San Francisco Chronicle - (Sunday)
Life-saving drug gives me no joy
New COVID shot is game-changer. Why am I one of the few to get it?
Last week, I became one of a select few Americans to receive prophylactic monoclonal antibodies that will protect me from COVID if I am exposed to it. I am immune compromised. So, unlike vaccines, the treatment I received, Evusheld, does not depend on my impaired immune system’s ability to make antibodies. Instead, the cells I need to fight COVID have been injected directly into my body. Evusheld has shown a reduction of symptomatic cases of COVID by over 80% — even six months after treatment. This level of effectiveness and durability cannot be overstated for patients who may not have mounted an adequate immune response to vaccines.
Needless to say, this is a game changer for people like me, who have felt trapped at home for the past two years — hostage to our compromised immune system’s limited ability to deal with the virus.
When I went in for my shots, the medical assistant described the joy that patients expressed as they came in to get Evusheld. A grandmother with cancer trembled with happiness, looking forward to seeing her grandchild for the first time; a mother with an organ transplant beamed because she felt like she could safely attend her daughter’s wedding now that she had this protection. To say receiving this treatment is life saving and life changing is no exaggeration.
So why haven’t I been able to experience this joy?
Part of it is guilt.
I am a doctor. I know how to navigate the system. I am insured and tech savvy (although my nephews would object to this characterization), and I understand how and when to ask my doctor for a referral to the latest treatments, whatever they may be. It’s hard to harness “I got mine” joy when millions of other immune compromised people without my education, privilege and resources could suffer death or disability without the protection I now enjoy. And there are few plans under way to effectively get these people the help they need, even as COVID cases climb once more.
The sad reality is that many highrisk patients do not even know about Evusheld, and neither do their providers. It is just another in a series of public health failures during this pandemic, where missed opportunities at policy level are augmented by failures in education and implementation at the level of providers and patients. The ones who lose out are always the most vulnerable. Immune compromised patients should not have to ask for Evusheld. We should be actively pursued to receive treatment, as if our lives mattered to those who are supposed to look out for us. We should have a government that acts in our interests, one that orders enough doses so that the more than 7 million immunocompromised Americans can get this protection.
Instead, our government ordered a paltry fraction of those doses; there is only enough for 425,000 vulnerable Americans to be effectively protected for one year. And even those doses are sitting on shelves while the most vulnerable among us continue to succumb to this virus.
Meanwhile, our country is collectively throwing away even the most basic protections like masking. At every turn, the most vulnerable among us have been told to get over it and move on, as if wanting to dodge death and disability by COVID is a selfish endeavor.
Any honest accounting of the past two years will show that decision after deliberate decision by those in power have, in effect, told the vulnerable that our safety, well-being — in essence, our lives — is up for debate.
When the Centers for Disease Control and Prevention cut the isolation period in half for asymptomatic infections at the height of the omicron surge in January, with no requirement for testing negative to return to work, this was a direct assault on the health and safety of every immunocompromised and at-risk worker in America. President Biden later touted the very effective COVID antiviral drug Paxlovid at his State of the Union address. Access to it was supposed to be implemented nationwide with a Test to Treat program. And yet that rollout failed.
Unfortunately, even now, many people at high risk still do not know about Paxlovid or that it needs to be taken within the first five days of symptoms. Of course, this lack of knowledge, again not just on the patient side but also the provider side, is yet another blow to the most vulnerable.
I can’t count the number of times I have had to tell someone who enjoys the privilege of living in an immunecompetent body that immunocompromised people do not want pandemic restrictions to last forever. We want to return to “normal,” too.
Perhaps more than anyone else, we have felt trapped and isolated — a level of FOMO so acute that it is pathological. And there is a way to move to normalcy that does not treat us like refuse.
One where we are ensured the access to the vaccines and medications we need to keep us safe.
One where basic protections such as masks and ventilation are not tossed aside before those of us who are the most vulnerable have been given the protection we need.
One where workplace flexibility for those who are high risk can continue.
One where funding for testing, treatment and vaccines for the uninsured is seen critical to the fight against COVID instead of a luxury not worth funding.
Refusing to fund and provide doses of Evusheld to those who need it is not an accident. It is a deliberate policy choice.
If I have to hear someone say again, “Well, the masks on planes needed to come off at some point,” I will scream. Masks on planes could have come off after every vulnerable American who qualifies for Evusheld received it.
So, no, I don’t feel joy over my newfound pharmaceutically induced freedom. It is hard to find a silver lining in being part of a society that has made it clear that your life is expendable.
Yes, myself and some others like me have found ways to evade the consequences of our disposability, but the message has been received loud and clear.
There is little satisfaction to be gleaned from the minor triumphs of navigating a system that has told us in a million ways how little our lives matter.