Breanna Reeves | The IE Voice
Over the last two years, the pandemic has exposed and uncovered inequities that exist in the American health care system. Throughout the pandemic, concerns regarding disproportionate access to COVID-19 testing, vaccines, masks and COVID-19 treatments have been brought to the forefront.
A study that examined racial and ethnic disparities among people who received COVID-19 treatments was recently released as part of the Center for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report. The study found that between March 2020 and August 2021, there was a lower use of monoclonal antibody treatments among Black, Asian, Hispanic and other races who tested positive for COVID-19 relative to white patients.
Monoclonal antibodies are molecules created in a laboratory that act as substitute antibodies in the body and in the case of COVID-19, attempt to block or neutralize the virus that causes COVID-19 to attach to human cells.
Research noted that the overall use of monoclonal antibody treatment was “infrequent,” but found that Hispanic patients received monoclonal antibody treatment 58 percent less often than did non-Hispanic patients. Black patients received treatment 22 percent less often than white patients and Asian patients received treatment 48 percent less often during November 2020 – August 2021.
The study surveyed 41 health care systems that participated in the National Patient-Centered Clinical Research Network. There were several limitations to the report such as the short period of time by which the survey was conducted, it only examined 41 health care systems and did not identify the underlying causes for the observed disparities.
Despite the limitations, Dr. Cameron Webb, Senior Policy Advisor for COVID-19 Equity on the White House COVID-19 Response Team, explained that although the findings are not nationally representative, they are instructive and give insight to what is happening in regard to COVID-19 and disparities. According to Dr. Webb, an updated study is needed since the use of monoclonal antibody treatments significantly increased after August 2021 which is when the research cuts off.
“But even that notwithstanding, we’ve done a lot to build equity into the monoclonal antibody treatments, but also with these new oral antiviral (pills) because of the three monoclonals, only one of them is effective against Omicron,” said Dr. Webb in an interview with Black Voice News/ IE Voice.
Dr. Webb also pointed out that the study only captures data from people who received monoclonal antibody treatment in healthcare settings, but didn’t account for government-run infusion sites that were set up.
The treatments were initially approved for Emergency Use Authorization by the Food and Drug Administration (FDA) beginning in November 2020. Since then, availability of the treatments have increased across the U.S. as COVID-19 cases increased.
There are several kinds of monoclonal antibody treatment options available to individuals who are identified as immunocompromised and have other medical conditions. These treatments are intended for people who experience mild-to-moderate symptoms and who may be at higher risk for progression to severe COVID-19. The National Institute of Health released guidance for prioritization of treatment.
Earlier in the pandemic, there were three kinds of monoclonal antibody treatments that were effective against circulating variants: Regeneron (combination medicine of Casirivimab and Imdevimab), Lilly (Bamlanivimab and Etesevimab) and Sotrovimab. These treatments are administered through injections into the vein or muscle, or through an infusion.
However, with the onset of Omicron, which is highly transmissible and more aggressive than previous variants, only Sotrovimab is effective against it, so there has been a shift away from using the other two products, according to Dr. Jennifer Chevinsky, deputy public health officer at Riverside University Health System.
The CDC COVID-19 Data Tracker estimates that Omicron now accounts for 99 percent of COVID-19 cases which has prompted the FDA and health facilities across the U.S. to stop the use of Regeneron and Lily monoclonal antibody treatments.
Another monoclonal antibody treatment is Evusheld. Evusheld is an investigational drug, not yet approved by the FDA, but was given Emergency Use Authorization (EUA) in December. Evusheld is a pre-exposure preventative medication for those who are at the highest risk of severe disease as a result of COVID-19.
“(Evusheld) is anticipated to protect them for around six months. And the important part of it [is] it’s not in replacement of the vaccine, but it’s in addition. So, it’s people that perhaps got the vaccine, but they may not still [be able to] mount as much of an immune response because of the condition that they have. And this additional treatment can help provide protection for them,” explained Dr. Chevinsky.
In Riverside County, there are two regional Evusheld locations: Desert Regional Medical Center and Eisenhower Medical Center.
In addition to monoclonal treatments, there are other treatment options such as an oral antiviral treatment and Remdesivir. Oral antiviral treatments are pills that can be taken if an individual tests positive for COVID-19 and is effective if taken within five days of having symptoms. There are two types of antiviral treatments: Pfizer’s Paxlovid and Merck’s Molnupiravir, which can only be obtained with a prescription from a doctor.
Remdesivir is an additional treatment option that is administered through the veins and is completed over three consecutive days. The treatment requires a patient to come in one day, then return home and do so for the following two days. These treatments are regulated through hospital facilities who order the medication, so it may not be offered at all hospital facilities in the county.
Dr. Chevinsky explained that the challenge with the oral antiviral pills and the monoclonal antibody treatment Sotrovimab is that these products are allocated from the federal level to the state and then to the local level. There has been a shortage with both products, but for different reasons. The antiviral pill is a newer product that only became available for emergency use last December for the treatment of mild-to-moderate coronavirus disease.
Riverside County is still experiencing an increase in COVID-19 cases and a slow rate of vaccinations and boosters. Riverside has reported 2,393 new cases on January 25 and 1,069 current hospitalized patients, including 168 Intensive Care Unit (ICU) patients.
According to Dr. Chevinsky, monoclonal antibody treatment sites in the county are going through all of the products week by week. “And this is what we’ve seen for a number of weeks now is that we’re maxing out the product every single week because of the need. We definitely are in a supply situation where the resources are tight around there.”
COVID-19 treatments are reserved for people who are at a higher risk such as people in older age groups and those with underlying health conditions like heart disease or cancer. Each treatment option has a specific assessment and criteria that allows medical professionals to examine which treatment is the best option for individuals.
Riverside County uses Sotrovimab across four sites throughout the county. People can seek monoclonal antibody treatment, even without a physician referral, if they call ahead of time at the following centers: Riverside University Health System Medical Center (951-486-6520), Desert Oasis Healthcare (760-969-6555), Eisenhower Medical Center (760-834-3516) and First American Wellness.
“All the regional centers that we set up, the idea behind them…was an equity focus in mind — wanting to remove barriers, so that regardless of what plan a person has in terms of insurance, even if they don’t have an insurance, that they were able to access any one of these sites without any out of pocket costs,” said Dr. Chevinsky.
In an effort to fill geographical gaps, Riverside added additional “equity sites” in communities that may not have access to local pharmacies like CVS or Rite-aid that have antiviral medication on hand, but still need access to COVID-19 treatments.
Dr. Webb addressed that with all the efforts to address gaps in access and availability to COVID-19 treatment and other resources, the pandemic has highlighted that “not enough people have access to the care that they need.”
“I think what it’s also teaching us is that not all communities are affected in the same way. And the communities that are disproportionately affected, we’d do well as a government to provide outsized resources to those communities. It helps everybody by keeping our communities safe,” said Dr. Webb.