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Health care system overload impacting Utah's monoclonal antibody distribution

Bamlanivimab, a monoclonal antibody infusion administered to individuals who are already diagnosed with COVID-19, is seen at a family health center.

Bamlanivimab, a monoclonal antibody infusion administered to individuals who are already diagnosed with COVID-19, is seen at a family health center. (Patrick Dove, USA Today Network)

Estimated read time: 4-5 minutes

SALT LAKE CITY — Overloaded health care systems and burned out health care workers were among problems in effectively distributing monoclonal antibody treatments highlighted by Utah Department of Health representatives in a presentation before the state's Health and Human Services legislative interim committee Wednesday.

When monoclonal antibody treatments were first introduced and authorized for emergency use by the U.S. Food and Drug Administration, they were considered a scarce resource. The FDA authorized the use of monoclonal antibody treatments to treat or stop COVID-19's progression in a high-risk person who tests positive and to prevent COVID-19 in a high-risk person who's been exposed.

The FDA later expanded its definition regarding high-risk, broadening the reach of people who qualify for treatment. Those who qualify must test positive for COVID-19 in fewer than 10 days, not be hospitalized or on oxygen due to the disease, and be at high risk for serious or severe disease.

Following the authorization, Utah officials prioritized the use of the treatment and quickly created a risk stratification model while collaborating with health systems on how best to use the resource, Michele Hoffman, deputy director at the Utah Department of Health, said. The system has been updated continuously relating to conditions of the pandemic and supply, she added.

But what once was considered a scarce resource and was in high demand is now being underutilized.

Health department data revealed that over the last several weeks, less than half of all monoclonal antibody treatments allocated to the state were being used. The department is working to address the gaps between doses administered and those that remained unused, Hoffman said.

The department outlined constraints health care systems are facing and solutions being put in place to help address them.

"Initially, supply was scarce and led to creation of the risk score to drive appropriate utilization. Today, human resources to administer monoclonal antibody treatments are the constraint, not available doses," officials told lawmakers.

The FDA's expansion of high-risk will allow the treatments to be utilized more, the department said. To help increase the public's knowledge regarding eligibility they've initiated billboards, social media campaigns and outreach to communities. The department has also deployed its Poison Control Hotline staff to connect with the public on questions regarding eligibility and how to schedule an appointment.

Other efforts by the health department include:

  • Provider letters are being sent to physicians to help support broader education.
  • Educating the public regarding COVID-19 testing, symptoms, and the time constraints of administering the monoclonal antibody treatment within that time.
  • Revamping the Utah Department of Health website to help individuals identity eligibility and treatment locations without putting increased demand on providers.
  • The addition of three Utah National Guard members to help monoclonal antibody treatment efforts and expand capacity.
  • Three additional treatment sites to expand capacity — at Davis Hospital, UDOH Murray, and Nomi Health in Orem.
  • Working with long-term facilities such as prisons and other areas with vulnerable populations.

The lack of utilization of the treatment was a point of frustration and concern for some Utah legislators.

"It's infuriating," Sen. Jacob Anderegg told Hoffman. "Over 60% of available doses, sitting there — that seems like a massive misallocation of our resources and a massive lack of focus for this potential life-saving (treatment), especially in those high-risk individuals."

Utah Department of Health Executive Director Nathan Checketts was quick to respond, reminding Anderegg of the persisting problem of overloaded health systems and burned-out health care workers — pointing to the system attempting to manage treatments amid high hospital bed counts.

"There is a scarcity in our system and it's the human resources required to administer a therapy that takes on the order of two to three hours per patient. It isn't just putting a shot in someone's arm, it takes human resources," Hoffman explained. "It's a very complex system that we're talking about."

The statement drew a terse response by Andregg, a businessman, who argued that "it's not that complex" and it "isn't rocket science."

The dialogue represented highlighted national conversations and rising tensions amid the ongoing COVID-19 pandemic.

Rep. Steve Eliason, R-Sandy, who works with hospitals, told the committee that health care workers are exhausted and demonstrated the point with a personal anecdote. He said that a nurse he worked with had broken down amid the pandemic-related stress, and that a patient had pulled a weapon when asked to put on a mask.

"The question I would pose then is: If anybody has any good ideas on where to find qualified nurses and health care workers to help out in this effort, I'm all ears," Eliason said. "If there's any great ideas of how we can bolster our health care workforce to come riding in and save the day, I would be the first one to love to hear those ideas."

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