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With Omicron Rising, Mississippi Has Shortage of Monoclonal Antibodies

Blue gloved hands administer a vaccine in the arm of a person with rolled up sleeve
The omicron variant is surging across the nation, and Mississippi is seeing the first signs of a sustained uptick in new cases and hospitalizations as a result. ​​U.S. Navy photo by Mass Communication Specialist Seaman Jackson Adkins

Mississippi is now in the early stages of the predicted surge of the omicron variant of coronavirus, with the Mississippi State Department of Health announcing 7,058 new cases of COVID-19 over the long Christmas holiday. That five-day total represents a daily average caseload of 1,412, a sharp, a sustained increase from cases in previous days and weeks.

At the same time, Mississippi is receiving fewer monoclonal antibody treatments than before, likely due to the immune evasive qualities of omicron. The most widely available monoclonals, a kind of treatment that exposes newly infected individuals to antibodies to give them a more robust response to the virus, are entirely ineffective against omicron.

State Health Officer Thomas Dobbs warned on social media today that fewer than the current daily average of newly infected Mississippians could expect monoclonal antibodies this week. “Prevention is the best medicine! Monoclonals in short supply – MS allocated < 400 doses this week!” Dobbs tweeted. “Be safe – avoid Omicron. Get boosted.”

Only sotrovimab and an unavailable Chinese monoclonal treatment still in clinical trials appear to be effective against the omicron variant. With significantly fewer available treatments as the omicron surge begins, monoclonal antibody treatments are likely best reserved for older, immunocompromised adults at heightened risk of severe complications of COVID-19.

National Institutes of Health guidance from late December explains that Sotrovimab “appears to retain activity against the Omicron variant.” Rationing of the treatment is necessary given its new significance as the only effective and available monoclonal option for the variant that is rapidly becoming dominant across the U.S.

Mississippi is not alone in its shortage of the vital antibody treatments. Texas is already almost entirely out of the treatment, and New York has been hit with critical shortages for over a week now.

Hospitalizations Rising

Omicron may well be one of the fastest-spreading diseases known to mankind, considering both its ease of spread and the rapidity with which it multiplies. Technically, measles is more infectious, but the quick replication of the virus means that it can spread far more quickly than measles.

Vaccination shows a massive reduction in chance of infection, hospitalization, and death even in the age group most likely to have a weakened immune system. Source: MSDH

What is not yet certain is the depth of the effect omicron will have on Mississippi’s hospital system. Increased hospitalizations are inevitable and have already materialized in MSDH’s reports. COVID-19 hospitalizations rose from a low of 239 to 326 in only the two days from Dec. 24 to Dec. 26.

University of Mississippi Medical Center’s Director of Communications Marc Rolph confirmed to the Mississippi Free Press in a statement that the hospital was seeing an increase in new COVID-19 patients as the omicron surge grows here. “We have been experiencing some upwards trends in patient numbers. Over 40 today for the first time in a long while,” Rolph wrote on Dec. 27.

Evidence that omicron presents a less severe course of disease on average continues to strengthen. Many of the earliest hotspots of the omicron variant have seen a decoupling of the earlier relationship between new cases and new hospitalizations, as well as the attendant deaths that follow.

Omicron’s most concerning quality is its ability to evade many forms of antibody immunity, causing a broad range of infections even in many vaccinated individuals. However, the evidence is clear that long-term, sustained protection against severe illness, hospitalization and death are maintained in the vaccinated, another factor that helps drive down the average mortality of individuals infected with omicron.

But reduced severity on average should not be confused with an inability for omicron to hospitalize and kill. The virus is, as all forms of COVID-19 thus far, particularly dangerous to older, immunocompromised individuals, who may now be at risk of waning resistance to a breakthrough infection.

Unvaccinated individuals continue to make up the vast majority of cases, hospitalizations and deaths. Ninety-four percent of new cases in Mississippi between Nov. 24 and Dec. 21 were found in unvaccinated individuals, 85% of patients hospitalized with COVID-19 were unvaccinated, and 77% of COVID-19 fatalities were in the unvaccinated.

The increasing proportion of vaccinated hospitalizations and fatalities is due to the highly vaccinated nature of Mississippi’s elderly population. MSDH also tracks the relative risk of disease, hospitalization and death among age groups based on vaccine status. For Mississippians older than 75, the group at highest risk, vaccination is associated with an eightfold reduction in risk of death.

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