We Have More, but Fewer COVID-19 Treatments
For many, Omicron presents an eerie sense of déjà vu. It feels like we are returning to the beginning of the pandemic.
But there are two critical differences. The first is the vaccines. But the second may prove to be more beneficial in the coming weeks – the treatments.
We now have more proven COVID-19 treatments than at the beginning of the pandemic, but they remain curiously scarce despite calls from policy experts to increase availability. Some of the latest treatments are even designed for at-home use, ostensibly to reduce the need for hospitalization, the principal metric used to determine COVID-19 impact.
These treatments have the potential to reduce the clinical and economic burden of Omicron, particularly since the variant can evade both natural and vaccine acquired immunity. But the Food and Drug Administration (FDA) has limited manufacturing to date, even for emergency use.
Within the limited supply authorized by the FDA, each state can allocate its own system for distributing and administering the treatment. For example, in Indiana, certain treatments will go to only designated hospitals and pharmacies. All of which is to say these treatments will be hard to find.
Which is a shame, because these treatments can combat severe COVID-19 cases among high risk populations and breakthrough COVID-19 cases among the fully vaccinated. Many healthcare workers on the frontlines of COVID-19 will tell you that no one treatment has proven consistently effective. They need as many tools as possible at their disposal. In this vein, limiting proven treatments seems to be an odd decision – until you consider the full context.
“None of these therapies that [we are] talking about, whether [it is] antibodies or the pills, are anywhere near as effective as vaccination”, said Dr. Helen Boucher, interim dean of Tufts Medical School. Her statement reveals more than she likely had intended. For it belies the lingering belief among public health leaders that more readily available treatments will lead to lower vaccination rates.
While never explicitly framed as such, this belief among the powers that be is responsible for the limited number of treatments. But coupling vaccines with treatments reduces the care for COVID-19 patients into a dichotomy – either vaccines or treatments.
It becomes a zero sum game. One comes at the expense of the other, which might have been true when vaccination rates were low and most available treatments were speculative.
But Omicron presents a unique dilemma. This late into the pandemic, the game has changed because it is no longer zero sum. It is varying shades of gray – meaning the optimal patient outcome might be getting vaccinated and having access to treatment.
The rules of the game should not be defined by constraints on the number of treatments available, but by clinical need. If a patient, regardless of underlying risk, benefits from treatment, then he or she should have access to it. Stratify treatment availability according to clinical need and vaccination status, assuming one or both may be needed in the course of treating patients.
COVID-19 is a long term condition and people previously treated or vaccinated may be infected again. All treatment options and vaccines must be available as they are needed since the clinical conditions for many patients change over time.
Yet policy makers remain affixed to the notion that more available treatments will reduce vaccination rates – and therefore fewer treatments will increase vaccination rates – and through such faulty logic have created a veritable prohibition on COVID-19 treatments.
But reducing the discussion around vaccines and treatments into a dichotomy presents an interesting conundrum – how to balance the perception of treatments with the clinical need for them?
Unfortunately, it seems that the perception will outweigh the need and that the ones who will suffer are the patients. In that sense, we are right. This is déjà vu. We are returning to the beginning of the pandemic.
Antibiotic Prescriptions Associated With COVID-19 Outpatient Visits Among Medicare Beneficiaries, April 2020 to April 2021
Outpatient Visits for COVID-19 and Associated Antibiotic Prescriptions Among Medicare Beneficiaries Aged 65 Years or Older, by Setting, US, April 2020 to April 2021. The volume of COVID-19 visits differed by setting: emergency department, 525 608 (45.8% of all visits); office, 295 983 (25.3%); telehealth, 260 261 (22.3%); and urgent care, 77 268 (6.6%).
Source: Journal of American Medical Association Network