For weeks, Dr. Emma Dishner has been flooded with calls from patients about how they can access COVID-19 treatments as the omicron variant surges across North Texas.
Dishner, an infectious disease specialist with North Texas Infectious Disease Consultants in Dallas, said her nurse practitioner spent Monday calling all the pharmacies in the area that were said to have doses of Pfizer and Merck’s new COVID-19 pills.
She didn’t find any.
“I get texted by people I went to medical school with, random friends, friends of friends who happen to have my number,” Dishner said. “My medical assistant fields most from patients, but we’re getting inundated with calls about these treatments. They’re very, very difficult to find.”
Hospitals and physicians across Texas and the U.S. are struggling to find doses of COVID-19 treatments for their patients, even as federal allocations of coronavirus pills and monoclonal antibodies to Texas increased this week.
Just over 4,000 courses of sotrovimab, the only monoclonal antibody treatment for COVID-19 patients effective against the omicron variant, were allocated to the state of Texas for the next week, a far cry from the 38,000 requests the Texas Department of Health and Human Services received for infusion treatment from Dec. 31 to Jan. 6.
The health region that ranges from the D-FW area to just west of Abilene will get 330 sotrovimab doses for the next week, not including the courses going to the Tarrant County regional infusion center.
The state allocated 1,520 doses of Pfizer’s Paxlovid, a pill used to lessen the severity of illness in non-hospitalized COVID-19 patients, to the same health region for the next two weeks. It also allocated for the area 6,800 doses of Merck’s molnupiravir, another outpatient COVID-19 pill.
While greater access to outpatient treatments effective against the omicron variant would be beneficial, the treatments aren’t a solution to the systemic problems caused by the COVID-19 pandemic, said Dr. Alejandro Arroliga, chief medical officer at Baylor Scott & White Health System.
“It’s like you’re pouring 20 gallons of water in the Mojave Desert. Even if you pour 40 gallons or 60 or 100 or 500, it will never be enough,” he said. “If the number of COVID-19 cases cannot come down, there is no health care system in the world that, in a short period of time, can create enough doses to treat patients.”
Dishner agreed that the treatments aren’t a long-term fix for the destruction caused by the virus.
“I mean, [the treatments] would be nice to have,” she said. “I think it would also be nice if everyone could or would get vaccinated, because an ounce of prevention is way better than even a lot of our treatments.”
COVID-19 pills and monoclonal antibody treatments are designated for use in the first few days of coronavirus infection for patients at high risk of severe illness from the virus. The treatments are meant to alleviate some of the pressures felt by the health care system by keeping patients out of hospitals.
“The monoclonal antibody, in my opinion, is our best defense or best treatment for COVID, at least in the early part of COVID,” Dishner said.
In previous surges, multiple monoclonal antibodies treatments, like courses created by pharmaceutical companies Eli Lilly and Regeneron, helped fill the need for infusion treatments. The omicron variant has limited the number of treatment options for COVID-19 patients as cases continue to skyrocket.
A new forecast from University of Texas Southwestern Medical Center researchers, released Monday, projects Dallas County will see more than 10,000 new COVID-19 infections per day by the end of January. Tarrant County is expected to see more than 8,000 new infections per day.
The COVID-19 pills, authorized for emergency use by the Food and Drug Administration less than a month ago, are easier to administer than monoclonal antibody infusions.
More doses are available of Merck’s molnupiravir, although it’s not the first choice of treatments for many doctors, especially those with immunocompromised patients.
The pill decreased the risk of hospitalization from COVID-19 by 30%, according to early studies, and its use is limited because of some drug interactions. The FDA advised that it not be used during pregnancy, based on findings from animal reproduction studies that showed the drug may cause fetal harm.
“A lot of people aren’t using it for a lot of those immune-suppressed patients, especially patients who had organ transplants or stem cell transplants,” Dishner said.
Early studies of Pfizer’s Paxlovid pill found the drug reduced the risk of hospitalization or death from COVID-19 by 89%, making it much more effective than molnupiravir. Paxlovid, however, is in much shorter supply.
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