“Monoclonal Antibody Treatments Save Lives,” announced the New York City Department of Health in an October 26 public notice. These treatments “are available and lifesaving,” the agency said, noting that they “have averted at least 1,100 hospitalizations and at least 500 deaths among people treated in New York City.” The agency urged the public to seek out these monoclonal antibody treatments as soon as possible: “When given early after symptom onset, mAb treatments can decrease the risk of hospitalization and death due to COVID-19, which is why it is crucial to get tested for COVID-19 as soon as symptoms begin – the sooner someone is tested, the sooner treatment can begin.”
The city’s health agency quoted its own Health Commissioner Dr. Dave A. Chokshi: “the science shows that monoclonal antibody treatments work and can make all the difference when it comes to the severity of COVID-19 illness.” It thus urged that “treatment should be given as soon as possible after someone tests positive for COVID-19.” Studies from Pfizer, cited by the agency, independently demonstrated just how effective the company’s antiviral treatment, called Paxlovid, can be: it “decreased Covid-19-linked hospitalisation or mortality risk from any cause by 88%.”
New York City Department of Health Press Release, Oct. 26, 2021
But with the Omicron variant now the dominant COVID strain in New York, both the city and state are facing severe shortages in the availability of effective antiviral monoclonal treatments. While Pfizer claimed its antiviral treatment would work against Omicron, the New York State Department of Health issued a memo to all health care providers this week warning that “Sotrovimab (Xevudy) is the only authorized monoclonal antibody product expected to be effective against the omicron variant.” Yet due to “a significant surge in cases and reduced effectiveness of existing therapeutics due to the omicron variant,” the agency warned that “supplies of oral antivirals will be extremely limited initially.” As of this week, the agency also said the same of its monoclonal antibody treatment: “supplies of Sotrovimab are extremely limited.”
These severe shortages mean that there will be far more people who are sick from COVID than there are available doses of antiviral and monoclonal antibodies treatment. That, in turn, requires that healthcare providers make decisions about who should be prioritized to receive such life-saving treatments and who should be deprioritized, and which factors ought to be used to determine priority.
Before determining priority schemes, it must first be determined which groups of COVID patients are eligible at all to receive these potentially life-saving treatments and which from the start are declared ineligible. The state Department of Health memo sets out the list of all factors which must be met in order for a patient to be eligible. They include age (must be older than 12), COVID status (must have tested positive), and progression of the virus (must have “mild to moderate COVID-19 symptoms”).
Then there is an additional requirement that makes intuitive sense: the COVID patient must “have a medical condition or other factors that increase their risk for severe illness.” It makes sense that the government would seek to prioritize those who are at higher risk for developing severe illness.