CONCORD — Just a few weeks ago, monoclonal antibodies were a major part of New Hampshire’s strategy to unburden overrun hospitals.
The treatments, often administered in an outpatient setting intravenously, bolster the body’s defense with synthetic immune cells to help patients fight COVID-19 without hospitalization. Until recently, the treatment dramatically decreased COVID-19-related hospitalizations, especially among those at risk of developing complications from the virus.
However, as the highly contagious omicron variant swept through the country, providers quickly realized that the monoclonal antibodies that staved off serious illness in patients with delta were easily evaded by the new variant.
Now that omicron comprises an estimated 99% of COVID-19 cases in New England, most monoclonal treatments are all but obsolete.
Dr. Keith Stahl, associate chief medical officer at Catholic Medical Center, remembered the announcement in mid-January that major monoclonal antibodies were no longer effective.
“It was just devastating,” he said. “It just sucked the wind out of our sails. We’ve seen it happen in other regions in the country, but I guess in a weird way we didn’t expect it to happen that quickly.”
The FEMA team that had been sent to aid in monoclonal antibody administrations closed up shop and relocated to aid the vaccination effort. Patients who had already booked appointments were turned away.
On Monday the U.S. Food and Drug Administration made the news official when they announced authorization for the ineffective treatments would be pulled.
“Because data show these treatments are highly unlikely to be active against the omicron variant, which is circulating at a very high frequency throughout the United States, these treatments are not authorized for use in any U.S. states,” the announcement read.
Sotrovimab, the one monoclonal treatment omicron cannot evade, is in such short supply that hospitals are rationing the treatment to patients at the highest risk of developing complications.
Stahl said Catholic Medical Center would be lucky to receive 10 doses of Sotrovimab this week. He said they have enough high-risk patients to administer 10 infusions a day if they had the supply. Sotrovimab is approved for people with a wide range of conditions including diabetes, obesity, chronic kidney disease and older age.
“At the end of the day, of all the people that are considered high-risk, it still boils down to a first-come, first-served,” he said.
Matthew Johnson, a spokesperson for Concord Hospital, said they too are limited in how many doses they can provide because of supply and staffing challenges.
“I haven’t heard that there’s going to be any substantial increase in deliverable there in the near future,” Gov. Chris Sununu said of Sotrovimab at a recent news conference. “I think the whole country is asking for more. There’s just a limited supply there.”
Newly approved antiviral pills have also been shown to reduce COVID-19-related hospitalizations. However, Stahl said they are similarly in short supply and interact badly with a number of other medications.
“If you think about it, a lot of the patients who would benefit most from either of the treatments are probably people on a lot of medications,” he said.
The rise of omicron’s prevalence in New Hampshire is not all bad news. The variant has lived up to its reputation for being less severe, Stahl said. The variant often infects cells in the nose and throat, sparing the lung’s deep tissue that can generate some of the most severe symptoms.
Stahl calls the rise of omicron a “mixed blessing.” The variant has ripped through New Hampshire with alarming speed; however, a similarly sized wave of hospitalizations has not yet followed.
Richard Levitan, an emergency room physician at Littleton Regional Hospital, said even though new cases are high as they’ve ever been in New Hampshire, the ER is quiet.
“The people we have in the hospital are the leftovers from delta,” he said. “If anybody gets really sick from omicron, we’re not seeing it.”