San Francisco Chronicle - (Sunday)
Don’t doubt that omicron can kill you
Surge, low supply of treatments for COVID create lethal scenario
There is a saying in my culture about a grain of rice — a bhaath no daano. You want to know what is happening in the pot of rice on the stove? The quality, the texture, the doneness of the rice? All you need is a bhaath no daano, a grain of rice, between your thumb and forefinger — pick out that grain, squeeze it between your fingertips, and it tells you all you need to know about the whole pot.
As a doctor who treats COVID patients, I get more opportunities than most to test the rice and see how our national anti-COVID efforts are faring. And that’s been especially true since omicron struck.
Two weeks ago, I referred three of my patients who were suffering from COVID symptoms for monoclonal antibody treatment, which has been highly effective in stopping disease progression for those in high-risk categories. A day and a half later, I received an email from the infusion center informing me they would be “unable to treat” my patients. The center had 200 referrals for a mere 18 doses that week. Despite the fact that two of my patients were pregnant, prioritized for treatment under National Institutes of Health guidelines, they did not make the cut to receive care. I immediately phoned my parents. Illness from omicron has the reputation of being less severe than previous coronavirus variants — but it can still be deadly. For those most at risk of falling gravely ill, it was clear the most effective COVID treatments were quickly running out amid omicron’s lightning-fast spread.
Both my parents are over 75 and immunocompromised as a result of chemotherapy for cancer. And yet NIH guidelines put them in the same priority tier to receive treatment as an unvaccinated 75-year-old with no medical conditions. I explained to them that with limited monoclonal antibody and antiviral doses available, there were no guarantees they would get the treatment they needed if infected. I begged them to be extra careful, to use only N95 masks around others and to limit any activities to the outdoors only.
Later that week, as scarce supplies of the new oral COVID anti-virals Paxlovid and Molnupiravir starting trickling in, clinicians like myself started playing a mainly futile game of whacka-mole, assembling and sharing spreadsheets to try and track supply. A local pharmacist told me they had just dispensed their 50th and final dose of the drugs, and they had no idea when they would get another shipment.
God forbid this information be freely available to clinicians in a central database with real-time tracking. Billionaires can hobby launch themselves into space, but, somehow, we can’t have that. Once again, I rung up my parents. Really, now is not the time to get COVID, I insisted. We are losing nearly 2,000 Americans a day from this virus, hospitals are filling up, we can’t get monoclonal antibodies to our patients, there are critical blood shortages and crisis standards of care are being activated.
Meanwhile, “think pieces” started their viral dissemination in the media, musing over whether people should stop trying to avoid the virus and accept the inevitability of contracting it. I wanted to scream.
Yes, everyone may contract the disease eventually. But when there are critical shortages of staff, tests and treatments — at a moment when surgeries to remove cancer tumors are being delayed due to an overwhelmed system — this wasn’t the time to subscribe to the COVID Inevitability Doctrine.
Not too long after, mom woke up with symptoms.
She went to the urgent care at her health maintenance organization, the one that claims it wants her to thrive. They tested her for coronavirus via a PCR test and informed her that the turnaround time for results was a whopping five days. The clinic did not have rapid tests and pharmacy shelves all over the county were bare.
My mom put me on the phone with her doctor, and I piped up to say how this would be a problem, since the antiviral medication Paxlovid — which reduces the risk of death and hospitalization from COVID by an astounding near 90% — needs to be taken within five days of symptoms.
The doctor encouraged us to scrounge around for a rapid test and kindly handed mom a prescription for Paxlovid in case we were able to get a positive test result. “We don’t have any supply at any of our pharmacies,” she said, “but perhaps you can try any an outside pharmacy and see if you have any luck.”
I asked her if she had successfully procured this medication for any of her patients. She hadn’t. But, she helpfully added, “I heard they have a lot in Texas.”
Thus began the first scramble for rapid tests. A combination of luck, family and friends enabled us to score a few.
I simultaneously began the quest to find a pharmacy that dispensed Paxlovid. I will not weary you with the details, but suffice it to say that had I not been doctor, it would have been impossible.
I located a single pharmacy in the county that had supply, and only after speaking to countless doctors and pharmacists who knew nothing about the new drug’s existence, how it worked or that it was even available.
Mom tested negative on the rapid antigen home test that day. We still await the lab results of her more reliable PCR test.
Wouldn’t it be nice to get a definitive answer about her infection status so that her window to receive Paxlovid does not close? It sure would.
It didn’t have to be this way. Nearly two years into a pandemic, a PCR test should not take five days for a result. Every home should have already had ample rapid tests available to them. Every person in the country should also
already have high quality N95 masks freely accessible to them, in various sizes, so that businesses and schools can stay open safely and people would not have to read or write articles about how to spot fake masks from real ones.
Nearly two years into a pandemic, an average of nearly 2,000 people a day should not be dying. Nor should the director of the Centers for Disease Control and Prevention consider the fact that the majority of the vaccinated dead from omicron had multiple comorbidities “encouraging news.”
Nearly two years into a pandemic, the CDC should not be shortening isolation guidelines unless those changes are grounded in science, not guided by what the economy can bear. Nor should the health and safety of our workplaces be up to the whims and political leanings of nine justices with lifetime appointments who live in a rarefied bubble.
We are nearly two years into this pandemic. My mom’s story is just one grain of rice in a pot of millions. And yet it’s enough to tell us about the broader condition. It is clear that ours is a pot not fit for human consumption.