Omicron wave prompts rationing of COVID medications in Alaska

A person's bear arms with an IV drip coming from the window
Inside his car, Josh Walton receives an IV infusion with a monoclonal antibody treatment for COVID-19 at a clinic in Wasilla in June of 2021. (Photo courtesy of Josh Walton)

After learning he’d been around someone with COVID-19 last June, Josh Walton got tested at an urgent care clinic in Anchorage. He said he wasn’t too worried because he’s fairly healthy, had been fully vaccinated and didn’t have any symptoms – yet.

The test came back positive. He started feeling it that evening.

“My symptoms weren’t too bad,” Walton said. “I’ve had much worse fevers. … I felt like I was having trouble staying warm. But I wasn’t shivering, I didn’t break into sweats, I wasn’t aching. I was just tired and cold.”

The coughing began the next morning. By his third day sick, he had headaches, too. But he managed to get an appointment for a monoclonal antibody treatment at a clinic in Wasilla.

The clinic had him drive into a car canopy for his treatment. A worker in protective gear hooked up an IV bag to his arm, right through his car window. It took about an hour, plus an hour of monitoring time in case of a bad reaction.

At a clinic in Wasilla, people sick with COVID-19 drive into car canopies like this one to receive monoclonal antibody treatments in June of 2021. (Photo courtesy of Josh Walton)
A health care worker in protective gear monitors Josh Walton in his car at a clinic in Wasilla as he receives an IV infusion with a monoclonal antibody treatment for COVID-19 in June of 2021. (Photo courtesy of Josh Walton)

“Wake up the next day and felt 100% better. Like, completely better,” he said with a laugh. “Which was amazing!”

If Walton had gotten sick today, it’s unlikely there’d be any treatments available to him. The specific product he thinks he got doesn’t work against the omicron variant. Among the effective treatments, supply constraints and a surge in cases mean there isn’t nearly enough to go around Alaska.

“Right now, the COVID therapeutics are a scarce resource, and we anticipate that that will continue to be the case in the foreseeable future,” said Jeannie Monk, senior vice president of the Alaska State Hospital and Nursing Home Association.

You might have heard that there’s only one monoclonal antibody treatment that works against omicron, and it’s in very short supply.

But as it stands right now, there are four products that the FDA has given emergency use authorization to that effectively treat omicron. In addition to the one monoclonal antibody treatment infused by IV, there are three are antiviral treatments: Two are taken as a series of pills, and the third is infused in a series by IV.

The antiviral medications interfere with how the virus replicates itself. The monoclonal antibodies are copies of particular proteins the immune system produces. They attach to the spikes on the coronavirus, keeping them from infecting cells.

Alaska confirmed more than 11,000 new COVID-19 cases in the last week. That doesn’t count cases found through home tests. Alaska’s latest weekly allotment of therapeutics would only cover 1,300 people. Part of that allotment includes treatments that don’t work against omicron. Another part is for an injected product that doesn’t treat someone who’s sick but is given before exposure to sick people to prevent infection.

According to state epidemiologist Dr. Joe McLaughlin, the state’s sampling indicates that omicron is causing 80% to 95% of Alaska’s COVID-19 cases. That means the treatments that do work against omicron are in extra high demand.

This situation is why the state has its Crisis Care Committee. It met Wednesday and is about to release clinical recommendations for who should get first dibs. Jeannie Monk participates in these meetings.

“So the Crisis Care Committee has been reviewing the scientific evidence, and trying to figure out what makes most sense for Alaska,” Monk said. “What they will do is provide prioritization tiers to outline who will benefit the most from this scarce resource.”

Monk said health care providers generally follow the committee’s guidance, which will be largely consistent with what a National Institutes of Health panel published at the end of December and what Bartlett Regional Hospital in Juneau announced it was doing with the one monoclonal antibody treatment that works on omicron, sotrovimab.

You’d think the sickest people would be first in line. But most of these treatments are not for them. The FDA’s emergency use authorizations actually warn that they may make them worse.

These medications are for people with mild and moderate cases — but at the highest risk of developing a severe case. First and foremost, people with compromised immune systems. Next, older people who aren’t up to date with their vaccines. Specifically, people age 65 and up with other health risk factors, or people 75 and up.

There are more tiers. But in a panel discussion on Wednesday, Alaska’s Chief Medical Officer Dr. Anne Zink said the supply is probably too limited to get to them.

The federal government foots the bill for these treatments and controls the supply. Zink said the state is working with the feds to get as much as possible.

“Lot of cases, not a lot of resources,” Zink said. “Short period of time, trying to do the most good for the most number of people in the space that we have.”

For most people, vaccines remain a safe and much more cost-effective way to prevent severe cases of COVID-19.

Correction: An earlier version of this story misstated that all four products that the FDA granted emergency use authorization to that are effective against omicron are for people with mild and moderate cases of COVID-19. One of the antiviral medications called remdesivir is for people with COVID-19 who are hospitalized. It’s given in a series of IV infusions, not pills. It is fully FDA approved for certain patients, but still under emergency use authorization for others.

Jeremy Hsieh is the deputy managing editor of the KTOO newsroom in Juneau. He’s a podcast fiend who’s worked in journalism since high school as a reporter, editor and television producer. He ran Gavel Alaska for 360 North from 2011 to 2016, and is big on experimenting with novel tools and mediums (including the occasional animated gif) to tell stories and demystify the news. Jeremy’s an East Coast transplant who moved to Juneau in 2008.

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