Science
High Demand for Drug to Prevent Covid in the Vulnerable, Yet Doses Go Unused
Sasha Mallett, Sue Taylor and Kimberly Cooley all have immune deficiencies that make them particularly susceptible to Covid-19, and all have tried to get the identical factor: a brand new therapy that may forestall the illness in individuals who both can’t produce antibodies after receiving a coronavirus vaccine or can’t get vaccinated in any respect.
Ms. Cooley, a liver transplant recipient in Duck Hill, Miss., obtained the antibody drug, known as Evusheld, from her transplant crew on the College of Mississippi Medical Heart with no hassle. However Ms. Taylor, of Cincinnati, was denied the therapy by two hospitals close to her house. And Dr. Mallett, a doctor in Portland, Ore., needed to drive 5 hours to a hospital prepared to present her a dose.
As a lot of the nation unmasks amid plummeting caseloads and contemporary hope that the pandemic is fading, the Biden administration has insisted it should proceed defending the greater than seven million Individuals with weakened immune methods who stay susceptible to Covid. Evusheld, which was developed by AstraZeneca with monetary assist from the federal authorities, is crucial to its technique.
However there may be a lot confusion in regards to the drug amongst well being care suppliers that roughly 80 p.c of the accessible doses are sitting unused in warehouses and on pharmacy and hospital cabinets — whilst sufferers like Ms. Taylor, 67, and Dr. Mallett, 38, go to nice lengths, usually with out success, to get them.
As a result of they’ve a weakened response to the coronavirus vaccine and should not be capable to battle off Covid-19, many immunocompromised folks have continued to isolate themselves at house and really feel left behind because the nation reopens. Evusheld, which is run in two consecutive injections, seems to supply long-lasting safety — maybe for half a 12 months — giving it appreciable enchantment for this group.
For now, although, the drug is in brief provide. As a result of it’s approved just for emergency use, it’s being distributed by the federal authorities. The Biden administration has bought 1.7 million doses — sufficient to completely deal with 850,000 folks — and had almost 650,000 doses prepared for distribution to the states as of this previous week, based on a senior federal well being official. However solely about 370,000 doses have been ordered by the states, and fewer than 1 / 4 of these have been used.
“There’s so many different people who find themselves scrapping and driving for hours to get Evusheld,” Ms. Cooley, 40, mentioned, “when in Mississippi it’s sitting on the cabinets.”
Interviews with medical doctors, sufferers and authorities officers counsel the explanations the drug goes unused are assorted. Some sufferers and medical doctors have no idea Evusheld exists. Some have no idea the place to get it. Authorities pointers on who ought to be prioritized for the drug are scant. In some hospitals and medical facilities, provides are being reserved for sufferers on the highest threat, reminiscent of latest transplant recipients and most cancers sufferers, whereas doses in different areas of the nation are being given out by means of a lottery or on a first-come, first-served foundation.
Hesitance can be a difficulty. Some medical doctors and different suppliers have no idea learn how to use Evusheld and are thus loath to prescribe it. The truth that it’s an antibody therapy will be complicated, as a result of most such remedies are used after somebody will get Covid quite than for preventive care.
Including to the confusion are revised Meals and Drug Administration pointers for Evusheld, launched final month, that known as for doubling the preliminary really useful dose after information confirmed the drug could also be much less efficient towards sure variants.
“It’s overwhelming and it’s all new,” mentioned Dr. Mitchell H. Grayson, chief of the allergy and immunology division at Nationwide Kids’s Hospital in Columbus, Ohio. “Suppliers are undoubtedly making an attempt to maintain up, it’s simply — I don’t understand how properly everybody’s doing with that.”
Roughly 3 p.c of Individuals are characterised by well being professionals as immunocompromised as a result of they’ve a illness that weakens their physique’s immune response or are receiving a therapy that does so. They embrace transplant recipients and folks with circumstances like most cancers, lupus and rheumatoid arthritis.
Evusheld’s arrival in December instantly set off a scramble. In Fb teams and on-line messages, sufferers and their family members started swapping details about learn how to get it. Authorities information units about Evusheld’s availability have been so advanced and complicated {that a} software program developer within the Seattle space, Rob Relyea, developed his personal mapping instrument that tracks how a lot of the drug is accessible and which suppliers have it.
“Individuals ought to know the place to go to get in line,” he mentioned.
Mr. Relyea, 51, had a vested curiosity: His spouse, Rebecca, is in remission from most cancers. They tried 10 hospitals unsuccessfully however then obtained the drug by means of luck, as Ms. Relyea’s identify was picked in a lottery for Evusheld at a hospital close to their house in early February, he mentioned.
However they haven’t heard something but about scheduling a second dose, which Ms. Relyea wants primarily based on the brand new suggestions.
Dr. Mallett, in Oregon, was one in all many who have been determined to get the drug. She has frequent variable immunodeficiency, a situation that retains her immune system from making sufficient antibodies. Her son began attending kindergarten in individual final fall, and when the Omicron variant surged, his instructor and classmates started testing constructive for Covid.
To seek out Evusheld, Dr. Mallett scoured a web based authorities database of shipments and spent weeks cold-calling hospitals, pharmacies and well being organizations that acquired the drug.
When she lastly discovered a hospital in La Grande, Ore., prepared to present her a dose, she labored together with her doctor to enroll as a affected person there. Then she dropped the whole lot and drove to the hospital within the rain, acquired the pictures and instantly turned again — an 11-hour journey in whole.
Dr. Mallett is extremely educated, medically savvy, rich and simply capable of take time away from her job — privileges that helped her get a dose, however that many others don’t have.
“I undoubtedly have lots of lingering moral qualms about how I went about getting this remedy,” she mentioned. “Did I make the most of our damaged system?”
Most of the well being staff Dr. Mallett known as whereas she was looking for a dose had not even heard of Evusheld — even when their workplaces had the drug in inventory.
Some consultants argue that Evusheld ought to go first to individuals who can’t get vaccinated due to extreme allergic reactions and to those that produce the fewest antibodies in response to coronavirus vaccines. However antibodies are just one part of the immune system, and the Facilities for Illness Management and Prevention nonetheless recommends towards utilizing exams that decide antibody ranges to evaluate somebody’s immunity.
“The most important drawback is that there’s completely no steering or prioritization or any rollout in place in any respect, and it’s been a large number,” mentioned Dr. Dorry Segev, a transplant surgeon at N.Y.U. Langone Well being who has been finding out coronavirus vaccines in transplant sufferers. “With out formal pointers, you actually can’t do something.”
The Biden administration is making an attempt to handle the confusion. Prime federal well being officers have been working to lift consciousness amongst state well being officers, suppliers and sufferers. They convened a name this previous week with advocates for the disabled to debate the revised dosing steering; in addition they urged affected person teams to companion with the administration on outreach and schooling efforts.
“I really feel actually strongly that this remedy has nice potential to assist the immune suppressed who don’t all the time reply to vaccinations,” mentioned Dr. Rachel Levine, the assistant secretary for well being within the Division of Well being and Human Companies, who spoke on the decision. However Dr. Levine mentioned she didn’t anticipate that the C.D.C.’s steering on antibody exams would change.
Sufferers who can’t be vaccinated are apparent candidates for Evusheld. However among the many vaccinated, Dr. Segev and different consultants say, the calculations turn into far murkier — and might contain assessments of different underlying circumstances or threat elements.
For sufferers who handle to get Evusheld, consultants say it’s nonetheless unclear precisely how a lot safety the remedy provides. It’s tough to gauge the affect of the drug in defending immunocompromised sufferers, as a result of many recruited for research have been avoiding dangerous behaviors and it will have been unethical to ask them to not. Researchers could not know the precise effectiveness of the drug for a lot of months.
Evusheld was discovered to supply safety akin to vaccines in a medical trial, however the variety of members who have been immunocompromised was by no means disclosed. Including to the uncertainty, AstraZeneca studied the drug earlier than Omicron surfaced. Analysis over the previous few months exhibits that Evusheld protects towards the variant, however it’s unclear to what diploma.
The shortage of strong data has annoyed Ms. Cooley, the liver transplant recipient in Mississippi. She continues to be taking the identical precautions as she did earlier than receiving Evusheld, reminiscent of getting groceries delivered, staying at house and seeing just a few trusted relations with masks on. That’s as a result of she cares for her aged mom and has seen numerous different aged folks, together with her grandmother, die from Covid-19 in her neighborhood, the place many individuals have chosen to not get vaccinated.
Some who can’t discover a dose of Evusheld have turned to on-line communities as an alternative of well being care organizations. They’re in search of assist from different immunocompromised folks, reminiscent of Dr. Vivian G. Cheung, 54, a doctor in Bethesda, Md., who has a genetic situation that impacts her immune system.
Dr. Cheung obtained a dose in January after calling numerous medical establishments for 2 weeks, and he or she has been serving to others navigate the method since then. She receives as much as 10 requests for assist daily, however she estimates that solely 1 / 4 of those that have reached out have succeeded in getting Evusheld.
Ms. Taylor, the girl in Cincinnati, has frequent variable immunodeficiency. However proper now, one hospital close to her is limiting its provide of Evusheld to its transplant sufferers, whereas one other just isn’t but accepting sufferers from outdoors its system. She is unable to look elsewhere; she mentioned she was uncomfortable driving lengthy distances due to her underlying well being circumstances.
Ms. Taylor mentioned that she didn’t wish to take a dose away from somebody who may want it extra, however that she would really feel much less “panic-stricken” if she might get Evusheld. She may be capable to begin seeing her youngsters indoors once more and inch again to the life she had earlier than Covid.
For now, she is in a holding sample of isolating, masking and hoping a dose will turn into accessible quickly.
Rebecca Robbins contributed reporting.
It’s been two weeks since Donald Trump won the presidential election, but Stacey Lamirand’s brain hasn’t stopped churning.
“I still think about the election all the time,” said the 60-year-old Bay Area resident, who wanted a Kamala Harris victory so badly that she flew to Pennsylvania and knocked on voters’ doors in the final days of the campaign. “I honestly don’t know what to do about that.”
Neither do the psychologists and political scientists who have been tracking the country’s slide toward toxic levels of partisanship.
Fully 69% of U.S. adults found the presidential election a significant source of stress in their lives, the American Psychological Assn. said in its latest Stress in America report.
The distress was present across the political spectrum, with 80% of Republicans, 79% of Democrats and 73% of independents surveyed saying they were stressed about the country’s future.
That’s unhealthy for the body politic — and for voters themselves. Stress can cause muscle tension, headaches, sleep problems and loss of appetite. Chronic stress can inflict more serious damage to the immune system and make people more vulnerable to heart attacks, strokes, diabetes, infertility, clinical anxiety, depression and other ailments.
In most circumstances, the sound medical advice is to disengage from the source of stress, therapists said. But when stress is coming from politics, that prescription pits the health of the individual against the health of the nation.
“I’m worried about people totally withdrawing from politics because it’s unpleasant,” said Aaron Weinschenk, a political scientist at the University of Wisconsin–Green Bay who studies political behavior and elections. “We don’t want them to do that. But we also don’t want them to feel sick.”
Modern life is full of stressors of all kinds: paying bills, pleasing difficult bosses, getting along with frenemies, caring for children or aging parents (or both).
The stress that stems from politics isn’t fundamentally different from other kinds of stress. What’s unique about it is the way it encompasses and enhances other sources of stress, said Brett Ford, a social psychologist at the University of Toronto who studies the link between emotions and political engagement.
For instance, she said, elections have the potential to make everyday stressors like money and health concerns more difficult to manage as candidates debate policies that could raise the price of gas or cut off access to certain kinds of medical care.
Layered on top of that is the fact that political disagreements have morphed into moral conflicts that are perceived as pitting good against evil.
“When someone comes into power who is not on the same page as you morally, that can hit very deeply,” Ford said.
Partisanship and polarization have raised the stakes as well. Voters who feel a strong connection to a political party become more invested in its success. That can make a loss at the ballot box feel like a personal defeat, she said.
There’s also the fact that we have limited control over the outcome of an election. A patient with heart disease can improve their prognosis by taking medicine, changing their diet, getting more exercise or quitting smoking. But a person with political stress is largely at the mercy of others.
“Politics is many forms of stress all rolled into one,” Ford said.
Weinschenk observed this firsthand the day after the election.
“I could feel it when I went into my classroom,” said the professor, whose research has found that people with political anxiety aren’t necessarily anxious in general. “I have a student who’s transgender and a couple of students who are gay. Their emotional state was so closed down.”
That’s almost to be expected in a place like Wisconsin, whose swing-state status caused residents to be bombarded with political messages. The more campaign ads a person is exposed to, the greater the risk of being diagnosed with anxiety, depression or another psychological ailment, according to a 2022 study in the journal PLOS One.
Political messages seem designed to keep voters “emotionally on edge,” said Vaile Wright, a licensed psychologist in Villa Park, Ill., and a member of the APA’s Stress in America team.
“It encourages emotion to drive our decision-making behavior, as opposed to logic,” Wright said. “When we’re really emotionally stimulated, it makes it so much more challenging to have civil conversation. For politicians, I think that’s powerful, because emotions can be very easily manipulated.”
Making voters feel anxious is a tried-and-true way to grab their attention, said Christopher Ojeda, a political scientist at UC Merced who studies mental health and politics.
“Feelings of anxiety can be mobilizing, definitely,” he said. “That’s why politicians make fear appeals — they want people to get engaged.”
On the other hand, “feelings of depression are demobilizing and take you out of the political system,” said Ojeda, author of “The Sad Citizen: How Politics is Depressing and Why it Matters.”
“What [these feelings] can tell you is, ‘Things aren’t going the way I want them to. Maybe I need to step back,’” he said.
Genessa Krasnow has been seeing a lot of that since the election.
The Seattle entrepreneur, who also campaigned for Harris, said it grates on her to see people laughing in restaurants “as if nothing had happened.” At a recent book club meeting, her fellow group members were willing to let her vent about politics for five minutes, but they weren’t interested in discussing ways they could counteract the incoming president.
“They’re in a state of disengagement,” said Krasnow, who is 56. She, meanwhile, is looking for new ways to reach young voters.
“I am exhausted. I am so sad,” she said. “But I don’t believe that disengaging is the answer.”
That’s the fundamental trade-off, Ojeda said, and there’s no one-size-fits-all solution.
“Everyone has to make a decision about how much engagement they can tolerate without undermining their psychological well-being,” he said.
Lamirand took steps to protect her mental health by cutting social media ties with people whose values aren’t aligned with hers. But she will remain politically active and expects to volunteer for phone-banking duty soon.
“Doing something is the only thing that allows me to feel better,” Lamirand said. “It allows me to feel some level of control.”
Ideally, Ford said, people would not have to choose between being politically active and preserving their mental health. She is investigating ways to help people feel hopeful, inspired and compassionate about political challenges, since these emotions can motivate action without triggering stress and anxiety.
“We want to counteract this pattern where the more involved you are, the worse you are,” Ford said.
The benefits would be felt across the political spectrum. In the APA survey, similar shares of Democrats, Republicans and independents agreed with statements like, “It causes me stress that politicians aren’t talking about the things that are most important to me,” and, “The political climate has caused strain between my family members and me.”
“Both sides are very invested in this country, and that is a good thing,” Wright said. “Antipathy and hopelessness really doesn’t serve us in the long run.”
President-elect Donald Trump joined Elon Musk in Texas and watched the launch from a nearby location on Tuesday. While the Starship’s giant booster stage was unable to repeat a “chopsticks” landing, the vehicle’s upper stage successfully splashed down in the Indian Ocean.
California health officials reported Tuesday that a child in Alameda County tested positive for H5 bird flu last week.
The source of infection is not known — although health officials are looking into possible contact with wild birds — and the child is recovering at home with mild upper respiratory symptoms.
Health officials have confirmed the “H5” part of the virus, not the “N1.” There is no human “H5” flu; it is only associated with birds.
The child was treated with antiviral medication, and the sample was sent to the U.S. Centers for Disease Control and Prevention for confirmatory testing.
The initial test showed low levels of the virus and, according to the state health agency, testing four days later showed no virus.
“The more cases we find that have no known exposure make it difficult to prevent additional” infections, said Jennifer Nuzzo, professor of epidemiology and director of the Brown University School of Public Health’s Pandemic Center. “It worries me greatly that this virus is popping up in more and more places and that we keep being surprised by infections in people whom we wouldn’t think would be at high risk of being exposed to the virus.”
A statement from the California Department of Public Health said that none of the child’s family members have the virus, although they, too, had mild respiratory symptoms. They are also being treated with antiviral medication.
The child attended a day care while displaying symptoms. People the child may have had contact with have been notified and are being offered preventative antiviral medication and testing.
“It’s natural for people to be concerned, and we want to reinforce for parents, caregivers and families that based on the information and data we have, we don’t think the child was infectious — and no human-to-human spread of bird flu has been documented in any country for more than 15 years,” said CDPH Director and State Public Health Officer Dr. Tomás Aragón.
The case comes days after the state health agency announced the discovery of six new bird flu cases, all in dairy workers. The total number of confirmed human cases in California is 27. This new case will bring it to 28, if confirmed. This is the first human case in California that is not associated with the dairy industry.
The total number of confirmed human cases in the U.S., including the Alameda County child, now stands at 54. Thirty-one are associated with dairy industry, 21 with the poultry industry, and now two with unknown sources.
In Canada, a teenager is in critical condition with the disease. The source of that child’s infection is also unknown.
Genetic sequencing of the Canadian teenager’s virus shows mutations that may make it more efficient at moving between people. The Canadian virus is also a variant of H5N1 that has been associated with migrating wild birds, not cattle.
Genetic sequencing of the California child’s virus has not been released, so it is unclear if it is of wild bird origin, or the one moving through the state’s dairy herds.
In addition, WastewaterScan — an infectious disease monitoring network led by researchers from Stanford University and Emory University, with laboratory support from Verily, Alphabet Inc.’s life sciences organization — follows 28 wastewater sites in California. All but six have shown detectable amounts of H5 in the last couple of weeks.
There are no monitoring sites in Alameda Co., but positive hits have been found in several Bay Area wastewater districts, including San Francisco, Redwood City, Sunnyvale, San Jose and Napa.
“This just makes the work of protecting people from this virus and preventing it from mutating to cause a pandemic that much harder,” said Nuzzo.
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