Monoclonal antibody treatment for COVID-19 touted by public health in short supply in Manitoba

The treatment touted by Manitoba's deputy chief public health officer as a tool to mitigate the damage caused by Omicron is in extremely short supply and must be administered quickly in order to be effective.

Dr. Jazz Atwal, Manitoba's deputy chief provincial public health officer, says public health is now looking to mitigate COVID-19 risk at an individual level. He said part of the approach will be helping higher risk patients access monoclonal antibody treatment.

What Atwal did not say is that Manitoba only has 268 doses of Sotrovimab remaining — the only monoclonal antibodies recommended by the province for use against Omicron — plus an undisclosed allotment available for First Nations communities.

"Unfortunately, it's not going to make a huge impact in terms of the number of cases that we can avert. But of course, every case that we avert is a good thing," said Dr. Philippe Lagacé-Wiens, assistant professor in the department of medical microbiology and infectious diseases at the University of Manitoba. 

"We have a very, very limited supply of the effective one, Sotrovimab, because globally it's just not widely available," said Lagacé-Wiens. 

Rescue treatment

A total of 122 doses of Sotrovimab have been administered since it became available on Dec. 20, said a spokesperson for Shared Health.

"This is the first real outpatient treatment option that we have," said Dr. Sylvain Lother, who sits on Manitoba's Scientific Advisory Committee for COVID Therapeutics. Lother says monoclonal antibody treatments should still be viewed as a rescue treatment, not a replacement for vaccination.

The number of patients eligible for Sotrovimab is extremely limited, and it must be administered within seven days of the onset of symptoms to be effective.

Manitoba Shared Health laid out three specific groups of people who may be offered the treatment in a memo to health-care providers from Nov. 20, and posted on its website:

• People 40 years of age and older who have no previous history of COVID-19 infection and who are not fully vaccinated.
• Unvaccinated or partially vaccinated people between the ages of 18 and 40, who have health conditions such as diabetes, smoking, obesity, heart disease, kidney disease, lung disease or cancer.
• Immunocompromised adults, including those receiving active treatment for solid tumours, some organ transplant patients, and patients receiving a number of drugs that suppress their immune systems. 

Patients who qualify could either present a positive PCR test or a positive rapid test administered by a health professional.

Jane Kraut received one of the 122 doses of Sotrovimab between Christmas and New Years. She is triple vaccinated but takes immunosuppressive medication for her psoriatic arthritis. 

She considers herself lucky to have found out about the monoclonal antibodies from her rheumatologist who referred her to receive the treatment.

"It was a fluke that I talked to my rheumatologist because it was more about my medication," said Kraut.

She kept boredom at bay while sitting with two other patients in a four-person intravenous infusion room by live-tweeting her experience. 

"Most people who reached out, it wasn't people who were unvaccinated. It was people like me who had an autoimmune condition or an underlying health condition," said Kraut.

More than 2k useless doses

Sotrovimab made up a small fraction of monoclonal antibody treatments made available to the province by the federal government. 

Manitoba originally had about six times more monoclonal antibody treatments, but most of the doses were Regeneron Pharmaceuticals' Casirivimab-Imdevimab, a combination drug which is not effective against Omicron, according to Lagacé-Wiens and the province. 

"Manitoba didn't use up its supply of Casirivimab-Imdevimab (approximately 2,200 doses) because there weren't enough individuals seeking treatment at the time. Monoclonal antibody treatment is best for specific patients that fit the outlined criteria. This greatly limits the amount of people eligible for treatment," wrote a Shared Health spokesperson. 

"Casirivimab-Imdevimab is useless [against] Omicron and has limited to no use in the current epidemiology," wrote Lagacé-Wiens. 

Casirivimab and Imdevimab were initially recommended for use as treatment for COVID-19, as they were proven to work against the Delta variant, which is no longer the dominant strain in the province. 

Undisclosed number of doses allotted to First Nations

The 268 doses of Sotrovimab remaining as of late Tuesday do not include Manitoba's allotment of Sotrovimab available for use in First Nations communities. 

The province is currently negotiating with the Public Health Agency of Canada to obtain additional supply of Sotrovimab.

"The Government of Canada continues to work with provincial and territorial partners to equitably allocate supply, including responding to requests for additional supply," wrote a Health Canada spokesperson in an email. 

On Jan. 6, pharmaceutical giant GlaxoSmithKline announced it signed an agreement with the Government of Canada to supply 20,000 doses of Sotrovimab in addition to 10,000 doses acquired by the federal government last fall. 

Health Canada authorized Sotrovimab for injection on July 30 for the treatment of mild to moderate COVID-19.

Kraut's advice to people who may be eligible is to advocate for themselves. 

"If people test positive and they're candidates, don't let it go because it's a short window," she said.

She says she is grateful to have been vaccinated, boosted and treated with monoclonal antibodies.

"I don't know what things would have been like if all of those things hadn't happened," said Kraut.  "I'm recovering, almost recovered and it's OK. But it wasn't fun."

Atwal said the government's risk mitigation strategy will also focus on ramping up vaccination through additional appointments and staff.

Manitoba is also preparing to use antiviral pills as a COVID-19 treatment once they are approved by Health Canada.