KAWARTHA LAKES-Some doctors who work in Toronto area hospitals are expressing concern about the unavailability of approved COVID-19 treatments in Ontario. They are also concerned about how public health is handling those who test positive for the virus.
The Public Health Agency of Canada approved the use of monoclonal antibodies to treat early COVID-19 in patients. Monoclonal antibodies are like the antibodies your body makes to fight viruses and other bugs according to Web MD. They are designed to target the Coronavirus spike protein. When the antibodies bind to the spike protein, they block the virus from entering your body’s cells. If it can’t enter the cells it cant spread according to experts.
Clinical trials show that Regeneron’s monoclonal antibody treatment reduces COVID-19-related hospitalization or deaths in high-risk patients by about 70%. Read more here:https://www.idsociety.org/covid-19-real-time-learning-network/therapeutics-and-interventions/immunomodulators/
And when given to an exposed person monoclonal antibodies reduced their risk of developing an infection with symptoms by 80 according to the science. Read more here: https://www.nejm.org/doi/full/10.1056/NEJMoa2109682
Health Canada authorized monoclonal antibody COVID-19 treatments, such as bamlanivimab and the casirivimab and imdevimab combination treatment by Roche/Regeneron (brand name REGEN-COV), are available for the provinces and territories to use in their healthcare systems according to the federal government.
“The casirivimab and imdevimab combination therapy (REGEN-COV) and bamlanivimab are for use in outpatients with mild to moderate COVID-19 to reduce the risk of progression to severe COVID-19 requiring hospitalization,” said Andre Gagnon, Media Relations Health Canada.
It’s unclear what quantity was shipped to Ontario but doctors say they cannot find it.
“Nobody can find it even if hospitals wanted to use it.” Dr. Wells, who is a Hospitalist at Toronto area hospital, told Kawartha 411 News. “I think the data is quite strong for these meds and we could save lives/hospital stays but the logistics/cost will be an issue the govt needs to plan for.” Â (Note we have agreed to change the name of the Dr. due to fears of repercussions)
“These days saying anything that isn’t the gospel of PHO can cost an MD their licence.” says Dr. Wells.
We contacted the Ontario Ministry of Health weeks ago to find out how doctors could get their hands on these approved life-saving treatments but have not heard back.
Dr. Wells says he has found one hospital in Ontario with a supply.
“The only site I was told has any is University Health Network but it’s unclear what they are planning to do with it. I have been in contact with one of the pharma companies involved and they also are unsure why it isn’t yet being used.”
The Ontario government seems to be talking out of both sides of its mouth. The Science Table Chair of Therapeutics, Dr Andrew Morris who works at UHN and was quoted in the National Post recently as stating monoclonal antibodies are a  “valuable tool not being used in Canada”. However, the Science Table group he chairs does not yet recommend monoclonal antibodies. Read more here:  https://covid19-
This differs from the Centres for Disease Control in the United States, National Institutes of Health and others who recommend its use. In addition, BC has updated its recommendations to state this medication could be given on a case-by-case basis http://www.bccdc.ca/
Dr. Wells says there are logistical and equitable distribution issues with monoclonal antibodies but these are challenges that can be overcome with some planning and resources and he doesn’t understand why the Ontario government isn’t doing these things.
“I am attempting to determine how we can obtain these medications and plan to work with the Pharmaceutical Companies and hospitals/outpatient infusion centers to provide this medication for our most at risk populations.”
According to Dr. Wells the treatment needs to be infused through an IV in an area with good ventilation/PPE for staff for 30-60 min (depends on concentration) with 30-60 minutes post infusion monitoring. Patients would then need to be driven home.
“Logistics are a bit tough but no harder than all the non-pharmaceutical interventions we have done.”
Doctors are also frustrated with Public health.
“We would need communication from public health to at risk positive cases to obtain the (monoclonal antibody)treatment. Right now GPs don’t know if/when a patient is positive for covid and the public health staff just tell them to stay home and isolate.” Dr. Wells told Kawartha 411 News. “Don’t get me started about the lack of information given to patients on approved nasal sprays to reduce risk of progression or telling patients to obtain a O2 monitor and seek care when below 93%.”
Multiple studies have shown that nasal steroid sprays used early in the disease course reduces the risk of severe COVID. Read more here:Â https://www.thelancet.
Measuring O2 can be done with an oximeter which can be purchased at Shoppers Drug Mart or provided by public health. Many people with COVID-19 have low levels of oxygen in their blood, even when they feel well. Low oxygen levels can be an early warning sign that medical care is needed according to experts.
“I would say regarding home treatment of COVID we have lacked clear public health guidance. Everyone at risk of covid progressing to a pulmonary/severe state should be given a 1) Home O2 monitor 2) discussion with their primary care GP on outpatient treatments (like nasal sprays) 3) Education on the disease course of COVID-19 (viral symptoms for first ~7-10 days which may or may not progress to more severe pulmonary symptoms)”.
We have also asked the Ministry of Health about this and have not had a response.
