Doctors struggle when Delta and Omicron circulate simultaneously

American doctors are facing a dilemma when they cannot distinguish F0 infected with Delta or Omicron mutations, which can cause patients to miss the golden time of treatment.

In F0s belonging to the high-risk group for Delta variant infection, monoclonal antibody treatment can reduce morbidity and mortality. But this method is less effective in people infected with Omicron.

US officials have advocated using a test kit that can distinguish Omicron infections based on the genetic characteristics of the mutation. But experts say this is not enough for large health systems, which are receiving huge numbers of patients.

The condition makes it difficult to get treatment in hot spots like Maryland. Here, Omicron infections account for about 58%. Meanwhile, the Delta variant is also thriving in the Great Plains and the Western Territories, including California.

Although there are no global studies on individual mutation rates, national networks and laboratories are still able to sequence genomes to track Omicron infections in the community. The local health system then uses this data to decide what treatment each patient should receive.

Many experts believe that the majority of patients infected with the Delta variant are suitable for monoclonal antibodies produced by Regeneron and Eli Lilly. Meanwhile, Omicron-infected F0s will improve health more quickly if using therapy from GlaxoSmithKline and Vir Biotechnology.

Federal officials are also adapting drug distribution strategies based on this recommendation. On December 23, the government halted shipments of Lilly and Regeneron’s antibody drugs after the Centers for Disease Control and Prevention (CDC) said 73% of the country’s infections were Omicrons.

This decision was strongly opposed by some political leaders in the Republican Party because the number of people infected with Delta remained high. On December 28, the CDC announced that the number of Omicron infections was only 53%. Federal authorities resumed distribution of the antibody drug from all drugmakers.

A ward for F0s treated with monoclonal antibodies at Pembroke Pines City Hospital, USA. Photo: NY Times

In the coming weeks, as the country grapples with two types of mutations that circulate unevenly in many regions, according to Dr. Alex Greninger, assistant director of the virology lab at the University of Washington Medical Center, Categorizing treatments for individual patients would be “extremely difficult”.

Dr. Greninger and colleagues have developed a test kit that distinguishes between nCoV strains. But he worries the health system cannot adapt quickly and categorize patients. Mass reporting is also quite difficult.

Furthermore, sequencing the gene took almost a week, well past the ideal time for treatment with antibody methods that reduce the risk of hospitalization in the first place. This makes it difficult for doctors and nurses, said Dr. Mark Siedner, a researcher at Massachusetts General Hospital.

In Massachusetts and surrounding states, an estimated 44.5% of infections are Omicrons. Dr. Siedner said his medical system has stopped using the monoclonal antibodies of Regeneron and Eli Lilly because they are not effective against the new strain.

A promising solution to this situation is Covid-19 drugs such as Paxlovid and molnupiravir, which can be easily used at home at the onset of symptoms. However, the supply of oral drugs is extremely limited.

Health officials and doctors across the country have a difficult time deciding which patients to take the drug. Some people who are at high risk for severe disease after nCoV infection are overlooked because they have been vaccinated.

Many hospitals run out of certain drugs, others only have a few dozen courses available. Medical staff must dispense vitamins to patients instead of therapeutic drugs. Others raced to establish patient selection criteria.

Dr Natasha Bagdasarian, director of the Michigan Department of Health, said: “We simply don’t have enough medication to distribute to people with Covid-19 in the coming weeks, including patients at risk of complications. severe illness. There’s no way to guarantee getting the drug to the right people at this time.”

Thuc Linh (Follow NY Times)


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