Over the past two years of the pandemic, there have been deep racial and ethnic disparities, with some communities of color having COVID hospitalization and death rates more than double those of other groups of people.
Now, a report from the Centers for Disease Control and Prevention suggests that there are inequities in the use of life-saving COVID treatments, with some people less likely than others to receive early treatment with monoclonal antibodies, including they have been shown to prevent hospitalizations and deaths.
The analysis found that Hispanic people faced the most barriers to accessing treatment; they received monoclonal antibodies 58% less often than their non-Hispanic peers.
Asian patients, as well as those who identified with the “other” category, including Native American, Alaska Native, Native Hawaiian, and multiracial patients, received monoclonal antibodies approximately 48% and 47% less often, respectively, than white patients. Black patients were treated with the protective proteins 22% less often.
The research team, led by Jennifer Wiltz and Amy Feehan, reviewed the electronic COVID treatment records of 805,276 patients ages 20 and older admitted to 41 US healthcare systems between November 2020 and August 2021. About 11% were treated in a hospital, where differences in usage among racial and ethnic groups were less pronounced.
Treatments included monoclonal antibodies, the antiviral drug remdesivir and the steroid dexamethasone, used to fight inflammation. Some are used early in an infection and can help prevent hospitalization for COVID, such as monoclonal antibodies. Others, like steroids, are used later in severe cases to fight uncontrollable immune reactions.
The average monthly use of monoclonal antibodies was 4% or less for all racial and ethnic groups, according to the report published on January 14. days of symptoms.
Overall, the average monthly use of monoclonal antibodies was low: 4% in white patients, 2.8% in black patients, 2.2% in Asian or other racial patients, and 1. 8% in Hispanic patients.
Once hospitalized, there appeared to be relatively small differences in dexamethasone use, and black patients received remdesivir about 9% more often than others.
The researchers said the disparities they found with monoclonal antibodies may not reflect those in the real world because they were limited to patients who received COVID treatments through a healthcare system; monoclonal antibodies can be given to patients at government-run infusion sites that are likely unregistered.
The researchers also did not analyze the reason for the disparities, but they speculate that a number of systemic factors are likely to be to blame, such as limited access to COVID testing, insufficient health insurance, bias potential among healthcare professionals or lack of a primary treating physician to recommend treatments, and language barriers, which can leave people unaware of therapies and vulnerable to serious but preventable COVID outcomes.
These factors also make it more likely that people of color will develop medical conditions that increase their risk of severe COVID, the CDC says, contributing to disproportionate rates of coronavirus infection, hospitalization and death among racial and ethnic groups. .
“I just want to emphasize how unsurprising I was by this data,” Dr. Utibe Essien, assistant professor of medicine and health disparities researcher at the School of Medicine, told BuzzFeed News. University of Pittsburgh. “This is not a new problem. There are so many levels and levers that we can all use to address this issue, from when these drugs are developed, to who is in the studies that test these drugs, to the ease with which patients have access to medicines at a doctor or pharmacy.
There are things that could help “potentially reverse” these disparities, Dr. Amesh Adalja, an infectious disease expert and senior fellow at Johns Hopkins University’s Center for Health Security, told BuzzFeed News.
Mobile clinics that bring monoclonal antibody treatments to patients and telemedicine visits that make it easier to see a doctor can help raise awareness and facilitate access to treatment for high-risk patients.
A recent study found that telemedicine visits increased attendance at follow-up doctor appointments after hospitalization by 52% to 70% among black patients. The study included patients discharged from five Pennsylvania hospitals for any reason from January 2019 to June 2020. In contrast, follow-up care among white patients declined slightly from 68% to 67% over the course of the study. same period.
COVID treatment guidelines don’t always take race and ethnicity into account
Although the CDC study looked at patients treated before the Omicron and Delta surges, some states like North Carolina, Texas, and Mississippi are still struggling with COVID treatment shortages, leading the physicians to prioritize therapies for patients most at risk.
National health officials often recommend COVID treatment guidelines, but states can make their own recommendations, which means advice and access to COVID therapies may differ depending on where you live.
The FDA, for example, includes race and ethnicity as a potential risk factor for severe COVID in its drug information sheets for healthcare providers. An FDA spokesperson told BuzzFeed News that it is up to physicians to “consider the risk-benefit ratio for an individual patient” when determining access to therapies.
Some states like New York and Utah have adopted this language, stating that doctors must consider race and ethnicity when assessing a patient’s risk for severe COVID.