Thousands of COVID-19 treatments sit unused in Michigan. Doctors aren't prescribing them

Thousands of doses of COVID-19 therapeutics and preventive treatments sit unused in Michigan because doctors haven't been prescribing them, the state's top doctor told the Free Press last week.

"The issue in the beginning had been that we thought demand would outpace supply and that didn't really happen in the state of Michigan or in most of the country," said Dr. Natasha Bagdasarian, the state's chief medical executive.

"What we really saw was the clinicians were a little bit hesitant to prescribe it ... because they were still learning about it."

Doctors haven't been prescribing Evusheld, the preventive coronavirus antibody therapy for people who are immunocompromised and who may not respond well to vaccines, at the rate at which Bagdasarian hoped they would.

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Evusheld, made by AstraZeneca, was shown in clinical trials to protect 77% of vulnerable people from developing COVID-19 for as long as six months after the double-injection treatment.

They also haven't been prescribing the COVID-19 antiviral pills Paxlovid and Molnupiravir as much as expected or bebtelovimab, a monoclonal antibody infusion that can be administered soon after a person is infected to reduce the risk of hospitalization, Bagdasarian said.

As of Friday, the Michigan Department of Health and Human Services reported a supply of:

  • 18,000 available courses of the Paxlovid antiviral pill.

  • 33,000 courses of the Molnupiravir antiviral pill.

  • 11,000 courses of Evusheld preventive monoclonal antibody therapy.

  • 5,000 courses of bebtelovimab post-infection monoclonal antibody therapy.

"With therapeutics, while theoretically, the issue we thought would be supply, in reality, we had a harder time actually getting it out to folks to be used."

This image provided by Pfizer in October shows the company's COVID-19 Paxlovid pills. In December, U.S. health regulators authorized the first pill against COVID-19, which Americans can take at home to head off the worst effects of the virus.
This image provided by Pfizer in October shows the company's COVID-19 Paxlovid pills. In December, U.S. health regulators authorized the first pill against COVID-19, which Americans can take at home to head off the worst effects of the virus.

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Part of the reason also is because not as many people are sick right now with COVID-19 in Michigan, so demand is down.

Case rates have fallen to one-year lows, and hospitals are getting a reprieve from the crush of sick patients who filled their rooms and lined their halls just a few months ago.

The Biden administration is concerned that this moment of relative pandemic quiet could leave the nation unprepared for another wave of sickness and death as the BA.2 omicron subvariant rages in some other parts of the world.

The administration lobbied heavily for billions more dollars in federal funding to buy additional coronavirus tests and antiviral treatments, to pay for more COVID-19 research, vaccines and monoclonal antibody therapy. But a bipartisan bill that would have delivered $10 billion to partially fund those efforts stalled last week in Congress.

Dee Tait, an RN in the ICU at St. Joseph Mercy Oakland Hospital in Pontiac, tends to an intubated COVID patient on Monday, Jan. 24, 2022.
Dee Tait, an RN in the ICU at St. Joseph Mercy Oakland Hospital in Pontiac, tends to an intubated COVID patient on Monday, Jan. 24, 2022.

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"Make no mistake: Inaction will leave our nation less prepared for any future surges and variants," said Jeff Zients, White House Coronavirus Response coordinator, in a statement issued Friday. "It will mean fewer vaccines, treatments, and tests for the American people. This is deeply disappointing — and it should be unacceptable to every American.

"We’ve worked too hard and come too far to leave ourselves and our economy vulnerable to an unpredictable virus. The virus is not waiting on Congress to negotiate. Congress must act with urgency."

In the meantime, Bagdasarian said state health leaders are doing all they can to ensure doctors know about the availability of the current supply of treatments in Michigan and that they are prescribing them to people who need them.

"We need to be able to encourage physicians to prescribe therapeutics and Evusheld as pre-exposure prophylaxis in the appropriate clinical situations," she said. "We've been doing things like webinars, but clearly we need more clinician education.

"We need to educate patients and families so that they can be strong advocates … and then working with with communities and working with individuals so that they can ask for these medications ... themselves.

"One of the things we've been talking about is going around and speaking to all of our health care systems in the state to really talk about how to integrate these COVID-19 tools into our everyday patient encounters."

With COVID-19 vaccines, she said, it's a similar situation.

When they first came to market in December 2020, there wasn't enough supply to meet demand. But now, Bagdasarian said, "vaccines are widely available and recommended for individuals over the age of 5 and there remains almost half of our state who are not fully vaccinated."

Nearly 60% of Michiganders — almost 6 million people — have been fully vaccinated against COVID-19 as of Friday, according to the U.S. Centers for Disease Control and Prevention. That compares with roughly 67% of the overall U.S. population.

A vial of the Pfizer Covid-19 vaccine sits on a table after doses were drawn for people attending a community vaccination event at Northport Public School in Northport on Thursday, September 16, 2021.
A vial of the Pfizer Covid-19 vaccine sits on a table after doses were drawn for people attending a community vaccination event at Northport Public School in Northport on Thursday, September 16, 2021.

But only about 3.2 million Michigan residents have gotten at least one booster dose, the CDC reported, roughly one-third of the state's population. Far fewer people ages 50 and older and those who are immunocompromised, now eligible for a second booster dose, have gotten them.

While booster doses are important, Bagdasarian said, especially against the omicron variant, reaching the people who've yet to get a single dose of a COVID-19 vaccine remains among state health leaders' biggest challenges.

"We have been working with community leaders, with communities, with trusted messengers and really trying to talk about vaccines and trying to communicate about vaccines in different ways," she said.

"Early on in the pandemic, we did a great job reaching out to people who were over the age of 65. And we've got great (vaccination) rates in our older Michigan residents. Where we are really struggling is with younger Michigan residents and with communities of color."

Vaccination rates in Michigan are above 70% among people ages 50 and older, state data shows, but among younger age groups, the percentage of those fully vaccinated is much lower:

  • 25% of children ages 5-11.

  • 45% of children ages 12-15.

  • 50% of those ages 16-19.

  • 48% of those ages 20-29.

  • 58% of those ages 30-39.

And among Black Michiganders, just 40.7% are fully vaccinated. That compares with a vaccination rate of 61% among Asian and Pacific Islanders; nearly 55% for Hispanic and native Hawaiian, American Indian and Alaska Native populations, and 53% of non-Hispanic white Michiganders.

"That means we need a different communication strategy and a different approach and to work with different trusted messengers and to really get out there and talk to communities more," Bagdasarian said.

"Individuals who had fewer reservations about vaccines, who had more trust in vaccines, they are already vaccinated. And now we need to work on partnering with communities who are maybe still a little hesitant and showing them the evidence and showing them why vaccination is a good option.

"There are no easy solutions."

Dr. Natasha Bagdasarian, chief medical executive for the Michigan Department of Health and Human Services.
Dr. Natasha Bagdasarian, chief medical executive for the Michigan Department of Health and Human Services.

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With coronavirus case rates so low right now, people aren't as concerned about the virus as they might have been a year ago, she said.

"We're in a recovery period right now," Bagdasarian said. "That doesn't mean that the pandemic is over. It means that we are just getting ready for what's in the future."

That future is likely to include another surge, she said, whether that's driven by BA.2, which now accounts for more than half of all coronavirus cases in the state, or another strain of the virus.

"We know that the proportion of BA.2 isolated in the U.S. and in our region of the United States has increased," Bagdasarian said. "We are watching very carefully for impacts here in our state. ... There are some early signs that BA.2 is having an impact here."

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There has been an uptick in the number of Michigan wastewater facilities reporting plateaus or increases in detection of coronavirus in sewage compared with previous weeks, according to a state health department report released Thursday.

COVID-19 hospitalizations have plateaued, too.

Because so many people are using at-home rapid antigen tests when they have symptoms of the virus rather than seeking tests at health care providers that report to the state health department, case rates and the percentage of positive tests are no longer the most accurate measures of how much spread is happening in the community.

Even if this isn't the start of another COVID-19 surge, Bagdasarian said the BA.2 subvariant "will not be the last ... we're concerned about."

"COVID isn't now some pandemic that's on the side that will be gone soon," she said. "It's a part of our society. It's something that's here to stay and we have to be able to live with it and treat it as any other preventable disease."

Contact Kristen Jordan Shamus: kshamus@freepress.com. Follow her on Twitter @kristenshamus.

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This article originally appeared on Detroit Free Press: COVID-19 treatments are being left unused in Michigan. Here's why