Two newly approved antiviral COVID-19 medicines are unlikely to "make a dent" in the escalating omicron surge in Colorado, officials said this week, as hospitalizations rise and the supply of monoclonal antibodies remains tight.
The antibodies formed a cornerstone of Gov. Jared Polis' response to the fall surge, which at one point threatened hospital capacity statewide. The treatments helped avoid hundreds of hospitalizations in November and December, he and other officials said.
But only one of the three antibody therapies is effective against omicron, sharply curtailing the national supply. That shortage won't be offset by the arrival of the antiviral pills, which come as omicron rips through Colorado, breaking records for positivity and case rates.
"If there were enough available, yes, it would absolutely help," said Rosemary Rochford, a professor of immunology and microbiology at the University of Colorado's Anschutz School of Medicine. "But this surge is going to go so fast. It's going to go up and over (by the time supply has improved)."
The antivirals are prescription pills that a person needs to start taking shortly after testing positive for the virus to prevent severe disease or death. Because they're pills, Rochford said, they're more accessible than monoclonal antibodies, which are administered via IV infusions. In the next several months, she added, antivirals will become increasingly important as supply improves.
But for now, they won't be able to replace antibodies. Before omicron, Colorado received between 4,000 and 5,000 doses of monoclonal antibodies each week, Scott Bookman, the state's COVID-19 incident commander, said at a news conference last week. That's dwindled to between 300 and 400 doses a week. Sotrovimab, the antibody treatment that's still effective against omicron, is being conserved more closely by hospitals for use only in the most at-risk patients.
Cara Welch, spokeswoman for the Colorado Hospital Association, said hospitals that can't get sotrovimab are transitioning away from providing antibodies and are shifting resources to testing.
She reiterated Rochford's point about antivirals being too little, too late.
"While this new option will be helpful in the long run, it’s likely that we will not have enough supply to make a real dent in what we anticipate seeing from our current case surge," Welch said. "Demand will outpace supply for at least the near future."
Of the two approved antivirals, Pfizer's Paxlovid is more promising at preventing death, Rochford said, calling it "really exciting." But Colorado's first biweekly shipment of the drug was for only 880 doses, a spokesman for the state Department of Public Health and Environment said Tuesday.
"Our distribution strategy is focused on efficiency, equity, and impact," the spokesman said in an email. "We anticipate that the supply of these medications will increase rapidly in the coming weeks."
Omicron's impact on hospitalizations is multifaceted, officials have said. On the one hand, it appears to cause less severe disease than delta, which until two weeks ago was the dominant variant in Colorado. The wave will also likely be over quickly, said Beth Carlton, an epidemiologist with the Colorado School of Public Health.
On the other, hospitals have warned that the sheer number of people infected with omicron still means an influx of patients. Hospitalizations in Colorado are still well below what they were in mid-November, but they've quickly reversed weeks of declines; between Monday and Tuesday, for instance, hospitalizations rose by 125 patients. The total now stands at 1,292, up from 1,167 on Monday but still below 1,565 from Nov. 22.
Carlton said omicron waves elsewhere have led to increases in hospitalizations. The latter spike has been less dramatic than the former, which is good news, she said. But so many people are infected with omicron that the potential for health workers to be exposed to the virus by patients at hospitals who aren't there strictly for COVID-19 is much higher, which increases the risk of workers getting sick and needing to quarantine.
Though virtually all providers are vaccinated through state and system requirements and are less likely to get seriously ill, omicron has proven capable of avoiding immunity. With community spread so high, Welch said, omicron will have a "significant impact" on hospital staffing.
On Tuesday, 52% of hospitals reported that they anticipated a staffing shortage in the next week. Welch said that was likely an undercount. What's more, hospitals' emergency departments — already running at higher volumes — are filling further with people seeking COVID-19 tests, as long lines form at state-run sites and rapid tests remain scarce.
Kathy Howell, the chief nursing officer for UCHealth, told reporters Tuesday morning that this was the "scariest point of this pandemic." Welch said that's a "shared sentiment across many of our hospitals and hospital systems."
"Obviously we’re continuing to do everything we can, and the state is working hard to do everything we can, but I think we’re at a point where all of the easy solutions have been tried," Welch said. "And we’re staring into this future that looks pretty bleak."
The last thing that hasn't been tried, she continued, is enacting the crisis standards of care for triage, which would give hospitals the ability to determine who gets what care when resources are extremely limited.
"Certainly we’ve been doing everything we can to keep us from reaching that point," Welch said. "That’s the ultimate hard stop we’ve been trying to avoid. If this variant doesn’t produce the hospitalizations, maybe we can avoid it yet again. But just looking at the case volume … it’s very worrisome."
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January 05, 2022 at 08:30PM
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New COVID-19 antivirals unlikely to help in omicron surge as hospitals ring alarm bells - Denver Gazette
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