https://www.theglobeandmail.com/canada/article-doctors-concerned-they-cant-access-covid-19-treatments-that-can/

Canadian physicians and scientists say they’re concerned over a lack of access to important COVID-19 treatments that can prevent some infections from becoming severe or deadly.

Health experts say the issue warrants immediate attention as cases in many parts of the country start to rise again.

Interest has grown in recent weeks over two new antiviral pills that may reduce the number of people who become severely ill with COVID-19.

While those two drugs aren’t yet approved here, Health Canada has authorized a handful of treatments called monoclonal antibodies that can reduce severe illness when given to people within a few days of symptom onset.

However, treatment with monoclonal antibodies, which must be administered intravenously, is not widely available to those who would benefit most in many parts of Canada, according to Andrew Morris, an infectious-disease physician at Toronto’s Mount Sinai Hospital and University Health Network.

“It’s almost random how people can get access to it,” said Dr. Morris, who is also a member of Ontario’s COVID-19 Science Advisory Table. “Most doctors and other health care providers have no idea how to access it.”

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Monoclonal antibodies can mimic the natural antibodies needed to fight off COVID-19 infections. While they have generated controversy in the past, notably when former U.S. president Donald Trump was treated with them after testing positive for COVID-19, mounting evidence shows they are effective and can help keep some people out of the hospital. They are generally recommended for early treatment in high-risk unvaccinated individuals or people who may not mount a sufficient immune response to COVID-19 vaccination, such as transplant recipients.

A study published last month in the New England Journal of Medicine found that sotrovimab, a monoclonal antibody approved by Health Canada in July, is effective at preventing severe illness linked to COVID-19 in some patients. In the study, researchers gave sotrovimab or a placebo to high-risk individuals who had recently tested positive. At the end of the study, 1 per cent of the sotrovimab patients had been hospitalized or died, compared to 7 per cent of the placebo group.

Some Canadian jurisdictions have started adopting monoclonal antibodies as an early treatment option to prevent high-risk patients from becoming severely ill.

Alberta announced this week that it would start offering sotrovimab to patients such as unvaccinated people 65 and older and transplant recipients.

Last month, Saskatchewan said it would start treating some high-risk individuals with monoclonal antibodies in Saskatoon and Regina.

Elsewhere, access is more difficult. Zain Chagla, an infectious-disease physician and associate professor at McMaster University in Hamilton, Ont., is running the province’s first outpatient clinic offering monoclonal antibodies to high-risk patients who recently tested positive. Dr. Chagla said some people drive in from a few hours away, but those who can’t get to the clinic miss out.

The province needs to expand the availability, Dr. Chagla said.

Alexandra Hilkene, a spokesperson for Ontario Health Minister Christine Elliott, said in a statement that Ontario Health will study the pilot to “determine the feasibility for broader administration and implementation.”

Dr. Morris said more urgency is needed, especially as cases climb in parts of Canada.

“If people cared enough, if health care bureaucracies cared enough, then they would do things to make this happen, because money needs to be put into it,” Dr. Morris said.

Dr. Chagla said part of the problem is logistical. Intravenous administration requires clinics and staff.

But the other challenge is making sure people get the treatment within five to seven days of symptom onset. Testing can be inconvenient and time-consuming.

Complicating matters is the fact some unvaccinated people are reluctant to get a COVID-19 test, in part because of the stigma associated with not being vaccinated, Dr. Chagla said.

“A lot of individuals probably don’t want to get tested if they’re unvaccinated,” he said.

He’s seen patients who received a COVID-19 diagnosis after the window for monoclonal antibody treatment closed.

“We know people that are being diagnosed on their trip to the ICU. It’s way too late for them,” he said.

Dr. Chagla said as more treatments for COVID-19 become available, policy makers and the public need to understand that timely testing is crucial to getting access to the drugs that can help.

“Testing is not just a public-health thing any more,” he said. “As these drugs come to market, we’re going to have to get people to get tested because we can prevent you from getting sick.”

Srinivas Murthy, an associate professor at the University of British Columbia’s faculty of medicine, said Canada also has to contend with supply issues, because global demand for monoclonal antibodies is increasing as more evidence shows they are effective.

He said there are discussions in B.C. about how best to use the limited supply of monoclonal antibodies for outpatients.

The challenges of rolling out monoclonal antibodies have some worried about similar problems when the new antiviral pills are approved. Although the pills do not have to be given in clinics, patients still need to get tested quickly so they can get them within a few days of symptom onset.

“Time and availability of the drug and figuring out how to give this to whom is incredibly complicated,” Dr. Morris said.

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