When everyone was scrambling for a Covid-19 vaccines last year, public health officials liked to say that the best kind of shot was the one you could get. Today, doctors are scrounging for a limited supply of Covid-19 treatments, and unfortunately, that same maxim doesn’t apply. Not all treatments are effective in treating omicron patients, and the ones that do work are in very short supply.
Take Raghu Adiga, the chief medical officer at Liberty Hospital in the surburbs of Kansas City, Missouri, where vaccination rates remain abysmally low. After two weeks without the antibody therapy sotrovimab, he was told that in the coming days his medical center could expect a new shipment of … six doses. “Who am I going to give it to?" he asked.
Infectious disease doctors nationwide are riding the omicron wave without the best existing treatments. Steady supplies of new drugs aren’t expected to materialize before the surge has passed. Doctors are left puzzling their way through complex calculations of what’s available, which medicines to use, and which patients are most in need.
Their predicament illustrates the continuing need for new Covid treatments and for greater supplies of those that exist.
Sotrovimab is currently at the top of everyone’s wish list. It works to neutralize the coronavirus before it can infect cells. But as the only antibody treatment still standing against omicron, sotrovimab is also the hardest to come by. GlaxoSmithKline and Vir Biotechnology, which manufacture it, are working to meet the surge in demand, but they’re unlikely to establish a steady supply before omicron is over.
Next in demand is Pfizer’s antiviral Paxlovid, a pack of 30 pills taken over five days. Paxlovid was granted emergency authorization in late December amid much fanfare, because an oral treatment promised to give doctors an easy way to keep people out of the hospital. In theory, people who tested positive at home could simply call their primary care doctors for a prescription.
In practice, supplies are so scarce, infectious disease doctors have become de facto gatekeepers of the drug, says Peter Chin-Hong, a specialist at the University of California, San Francisco. One problem is that the public still doesn’t know to ask for the pills, and even when they do, many general practitioners aren’t comfortable prescribing them, Chin-Hong says. Paxlovid combines Pfizer’s new antiviral with an older HIV drug known to interact with many other commonly prescribed medicines. A doctor will want to know someone’s history to decide whether it’s safe to use, or whether the patient should pause other drugs while taking the antiviral.
Even for doctors comfortable with prescribing Paxlovid, tracking down doses can be an odyssey because pharmacy supply databases are often out of date, or the one available pill pack is too far away, says Shivanjali Shankaran, an infectious disease specialist at Rush University Medical Center, in Chicago.
Molnupiravir, an oral antiviral from Merck that was also authorized for emergency use last month, is somewhat more available. But its benefits looked more modest in clinical trials, and it carries safety warnings (it shouldn’t be given to anyone who is or plans to become pregnant), and these seem to be steering doctors toward Paxlovid.
One drug that is readily available is Veklury, an antiviral developed by Gilead Sciences that’s administered intravenously to hospitalized Covid patients. Perhaps more recognizable by its generic name, remdesivir, this was the first Covid antiviral to get the FDA’s nod. But the evidence that it helps those patients recover is shaky.
Nevertheless, hospitals are using it because it’s what they have. Indeed, Gilead’s sales of remdesivir in the third quarter were $1.9 billion, more than double the previous quarter.
There’s a decent case to be made for using remdesivir in an outpatient setting — that is, providing it to newly diagnosed Covid patients in infusion centers rather than hospitals. A recent study showed that giving someone the drug within the first seven days of symptoms appearing lowered the risk of hospitalization or death by 87%. Yet many hospitals don’t have the staff, beds or infusion capabilities to offer it in that setting, says Andrew Badley of Mayo Clinic.
Doctors’ reluctance or inability to use some drugs against omicron demonstrates the ongoing need for new Covid-19 treatments that are safer and easier to use. It’s essential that drug makers continue this search.
Perhaps the current scramble for treatments will soon pass — along with the omicron wave. Even so, it should serve as warning that doctors and hospitals will need to be better supplied for any next variant that comes along.
Congress can help, as it now considers adding Covid relief to the omnibus government funding bill — by providing funding to ensure that hospitals stock
Lisa Jarvis, the former executive editor of Chemical & Engineering News, writes about biotech, drug discovery and the pharmaceutical industry for Bloomberg Opinion.
