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MURRAY — Utah public health officials are scrambling to make a COVID-19 treatment that was given to then-President Donald Trump during his 2020 bout with the virus more widely available throughout the state by opening new infusion sites starting with a mobile field hospital set up this week in Murray.
Monoclonal antibodies — laboratory-created clones of virus-fighting antibodies administered through an intravenous infusion — have been used in Utah since November 2020 to help prevent hospitalizations from COVID-19, including in nursing homes and through doctor referrals,
But Senate President Stuart Adams, R-Layton, is calling for Utah to do more, citing Florida and other states pushing the treatment as setting a good example even as the federal government has stepped in to control distribution of the treatment to avoid a nationwide shortage.
"What a tragedy to have something that helps people that are medically frail, and the medical community doesn't even know about it," Adams said, citing conversations he's had with some hospital administrators who told him many Utah doctors don't know the infusion treatment is available.
The Senate leader said he only became aware of what monoclonal antibodies can do after hearing earlier this month about a recent Intermountain Healthcare study showing the treatment reduced severe illness and hospitalizations by more than 50 percent.
"I was shocked that as a Senate president, the first of September I didn't know a thing about it," Adams said, adding that while he did recall Trump received the treatment, "I had no idea. People said it worked but I was not aware of a medical study."
After closed-door meetings between lawmakers and Gov. Spencer Cox earlier this month to discuss how to deal with the ongoing surge in COVID-19 cases that is filling hospitals beyond capacity, Adams told reporters the state needed to do a better job of promoting monoclonal antibodies treatments.
Concerns that rapidly growing demand nationwide — but especially in Florida, Texas and five other southern states said to be using 70% of the nation's supply of monoclonal antibodies while vaccination rates and mask usage remain low — led to the Biden administration last week taking over distribution of the treatment.
Utah getting more monoclonal antibodies — for now
Utah expects to increase the number of treatments given in the state, according to Kevin McCulley, Utah Department of Health director of preparedness and response. He said there have been an estimated 7,000 treatments in the state since November 2020, including about 525 last week.
Under the new system of federal distribution, however, drugs for 1,330 monoclonal antibodies infusions were shipped to the state for this week, and enough for another 1,608 are due next week, McCulley said. While that's enough to handle the expected growth in demand for now, he said it's possible supplies will fall short in the future.
About half of Utah's allocation is going to Intermountain Healthcare, University of Utah Health and other major health care providers that already offer the treatment in hospitals and other facilities equipped for infusions, McCulley said, and 15% is headed to rural hospitals.
He said the remaining 35% will be used by the state health department, to treat at least 50 people per day at the new mobile field hospital in Murray staffed by members of the Utah National Guard and anticipated to stay in place through the spring, as well as residents of the 90 or so nursing homes experiencing outbreaks.
Additional mobile field hospitals to administer the infusions are being considered for northern and southwestern Utah, as well as the southern portion of the Wasatch Front, McCulley said. The effort is part of a $2.5 million state program put in place in November 2020 with federal coronavirus relief funds, he said, but more may be needed.
"As a department, in general, we are very thankful for the guidance provided by the leadership of the state to direct us, and help us prioritize these critical missions," McCulley said. "And to ensure that we're provided appropriate funds to implement missions that can be helpful in the fight against COVID."
Monoclonal antibodies are only available in Utah to those 16 and older who have tested positive for the virus within seven days of symptoms appearing and are referred by a doctor, using the state's adjustable scoring system based on age, race, health issues and other risk factors, including not being vaccinated against COVID-19.
In Florida, anyone 12 and older at high risk can get the treatment, whether they've tested positive or just been exposed to COVID-19, vaccinated or not. Florida Gov. Ron DeSantis, a staunch opponent of vaccine and mask mandates, credits 25 state-run infusion sites that began opening in mid-August with reducing hospital admissions.
But one of the southern states that has been a big user of the treatment, Tennessee, just announced monoclonal antibodies will now be limited to people who are not vaccinated against COVID-19, with an exception for those who are both vaccinated and immunocompromised.
DeSantis attracted national attention in July for mocking new federal masking recommendations during a speech in Salt Lake City to lawmakers from around the country at the American Legislative Exchange Council conference, but Adams said he doesn't remember talking with the Florida governor about monoclonal antibodies.
'Danger' seen to promoting treatment over vaccines, masks
The treatment, which at $2,100 is about a hundred times more expensive than a dose of vaccine, is being seen as particularly appealing to Americans who have been reluctant to be vaccinated against COVID-19 as the delta variant of the virus has sent cases surging around the country.
That's raised concerns that the monoclonal antibodies treatment, which takes more than an hour and requires experienced medical personnel to administer, is getting more attention than better and cheaper methods of dealing with COVID-19 — vaccines and masks.
"One of the biggest tragedies of this pandemic is the extent to which simple things like mask-wearing and vaccine requirements have been politicized," said Chris Karpowitz, co-director of Brigham Young University's Center for the Study of Elections and Democracy.
Now some people "seem to be casting about for almost any alternative to the simple steps that have been proven to work," Karpowitz said, stressing the importance of the monoclonal antibodies treatment not being seen as an alternative to vaccines, or as a reason to avoid the shots.
"In Utah politicians often emphasize cost-effective ways of accomplishing public policy goals, and these treatments, while helpful, are not the most efficient way of protecting the public," he said, questioning whether focusing on monoclonal antibodies could detract from efforts to get more Utahns vaccinated.
"If both can be pursued fully, then that's ideal. But the danger would be pursuing these treatments at the expense of vaccines that have repeatedly been shown to work well," the political science professor said, calling for elected officials to be clear that the treatment is not a replacement for other measures.
Monoclonal antibodies are simply not a substitute for vaccinations.
–Dr. Brandon Webb, an Intermountain Healthcare infectious diseases physician
'We've been bending over backward to give this'
Doctors who are part of a working group setting guidelines for how monoclonal antibodies are used in Utah have similar concerns. Currently, just under 52% of all Utahns are fully vaccinated against COVID-19, meaning it's been two weeks or more since their final dose, and there are few mask mandates.
"For those of us in the medical community, trying to piece all of this together, it's just really frustrating," said Dr. Emily Spivak, a University of Utah Health infectious diseases physician. She took issue with Adams' statements suggesting the treatment is not being used enough.
"It sounded a little bit like blaming us, and none of which is true. We've been bending over backward to give this. This will help keep people out of the hospital," Spivak said, but "it's very labor-intensive. It's distracting about what really should be the discussion, which is getting vaccinated and wearing masks."
Spivak said Utah has been recognized nationally for including race in calculating whether someone qualifies for the treatment. The federal combatcovid.hhs.gov website includes details of Intermountain Healthcare's "equitable risk-adapted strategy" for using monoclonal antibodies among its promising practices for healthcare professionals.
Utahns "definitely should not be relying on this treatment to save them. Again, if people get sick and they're not vaccinated and they're high risk, we will of course do our best to get them this therapy," she said, adding, however, "it is much more effective, cheaper, easier, to get the vaccine than these monoclonal antibodies."
Dr. Brandon Webb, an Intermountain Healthcare infectious diseases physician, also said there's "a very real risk" the treatment may become a disincentive for some people to get vaccinated.
"Monoclonal antibodies are simply not a substitute for vaccinations," Webb said.
He said that makes it "really important that we continue to message correct information, which is that no secondary preventative or treatment option can take the place of the benefits of primary prevention, including vaccination, social distancing, limiting gatherings and masks where appropriate."
