By Marcus Powlowski, Thunder Bay-Rainy River MP
Canadian hospitals and ICUs are currently being overwhelmed with severe COVID-19 cases. We need to urgently stem this caseload or risk a healthcare catastrophe. Although vaccines are a large part of the answer to this problem, we also need to prevent mild COVID-19 cases becoming severe cases. In our view, no current treatment does this better than combination monoclonal antibodies. Unfortunately, access to this treatment remains almost non-existent in Canada.
The evidence to support the use of monoclonal antibodies in the treatment of COVID-19 in patients, particularly high-risk patients when given early in the disease, grows more compelling each week. The National Institutes of Health (NIH) in the United States has recently reviewed the evidence from multiple published and unpublished studies and issued guidelines that strongly recommend their use in patients with mild to moderate disease who do not require hospital admission, but who have medical conditions which put them at risk of severe complications of COVID-19.
These patients would include those with severe obesity, kidney disease, diabetes, and immuno-compromising conditions, as well as those aged >65 or >55 with cardiovascular disease, hypertension or chronic pulmonary disease. In these patients, the use of monoclonal antibodies appears to significantly reduce the likelihood of hospital admission (a recent study showed a 70-80% reduction) or death. Recently published experience from the United States has also demonstrated that for every eight patients treated, one hospitalization could be prevented – something of critical importance for our present crisis of hospital capacity.
Yet despite this evidence and the fact that the Canadian federal government purchased 32 million dollars of these drugs in the form of bamlanivimab, the use of this treatment in Canada is almost non-existent – and for not particularly clear reasons.
Part of the problem certainly lays with regulatory approval. Although the monoclonal antibody bamlanivimab has been approved by Health Canada, both Eli Lilly and Regeneron are awaiting approval for their products which combine two monoclonal antibodies (bamlanivimab and etesevimab, and casirivimab and imdevimab, respectively). These combinations are important – the NIH now recommends them for use in the United States as they are more effective against the COVID-19 variants currently present in that country (though bamlanivimab, which Canada has a significant supply of, seems to work well alone on both the wild type and the UK variant which makes up between 90-92% of variant strains presently circulating in Ontario). A new and very promising monoclonal antibody from GlaxoSmithKline (VIR-7831) is also awaiting approval in Canada.
Yet regulatory hurdles are likely just one part of the problem. Another likely factor is the lack of resources and personnel hospitals have access to. This treatment has to be infused on an outpatient basis to infectious patients. Staff, money, and space may make this untenable for many hospitals and treatment centres already overwhelmed by COVID-19 cases.
The pace at which the evidence on the efficacy of these drugs was made available and the fact that much of this has not been published in peer reviewed journals has also likely had a role in the absence of these drugs in Canada. Certainly, this latter point is important, and we do not wish to downplay the importance of peer-reviewed research. However, the evidence for these treatments is right now sufficiently robust – and the side-effects sufficiently limited – that Canadian physicians should be able to offer these treatments to eligible patients. Indeed, the United States accepts this evidence and has already set up over 5000 infusion sites which have administered this treatment to close to a million people.
Given the increasingly good evidence in support of the use of monoclonal antibodies and the urgency of the COVID-19 situation in Canada, we call on all orders of government to immediately work with clinicians and hospitals to increase access to these potentially life-saving drugs, including expediting the approval of combination monoclonal antibodies. If we act now, we might be able to reduce the overcrowding of our ICUs and prevent needless deaths.
MP Dr. Marcus Powlowski, Thunder Bay-Rainy River
MP Dr. Helena Jaczek, Markham-Stouffville
MP Patrick Weiler, West Vancouver—Sunshine Coast—Sea to Sky Country
MP Ryan Turnbull, Whitby
Dr. Michael Silverman (Infectious Disease) Chief of Infectious Diseases at Saint Joseph’s Health Centre and London Health Sciences Centre
Dr. Sarah Shalhoub MD (Infectious Disease) London Health Sciences Center
Dr. Valerie Sales (Infectious Disease) Stouffville Hospital
Dr. Reza Rahimi (Infectious Disease) London Health Sciences Center
Dr. Asma Syed (Infectious Disease) St Joseph’s Health Centre
Dr. Daniel Ricciuto (Infectious Disease) Lakeridge Health Corp
Dr. Anand Kumar (Infectious Disease and Intensive Care) Winnipeg Health Sciences Center
Dr. Mahshid Mohammadi (Infectious Disease) London Health Sciences Center
Dr. Megan Devlin (Infectious Disease) London Health Sciences Center
Dr. Marko Mrkobrada (Internal Medicine) COVID-19 Clinic, London Health Sciences Center
Dr. Erin Spicer (Internal Medicine) COVID-19 Clinic, London Health Sciences Center
Dr. Michael Nicholson MD (Respirology) London Health Sciences Center