While there are treatments available to help fight COVID complications, they are in very short supply.

The ever-evolving science of the pandemic applies to therapeutics being developed to treat COVID-19 infections, and omicron has meant a shift in which treatments work and don’t work for keeping patients out of the hospital.

In previous variant waves, monoclonal antibody treatments were limited but fairly effective at treating patients who were at higher risk for being hospitalized with the virus.

Patients with access to the treatment would get an infusion of antibodies fairly soon after testing positive, in the hopes that treatment would help keep them out of the hospital.

Omicron has thrown providers a curveball, however. The Food and Drug Administration limited the use of certain antibody treatments last week because they are less effective against the variant .

That leaves hospitals with two antiviral pills, Pfizer’s Paxlovid and Merck’s Molnupiravir, as well as sotrovimab, a monoclonal antibody product, all of which are under emergency use authorization for treatment of COVID-19.

While the new therapeutics offer hope and have been working in some patients to prevent hospitalization and more severe disease, supplies are scarce.

Both the federal and state health departments have developed stringent allocation guidelines to prioritize which patients are most eligible for these treatments.

The Department of Health allocates the limited supply coming into the state to medical hubs throughout Washington, including MultiCare and Providence providers, as well as other pharmacies, with additional federal doses going to clinics like CHAS.

With limited supplies, the department has issued eligibility guidelines for physicians to target treatments to those who are most at risk for severe COVID disease.

Monoclonal antibody treatment is prioritized for the following:

• Fully vaccinated and boosted people 70 and over, pregnant people or those who are moderately to severely immunosuppressed.
• Unvaccinated or partially vaccinated people with a condition or disease that makes them higher risk, including but not limited to: people 65 and over, in disproportionately impacted communities and people with underlying health conditions, including cancer, kidney disease, diabetes, obesity, transplant recipients, and people who are pregnant or immunosuppressed.

Paxlovid and Molnupiravir can be used to treat COVID for people in the above categories, with some notable exceptions. Molnupriavir cannot be given to those that are pregnant, while Paxlovid can.

Paxlovid cannot be used in patients who take certain medications to treat severe liver or kidney disease.

Both pills are five-day courses, and patients are ideally prescribed within five days of being diagnosed with COVID-19 or when they become symptomatic.

But there is simply not enough to go around.

In the Spokane and Coeur d’Alene region, there is enough Paxlovid allotted to providers to treat 620 patients, with just 32 courses currently available.

For Molnupiravir, there is enough medication to treat 1,680 patients, and 650 courses are available, according to data from the Department of Health and Human Services’ therapeutic distribution locator.

The limited availability, plus the limited time window in which these medications are effective, make access even more challenging.

Access to these treatments should be “the sooner the better,” said Dr. Cara Beatty, chief medical officer at Providence Medical Group.

Ideally, someone who is at risk of being hospitalized with the virus who qualifies for the treatment would get an infusion or start taking the prescriptions within five days of becoming symptomatic or testing positive. Beatty said they can go up to 10 days out from the time a person tested positive or started showing symptoms for treatment.

This makes coordination extremely important, and Beatty said Providence is getting self-referrals from patients with underlying health conditions as well as referrals from case investigators or health care partners with patients who would qualify for treatment.

With supply limited, Beatty said they are closely adhering to state and federal allocation guidelines to ensure the people who need the treatment most, get it.

Vaccinations, the best way to stay out of the hospital with COVID-19, are available widely in the community to all residents 5 and over. People ages 35 and older in Washington state who are unvaccinated against COVID-19 are seven times more likely to be hospitalized with the virus than their fully vaccinated peers.

Beatty said the percentage of people hospitalized with just two doses is lower, particularly when it comes to patients who need the intensive care unit. Three doses of the vaccines are better, she said.

And while the COVID therapeutics are good, “none of these three things are as effective as vaccination,” she said.

The Department of Health anticipates the federal allocation of these antivirals to increase through the spring, and providers hope that will happen. In the meantime, providers are using stringent guidelines to protect those most at risk.

“We need more,” Beatty said. “We are very optimistic about these treatments making a difference.”