Vulnerable Australians with Covid could miss out on lifesaving treatment due to testing delays
Vulnerable Covid patients are set to miss out on the lifesaving treatment sotrovimab, doctors say, because it must be taken within five days of getting sick.
Waiting times for PCR tests and results, a lack of rapid antigen tests, and the need for a GP referral could mean treatment comes too late, according to the Royal Australian College of General Practitioners.
The health minister, Greg Hunt, announced on Monday that the federal government had bought an additional 45,000 units of sotrovimab, bringing the national stockpile to 81,000.
The monoclonal antibody treatment is designed to help those who become ill with Covid and have risk factors including lung, heart or kidney disease, obesity, diabetes, being over the age of 65, and undergoing cancer treatment. Clinicians can consider its use for women in their second or third pregnancy trimester. It has a 79% effectiveness rate at reducing serious illness, hospitalisation and death.
Mark Morgan, professor of general practice at Bond University and chair of the college’s expert committee on quality care, said GPs were “crying out” for clear clinical pathways to use the treatment.
“To be effective, it has to be given in the first five days [after symptoms appear], and there are all sorts of problems with getting tested and finding out if your symptoms are from Covid or not because people can’t access the PCR or rapid antigen tests,” he said.
“So there are lots of difficulties finding out if you’ve got Covid, then another layer of difficulty playing catch ups with the health systems as to who would access this medicine and how
it would be given.
“It has to be injected over half an hour, and [the patient then has to be] watched for an hour. And this is someone who’s infected.”
Morgan said he didn’t think many GPs would have the proper setup established to deliver the treatment themselves and would probably then refer the patient to hospital.
“The thing I’m most concerned about is the delays in testing capacity, delays in results, lack of knowledge about the treatment options in the community, so that people will miss out on the treatments.”
With the focus on vaccinations, he said, treatments for the infected had been overlooked.
“They let [Covid] rip before they had their ducks lined up,” he said.
It’s also unclear how long the 81,000 treatments would last. In a press release from August 2021, Hunt said: “Medical experts estimate that eight to 15 per cent of adults with COVID-19 will be recommended for treatment with sotrovimab.”
With more than 271,000 new cases this week, if 15% were eligible, around half the existing stockpile would be needed. At the lower end of 8%, the treatments would last four weeks if case numbers did not go up at all.
However, the range of 8% to 15% was estimated before the Omicron variant arrived and before high vaccination levels were achieved, which could affect the numbers of people eligible.
The United States currently has a sotrovimab shortage.
Sotrovimab is an “artificial copy of natural immunity, made in a laboratory and injected into a vein,” Morgan said.
It would not help someone with full immunity, but those who were not vaccinated or had underlying conditions could be kept out of hospital.
Rapid antigen testing, if made widely available, would speed up access to sotrovimab.
Morgan said he would like to see a greater focus on available treatments as infections rise. According to the Therapeutic Goods Administration, there is a critical shortage of one form of heparin, a blood-thinning drug that has been shown to block the transmission of Covid when used as a nasal spray. There is also a critical shortage of dexamethasone, a steroid medication which can help critical Covid cases.
However, there is often a “reasonable alternative” to such drugs.
Morgan expects Covid case numbers to keep rising sharply, and said GPs wanted guidance.
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“GPs are crying out for clear clinical pathways, and guidance and knowledge about how best to help their patients and make sure their service is integrated with pharmacies, hospitals, etc,” he said.
“It’s going to really be a quite confronting couple of months.”
The health department and health minister’s office have been contacted for comment.