Living with the virus | The duty

Finally, there is good news in the disrupted, often chaotic world of the healthcare system. Following pressure from the medical profession as well as from certain community associations, the Quebec government has just approved a therapeutic treatment against COVID-19. “In light of the increase in the number of cases […] during the fourth wave ”, says the ministerial opinion of October 8,“ it seems opportune to use monoclonal antibodies in support of other measures ”.

Another way of saying that the vaccination campaign is reaching its limit, the time has come to learn to “live with the virus”. To give yourself the means to cure COVID, not just to prevent it. If vaccination is rightly the preferred route, we now know that it is not a miracle solution. We will most likely continue to get sick from SARS-CoV-2 because it cannot be eliminated. Despite an increasing choice of vaccines, the staggering gap between rich and poor countries makes disease suppression somewhat paltry. What is the point of an exceptional vaccination rate – over 80% in Quebec among those aged 12 and over – if, elsewhere, in low-income countries, only 2.8% of the population has received a dose? Without a high rate of vaccination all over the planet, the virus will continue to spread. Not to mention the uncertainty that persists, recalls the WHO, as to “the degree of protection of current vaccines against emerging variants of the virus”.

So, let’s come back to these neutralizing antibodies, the effectiveness of which has been shown by several studies. One of them, recently published in the New England Journal of Medicine, showed a 70% decrease in hospitalizations and an absence of death when a combination of two antibodies (bamlanivimab and etesevimab) was administered a few days after the diagnosis of COVID in people at risk – that is, that is to say the 65 years and over, the immunosuppressed and any person suffering from comorbidity (obesity, diabetes, asthma, etc.). Widely used in the United States, France and Germany, this treatment is the only one, according to the latest WHO treatment guide, that has a beneficial effect when it matters most: before people get really sick. As such, other treatments, including the famous hydroxychloroquine of Dr Raoult, remdesivir, lopinavir / ritonavir, and ivermectin are all not recommended. The only other treatments that are now blessed by the WHO are corticosteroids and receptor blockers – reserved for severe cases.

Although monoclonal antibodies must be administered by intravenous infusion, which requires time and supervision, the value of such treatment is clear. As this treatment was approved as an emergency measure by the FDA in the United States last November, and then by Health Canada shortly after, many wonder why it was not available sooner.

After being head of intensive care at St. Mary’s Hospital Center in Montreal last February, Dr.r Hugo Viladevall believes that with this treatment, he could have saved some of his patients. Including a lady who accidentally contracted the virus just when she was due to leave the hospital, and who died shortly after. Knowing the clinical success of monoclonal antibodies in the United States and knowing that Health Canada approved them, Dr.r Viladevall immediately requested that they be placed on the list of treatments offered at St. Mary’s. His request went unanswered. The hospital is still not authorized to provide this treatment, moreover, despite the ministerial directive of October 8, which requires that we establish “a site of administration of monoclonal antibodies in at least one facility per territory of” establishment ”.

This is the less shining side of this apparent “good news”. According to the information obtained, only the McGill University Health Center is currently administering the said treatment, and this, in an extremely parsimonious manner. Why ? Difficult to say, because the Ministry of Health, after having formalized its policy on monoclonal antibodies, refuses to grant an interview on the subject.

“Why all this mystery? Says McGill immunologist and professor of medicine Abraham Fuks. “Quebec has administered its vaccination campaign better than anyone else,” he said. Why not use this know-how, part of these resources, to now facilitate access to monoclonal antibodies? Why not run a real promotional campaign?

On the contrary, here we seem to want to go backwards. First, it is difficult to understand why, out of a total of 9000 doses purchased by the federal government according to the pharmaceutical distributor Hoffmann-La Roche, only a few hundred were ordered by Quebec. Didn’t he see fit to negotiate a better contract? Asks the founder of the Canadian Association of Community Health, Samuel Herzog. The Montreal businessman, who has long campaigned for the distribution of neutralizing antibodies in Quebec, notes that clinics wanting to obtain supplies from the designated supplier (McKesson) are refused, due to lack of stocks.

One step forward, two steps back? While we should certainly be delighted with the fact that Quebec now has an effective treatment in its fight against COVID-19, we may wonder why progress is being made in a trickle, without much explanation or great means.

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