Mass. doctors switch COVID-19 treatment amid omicron surge, with new drugs available in limited supply

There are some promising new options for COVID-19 treatment in Massachusetts.

A pill from Pfizer cleared for emergency use decreases the risk of hospitalization and death from the virus by nearly 90%. A pill from Merck received authorization soon after, however it's not as effective as Pfizer's treatment. And there's another medication that's effective against the omicron variant.

But the supply of all those treatments is very limited.

To understand what this means for COVID patients and doctors wrestling with what to prescribe, WBUR's Morning Edition host Rupa Shenoy speaks with Dr. Sandeep Jubbal, medical director for UMass Memorial's COVID Treatment Center.

Highlights from this interview have been lightly edited for clarity.

On many current treatments' ineffectiveness against the omicron variant, and UMass Memorial's shift to a treatment that can combat omicron

"Omicron is fairly resistant. It carries more than 35 mutations on the spike protein, which is the key binding site for the anti-spike monoclonal antibodies. Now, owing to these mutations, the omicron variant acquired resistance to Regeneron monoclonal antibodies that were highly effective against the delta variant. So fortunately, there is another monoclonal antibody called sotrovimab, which still holds the neutralization capacity against omicron and is now the only effective monoclonal antibody therapy. So after around 2,700 Regeneron infusions from July 14 through Dec. 22, UMass is transitioning to a sotrovimab starting today."

On what monoclonal antibodies are and how they work against COVID-19

"These are proteins that bind the viruses or the bacteria in the system. So these are produced in the labs and given intravenously to patients who have mild to moderate COVID-19. So when they [are given] intravenously, they bind to all the viruses and specifically to the spike protein of the virus, and [prevent] the virus from binding and infecting human cells."

On the process of deciding which patients will receive sotrovimab

"Patients who have risk factors that puts them at a higher risk of ... progression to severe COVID-19. And with severe COVID-19, we mean anybody with the risk of hospitalization or of bad outcomes, including death. So any patient who is elderly, who is unvaccinated, who has a higher BMI, or any patient with a suppressed immune system owing to their disease state, or being on any immunosuppressive medication are at higher — or considered [as] being at a higher risk — for severe outcomes from COVID-19."

"We're a much better spot than we were two years ago when we had nothing in our arsenal. Now we're looking at a highly effective intravenous treatment, as well as an equally effective oral option. It is very satisfying to know that we have these options now."

Dr. Sandeep Jubbal

On the medication's limited supply, and how long it will last

"Fortunately, [the Department of Public Health] has been supplying us with the monoclonal antibodies on a weekly basis. We have a capacity of treating almost 200 patients a week, and for the past month or so DPH has been supplying the amount meeting our capacity."

On Pfizer's pill, paxlovid — which must be taken early after infection — and which patients it works best for

"These are the same patients who are identified [as] having high risk factors for progression to severe COVID-19. So the only difference between the intravenous therapy and the oral medications is that the oral medication has to be within five days from symptom onset, whereas the intravenous treatment you can give up to 10 days from symptom onset."

On whether Jubbal is surprised we're two years into the pandemic, and there aren't more effective treatments widely available

"We’re in a much better spot than we were two years ago when we had nothing in our arsenal. Now we're looking at a highly effective intravenous treatment, as well as an equally effective oral option. It is very satisfying to know that we have these options now, and especially given the fact that these options are highly effective against the omicron variant."