to restrict its use. Remdesivir resources have since become more plentiful, but the treatment is primarily used for patients already hospitalized with severe Covid.

Drug manufacturers say they are working as fast as they can to produce more treatments.

When the FDA authorized use of the treatment last May, the federal government did not immediately order the supply of the GlaxoSmithKline antibody. At the time, the country had an abundance of other antibody treatments.

In the fall, Biden’s administration ordered about 450,000 doses – the maximum amount Glaxo can deliver since the British company has committed to fulfilling orders from other buyers. (The U.S. government said it plans to purchase another 600,000 treatment courses.)

Meanwhile, Pfizer developed Paxlovid in less than two years. But it takes up to eight months to manufacture the pills. While Pfizer started producing them before embarking on a major clinical trial of the drug last summer, large quantities are only now beginning to be available.

A growing number of hospitals are placing restrictions on treatments.

In western Indiana, Sullivan County Community Hospital officials last month restrict suitability for antibody infusions, after weeks of taking much less doses than they had ordered. They chose to exclude vaccinated people almost entirely.

“Maybe when you have a family member or neighbor who doesn’t meet the requirements, or your child’s teacher at school, it makes some of these restrictions harder to enforce,” said Lori Resler, the hospital’s chief nurse. officer.

Director of infectious diseases at the University of Texas health system, Dr. Luis Ostrosky said in Texas, doctors and their staff search a long list of pharmacies to see who has Paxlovid in stock before prescribing the treatment. The idea is to avoid sending patients on a wild goose chase, as many pharmacies only take 20 Paxlovid treatment courses.

On Monday, Brooks Rizzo, a family nurse, and Ruleville, Miss.

Ms Rizzo said her clinic has not received any antibody treatment since December 24 and not between hospitals They were originally selected to receive Paxlovid materials. He said clinicians resort to providing vitamins and over-the-counter medications.

An infectious disease specialist at the University of Washington, Dr. Shireesha Dhanireddy said she spent last weekend reviewing charts of Covid patients to find out who should receive scarce treatment. There are tens of thousands of patients in the three hospital systems, but only 60 cycles of Paxlovid. Those taking the pills include patients receiving certain types of chemotherapy and patients who have recently had an organ transplant.

At Johns Hopkins University, infectious diseases and epidemiology expert Dr. Kelly Gebo said employees are rushing to develop algorithms to help allocate scarce treatments. As part of the shortage problem, workers are getting sick, making it difficult to deliver resource-intensive treatments such as monoclonal antibodies.

“Not being able to provide optimal care when we have limited resources is frustrating as healthcare professionals,” he said.

Sharon LaFraniere contributing reporting.