ANTIBODY TREATMENT

Isidro Bernardino receives a COVID-19 antibody infusion in August at Titus Regional Medical Center in Mount Pleasant.

As the nationwide shortage of monoclonal antibodies for infusion centers to administer affects the nation, East Texas facilities are awaiting the arrival of those treatments.

The U.S. Department of Health and Human Services (HHS) announced shipments of sotrovimab, the monoclonal antibody treatment effective against the omicron variant, to resume this week. It will deliver 55,000 doses of product and an additional 300,000 doses of sotrovimab is expected to be available for distribution this month.

Last Wednesday, the HHS and the Assistant Secretary for Preparedness and Response (ASPR) announced the pause of further allocations of select monoclonal antibody treatments in areas of the country where the omicron variant has an 80 percent prevalence. Officials stated sotrovimab was the only treatment to be administered, but the decision was retracted just before the New Year’s weekend. On Friday, the group said other treatments could be administered but they are not effective against omicron.

“If the Delta VOC still represents a significant proportion of infections in a region and other options are not available or are contraindicated, eligible patients can be offered bamlanivimab plus etesevimab or casirivimab plus imdevimab, with the understanding that these treatments would be ineffective if the patients are infected with the Omicron VOC,” HHS said in a release on Friday. “This concern can be mitigated if virus-specific diagnostic testing in a given patient indicates infection with the Omicron VOC is unlikely.”

Dr. Tom Cummins, Division Chief Medical Officer for UT Health East Texas, said the pause was due to the therapies not being effective against the omicron variant. He added though, that he believes East Texas has already reached that 80 percent of omicron prevalence.

Cummins explained there may have been backlash because of the HHS’ pause of the distribution in areas where the delta variant, still classified as a variant of concern, is still prevalent, Cummins said. The alternate therapies remain effective against delta, but not omicron.

At UT Health East Texas’ Regional Infusion Center, located at the UT Health East Texas North Campus in Tyler, there are no sotrovimab monoclonal antibody treatments available, Cummins said, but it has been requested.

“We don’t have any of the sotrovimab. Most of our facilities that were infusing are now out of the others (treatments) as well. We may have a few doses at the North Campus facility, but we really sort of stopped distributing it because of the efficacy against the omicron variant,” Cummins said.

According to the Texas Department of State Health Services’ map of monoclonal antibody treatments, on Dec. 31, there were 35 patient courses of the sotrovimab monoclonal antibody treatment available at Christus Mother Frances Hospital in Tyler. Since then, the count has not been updated.

In Longview, only there is a very limited supply of the sotrovimab treatment at Hospitality ER and is only available for critical and high-risk patients, a representative from the clinic said Monday. There are no other facilities in the area that have the treatment, according to the state website.

Those treatment centers await the distribution of the allocation of treatment expected this month, according to the HHS.

According to the Public Health Emergency division of the HHS, between Jan. 3 to Jan. 9, Texas is expected to receive 11,376 total allocations of monoclonal antibody treatments, 2,406 of those will be sotrovimab.

There are other treatments available that remain effective against the omicron variant for those in need, including the oral COVID-19 antiviral medication, which is now available locally in limited quantities with a prescription while supplies last. Cummins said this is only recommended for use in people who are at high risk of severe illness.

Monoclonal antibody treatments have historically had an impact in hospitalization rates and local emergency room visits, but the lack of treatment now may not be as much of a problem just yet.

“If the virus does here what it has done in other countries, which is, have a really high, rapid rate and escalation in number of people infected, but the mass majority of them having a very mild infection and a very rapid decrease in the number of cases again, if that happens, then no, the lack of sotrovimab is not a big issue,” Cummins said, and added that if it persists, it may become a problem.

While some facilities across the state are seeing high hospitalization rates, Cummins said several people are testing positive in the UT Health system, but although hospital numbers have risen, they have yet to reach hospitalization levels historically seen with other variants, including delta.

“With the level of positivity we’re seeing, I would’ve expected a lot more people being hospitalized and critically ill, whereas we have a very small number on the ventilator, and while our numbers are rising, they aren’t rising at the same rate as the positive rate,” Cummins said.

At UT Health East Texas’ Tyler facilities, there are 18 COVID patients hospitalized and seven are on ventilators. There are a total of 56 patients hospitalized for COVID across the division with 10 on a ventilator.

At Longview Regional Hospital there are 13 COVID-19 patients hospitalized, according to hospital officials.

“This is kind of what I expected to see, based on what we were hearing about omicron from other countries, other places. The original reports was that it caused a milder symptom complex, so if that were the whole truth, you would expect lower numbers in the hospital, lower numbers on the ventilator, and so far, that’s what we’re seeing,” Cummins said.

He added a different variant could take hold and get into a much more vulnerable population, but so far, it’s what he expected to see.

Cummins said 90 percent of those hospitalized are not vaccinated against COVID-19. There have been breakthrough cases in some fully vaccinated and boosted, he said. Those hospitalized range in age from the mid-30s to upper 80s.

Eligible COVID-19 patients will need a form filled out by their doctor, which will act as a prescription for the infusion. To ensure the facility is utilized for patients who meet the treatment qualification standards for this type of treatment, a referral is required and walk-in patients cannot be seen. If you do not have a general practitioner, call the UT Health infusion center at (903) 877-7119 for more information.

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