According to Kevin Dieckhaus, chief of UConn Health’s Division of Infectious Diseases, it’s nowhere near enough.
“We’re having to be very selective on who can receive monoclonal antibodies,” he said. “The demand far outpaces the supply.”
The U.S. Food and Drug Administration first approved a monoclonal antibody treatment for use on COVID-19 cases last November under an emergency use authorization.
The authorization for that first treatment, bamlanivimab, made by Eli Lilly, was revoked but, since then, several similar treatments have been approved and shown to be effective.
On Dec. 8, FDA approved the use of a new, long-acting monoclonal antibody treatment for immunocompromised patients, though it is not in wide supply yet.
“The monoclonals that we previously had a huge supply of aren't considered effective anymore,” said Brooks Walsh, an emergency room doctor at Bridgeport Hospital. “Monoclonals at this time, as of last shift, were not easily available.”
“The new injectable monoclonal is in extremely short supply, and the oral medication that just got approved by the FDA is rarer than hens’ teeth so far,” he said.
Paxlovid, an antiviral pill developed by Pfizer, was approved for use earlier in December. The first shipments reached Connecticut hospitals on Dec. 27.
Monoclonal antibodies have, in the short time since they were approved for use, proven to be very effective, particularly if they are used early in the course of disease, experts said.
“Monoclonal antibodies are a very good intervention right now, because it is something you can do early on,” said Mauricio Montezuma, an attending physician at UConn Health in infectious diseases.
Ulysses Wu, head of infection prevention at Hartford HealthCare, said the issue is not the availability of monoclonal antibodies but the “bandwidth” to administer them.
“The issue that health systems are facing is the availability and bandwidth to distribute and infuse the medication,” he said.
For Dieckhaus, the limited availability of what has proven to be a life-saving treatment presents something of an “ethical quandary.”
“A majority of patients in our hospital are unvaccinated,” he said, and “people who are unvaccinated are taking up a lot of resources.”
Should Dieckhaus and medical professionals like him provide an “intense treatment” in limited supply to patients who have eschewed the best defense against severe illness from COVID?
“Versus, do you give that to someone who has basically done everything right,” he asked. “That’s been a real ethical dilemma. I’ve been called out for it.”
It’s a dilemma that Dieckhaus has already resolved. He likened the situation to treating a patient who didn’t wear a seat belt before getting into a car wreck.
There would be no hesitation to treat a patient in need, he said: “We don’t sit back and assign blame. We don't let that alter our management.”
“Whatever tool you have, you want to apply it to help the greatest number of people or the greatest impact,” he said. In this case, the greatest impact might be someone who chose to be unvaccinated.”
