During the past two years of the pandemic, there have been some profound racial and ethnic disparities, with some communities of color having COVID hospitalization and mortality rates more than double that of other groups of people.
Now, a Centers for Disease Control and Prevention report suggests there are inequities in the use of lifesaving COVID treatments, with some people less likely than others to get early treatment with monoclonal antibodies, which has been shown to prevent hospitalizations and deaths.
The analysis found that people who are Hispanic faced the most barriers in accessing the treatment; they received monoclonal antibodies 58% less often than their non-Hispanic peers.
Patients who were Asian, as well as those who identified with the “other” category, including Native American, Alaska Native, Native Hawaiian, and multiracial patients, received monoclonal antibodies about 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, looked at electronic records for COVID treatments in 805,276 patients 20 and older admitted across 41 US healthcare systems between November 2020 and August 2021. About 11% were treated in a hospital, where the differences in use among racial and ethnic groups were less pronounced.
The treatments included monoclonal antibodies, the antiviral medication remdesivir, and the steroid dexamethasone, which is used to fight inflammation. Some are used early on in an infection and can help prevent COVID hospitalization, like monoclonal antibodies. Others, like steroids, are used later in serious cases to battle out-of-control immune reactions.
The average monthly use of monoclonal antibodies was 4% or less for all racial and ethnic groups, according to the report released Jan. 14. Monoclonal antibodies are laboratory-made proteins infused or injected into patients, typically in health clinics or doctor’s offices within 10 days of symptoms.
Overall, average monthly use of monoclonal antibodies was low: 4% in white patients, 2.8% in Black patients, 2.2% in patients who were Asian or another race, and 1.8% in Hispanic patients.
Once hospitalized, there seemed to be relatively small differences in the use of dexamethasone, and patients who were Black received remdesivir about 9% more often than others.
The researchers said the disparities they uncovered with monoclonal antibodies may not reflect those in the real world because they were restricted to patients who received COVID treatments through a healthcare system; monoclonal antibodies can be given to patients in government-run infusion sites that likely go unrecorded.
The researchers also didn’t analyze the reason for the disparities, but they speculate that a number of systemic factors are likely to blame, such as limited access to COVID testing, insufficient health insurance, potential bias among medical professionals or a lack of a primary care doctor to recommend the treatments, and language barriers, which can leave people unaware of therapies and vulnerable to severe yet preventable COVID outcomes.
These factors also make it more likely people of color will develop medical conditions that raise their chances of severe COVID, the CDC says, contributing to disproportionate coronavirus infection, hospitalization, and death rates among racial and ethnic groups.
“I just want to emphasize how little I was surprised by these data,” Dr. Utibe Essien, an assistant professor of medicine and health disparities researcher at the University of Pittsburgh School of Medicine, told BuzzFeed News. “This is not a new issue. There are so many tiers and levers that we can all be pulling to address this, going all the way from when these drugs are developed to who is present in the studies that test these drugs to how easy is it for patients to access medications at a doctor or pharmacy.”
There are some things that could help “potentially reverse” these disparities, Dr. Amesh Adalja, an infectious disease expert and senior scholar at the Johns Hopkins University 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 spread awareness and access to treatments for high-risk patients.
One recent study found telemedicine visits helped increase attendance at follow-up doctor’s appointments after hospitalization from 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 dropped slightly, from 68% to 67% in the same period.
COVID treatment guidelines don’t always take into account race and ethnicity
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 doctors to prioritize therapies for the highest-risk patients.
National health officials often recommend COVID treatment guidelines, but states may make their own recommendations, meaning guidance 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 medication fact sheets for healthcare providers. An FDA spokesperson told BuzzFeed News it’s up to doctors to “consider the benefit-risk for an individual patient” when determining access to therapies.
The CDC acknowledges that some racial and ethnic groups are more likely to get sick and die from COVID, but the agency relies on the COVID-19 Treatment Guidelines Panel — a National Institutes of Health group of US medical professionals — for recommendations on treatment use.
In December, the panel recommended clinicians prioritize COVID treatments for certain patients under a tiered approach that does not consider race or ethnicity in scenarios where supplies are limited.
At the top of the list are those who cannot produce adequate protection against the coronavirus either by vaccination or infection, which includes people who are immunocompromised. Just as much precedence should be given to unvaccinated people at high risk for severe disease, particularly those 75 or older, or those age 65 and older who have other risk factors.
In the event your doctor isn’t aware of potential treatment options for you, the FDA suggests directing them to its website with information on authorized COVID therapies.
If your doctor thinks you’ll benefit from treatment, you may need to schedule an appointment at a clinic or infusion site. The National Infusion Center Association shows where all available COVID antibody therapy sites are located in your area. Just enter your city, state, or zip code to get started.
“I always recommend that people continue to maintain safe practices (masking, social distancing, and staying home when sick if possible) and if ever feeling seriously ill, going to the doctor, urgent care, or ER,” Essien said.