Nebraska doctors are warning that treatments effective against the omicron variant of COVID-19 are in such short supply that not all of the high-risk patients who qualify for them are getting them.
The upshot: The treatments, some of which are new and promising, won't be an option in the near future for the vast majority of Nebraskans.
That means vaccination and boosters remain the best way to prevent serious illness, hospitalization and death.
While efforts are underway to bolster production of the treatments, ramping up to the point where they will make a difference during the omicron wave "is logistically just not going to be possible," said Dr. Mark Rupp, chief of the University of Nebraska Medical Center’s infectious diseases division.
"I don't want folks to have the wrong idea that, 'Oh, they've got all these medicines that they can now treat people and either prevent them from getting more seriously ill, or if they are seriously ill we can rescue them in the hospital," Rupp said. "That's just not reality, unfortunately."
The warning comes as cases of COVID-19 in Nebraska jumped to 14,799 for the week ending Wednesday, more than double the 7,176 cases recorded during the previous seven-day stretch. The tally was the second-highest weekly total of the entire pandemic, just below the 15,348 cases recorded during the second week of October 2020.
COVID-19 hospitalizations, which lag infections by about two weeks, continued to tick up after a brief dip over the Christmas holiday, reaching 568 statewide Thursday. That included 352 in metro Omaha hospitals.
The state recorded 78 additional deaths during the past seven days, the highest weekly figure in exactly a year. It's not clear, however, whether those deaths, which also lag infections by weeks, are attributable to the delta variant or to omicron.
Dr. Barbie Young Gutshall, a physician in O'Neill, wrote in a social media post that the hospital there now has an entire wing of COVID-19 patients and that its family room had been turned into an infusion center.
She, too, stressed that health care providers soon would have next-to-nothing to offer patients because of the limited supply of therapies that can target omicron.
Rupp said some of the monoclonal antibodies that providers used successfully during prior waves to keep people with COVID-19 from become seriously ill are not effective against the omicron variant. That includes the infusion that became commonly known as the BAM drug.
The monoclonal therapy that is effective against omicron, called sotrovimab, is in short supply across the country. The state receives an allotment and parcels it out to providers across the state.
Nebraska Medicine, UNMC's clinical partner, posted Friday on Facebook that the health system currently receives enough of the therapy for about five people a day. But the hospital has 75 to 100 outpatients a day who meet federal criteria to receive intravenous infusions of the drug.
"We way outstrip the number of people who would meet the criteria for use," Rupp said.
CHI Health officials said their hospitals, too, have limited supplies of the treatment. The health system randomizes who will receive the infusions based on extensive criteria and a review by a multidisciplinary team.
"The best current treatment we have to recommend is that patients get vaccinated, and get a booster if previously vaccinated," CHI Health officials said in a statement.
Rupp said Nebraska Medicine also has enough of another long-acting therapy called evusheld to infuse between 50 and 100 high-risk people a week. That drug, a preventative, gives people about six months of antibody protection. The health system has about 10,000 patients who would qualify, with 1,000 in the highest-risk group. That group includes people who probably haven't mounted an immune response despite vaccination, a group that typically consists of transplant and high-risk cancer patients.
The health system also is starting to administer three days of intravenous remdesivir to outpatients. A recent study showing that the drug, which previously has been used in seriously ill patients who require oxygen support, could substantially decrease the risk of progression in high-risk patients. It's best used within five to seven days of infection.
But administering it is not easy. "We will be maxing out the number of infusion chairs in our infusion centers to give that," Rupp said.
Two new oral treatments also are available. The first, molnupiravir, prevents progression in about 30% of patients. Nebraska Medicine currently gets about 40 courses a week. "But by no means is it a game-changer," Rupp said.
Data suggests that the more promising of the two, paxlovid, is up to 90% effective in keeping people from becoming seriously ill and requiring hospitalization. Rupp said the hospital, to the best of his knowledge, has not received any doses of the drug.
The first doses of the drug apparently have been directed to clinics that serve those with limited access to health care, such as Omaha's OneWorld Community Health Centers and Charles Drew Health Center.
Andrea Skolkin, OneWorld's CEO, said the health center has received enough for four patients a day. More is coming, but officials don't know how much or when. The health center has to prioritize who receives it.
President Joe Biden said Tuesday that he had doubled the nation's order of the drug to at least 20 million courses and is accelerating delivery. The first 10 million courses are to be available by June and the rest by the end of September.
Meanwhile, health systems are bracing for more patients and urging Nebraskans to help head off a surge, namely by getting vaccinated and boosted, wearing quality, well-fitting masks in public and avoiding large crowds.
Jeremy Nordquist, president of the Nebraska Hospital Association, tweeted Tuesday that hospitalizations due to COVID-19 may double in Nebraska over the next two or three weeks.
"At the same time, hospital staffs will be limited due to COVID spread," wrote Nordquist, a former state senator. "This very well may be the worst of the pandemic. Nebraskans, you know how to help our hospitals & #HealthcareHeroes. Please do!"
Said Rupp, "There's a popular belief out there that omicron is very mild and that people don't have to worry about it. But the issue is there's just such a vast wave of folks who are sick that even if a much lower proportion of them get seriously ill and require hospitalization, it's going to still result in a very high crest of hospitalizations and a high stress level on the medical system."
World-Herald Staff Writer Henry J. Cordes contributed to this report.
Virus Q&A: Answers to common questions about COVID-19 vaccines, travel and more
Do at-home COVID-19 tests detect the omicron variant?
Yes, but U.S. health officials say early data suggests they may be less sensitive at picking it up.
Government recommendations for using at-home tests haven't changed. People should continue to use them when a quick result is important.
"The bottom line is the tests still detect COVID-19 whether it is delta or alpha or omicron," says Dr. Emily Volk, president of the College of American Pathologists.
Government scientists have been checking to make sure the rapid tests still work as each new variant comes along. And this week, the Food and Drug Administration said preliminary research indicates they detect omicron, but may have reduced sensitivity. The agency noted it's still studying how the tests perform with the variant, which was first detected in late November.
Dr. Anthony Fauci, the top U.S. infectious disease expert, said the FDA wanted to be "totally transparent" by noting the sensitivity might come down a bit, but that the tests remain important.
There are many good uses for at-home tests, Volk says. Combined with vaccination, they can make you more comfortable about gathering with family and friends.
If you've been exposed to a person who tested positive but you don't have symptoms, a rapid test five days later can give a good indication of whether you caught the virus. It can also help if you're not sure whether your runny nose or sore throat is COVID-19.
But consider the context when looking at results. If you feel sick after going out to a nightclub in an area with high infection rates, for example, you should look at a negative result from an at-home test with a little more skepticism, Volk says.
Following up with a PCR test is a good idea, she says. Those tests are more accurate and are done at testing sites and hospitals.
Can my pet get COVID-19?
Yes, pets and other animals can get the coronavirus that causes COVID-19, but health officials say the risk of them spreading it to people is low.
Dogs, cats, ferrets, rabbits, otters, hyenas and white-tailed deer are among the animals that have tested positive, in most cases after contracting it from infected people.
While you don't have to worry much about getting COVID-19 from your pets, they should worry about getting it from you. People with confirmed or suspected COVID-19 should avoid contact with pets, farm animals and wildlife, as well as with other people, according to the U.S. Centers for Disease Control and Prevention.
"If you wouldn't go near another person because you're sick or you might be exposed, don't go near another animal," says Dr. Scott Weese at Ontario Veterinary College.
Not all infected pets get sick and serious illness is extremely rare. Pets that show symptoms typically get mildly ill, the CDC says.
Some zoos in the U.S. and elsewhere have vaccinated big cats, primates and other animals that are thought to be at risk of getting the virus through contact with people.
This particular coronavirus most likely jumped from animals to humans in the first place, sparking a pandemic because the virus spreads so easily between people. But it does not easily spread from animals to people. Minks are the only known animals to have caught the virus from people and spread it back, according to Weese.
Three countries in northern Europe recorded cases of the virus spreading from people to mink on mink farms. The virus circulated among the animals before being passed back to farmworkers.
How easily animals can get and spread the virus might change with different variants, and the best way to prevent the virus from spreading among animals is to control it among people, Weese says.
Is travel safe during the pandemic this holiday season?
It depends. It can be safe if you're fully vaccinated against COVID-19, but officials say people who haven't gotten the shots should delay travel.
Regardless of vaccination status, all travelers should keep taking precautions like avoiding indoor, unmasked crowds, says Dr. Keith Armitage, an infectious disease expert at Case Western Reserve University.
"The delta variant has really brought us back to an earlier time in the pandemic," he says.
The U.S. Centers for Disease Control and Prevention says not to travel if you're sick, or if you tested positive for COVID-19 and your isolation period isn't over yet — even if you're fully vaccinated. Unvaccinated people who decide to travel should get a COVID-19 test one to three days before travel and three to five days after returning.
All travelers must still wear masks on trains, planes and other indoor public transportation areas, the agency says.
Airlines say plane cabins are low risk since they have good air circulation and filtration. However, there is no requirement for vaccination or testing before domestic flights, and passengers can remove their face masks while eating or drinking.
Hotels aren't risky for the vaccinated as long as they wear masks around strangers, Armitage says. More fraught are family gatherings with unvaccinated individuals, particularly for those who are older or have health problems.
Health experts suggest looking at the case levels and masking rules in the place you are visiting before you travel.
Why can't some COVID-19 vaccinated people travel to the US?
Because they might not be vaccinated with shots recognized by the U.S. Food and Drug Administration or the World Health Organization.
When lifting overseas travel restrictions in November, the U.S. required adults coming to the country to be fully vaccinated with shots approved or authorized by the FDA or allowed by WHO.
Among the most widely used vaccines that don't meet that criteria are Russia's Sputnik V vaccine and China's CanSino vaccine. Sputnik V is authorized for use in more than 70 countries while CanSino is allowed in at least nine countries. WHO still is awaiting more data about both vaccines before making a decision.
Vaccines recognized by the FDA and WHO undergo rigorous testing and review to determine they're safe and effective. And among the vaccines used internationally, experts say some likely won't be recognized by the agencies.
"They will not all be evaluated in clinical trials with the necessary rigor," said Dr. William Moss, executive director of the Johns Hopkins International Vaccine Access Center.
An exception to the U.S. rule is people who received a full series of the Novavax vaccine in a late-stage study. The U.S. is accepting the participants who received the vaccine, not a placebo, because it was a rigorous study with oversight from an independent monitoring board.
The U.S. also allows entry to people who got two doses of any "mix-and-match" combination of vaccines on the FDA and WHO lists.
Are COVID-19 boosters the same as the original vaccines?
Yes, COVID-19 boosters use the same recipe as the original shots, despite the emergence of the more contagious delta variant. The vaccines weren't tweaked to better match delta because they're still working well.
The vaccines work by training your body to recognize and fight the spike protein that coats the coronavirus and helps it invade the body's cells. Delta's mutations fortunately weren't different enough to escape detection.
The increased protection you might get from a booster adjusted to better match the delta or other variants would be marginal, says Dr. Paul Goepfert, director of the Alabama Vaccine Research Clinic at the University of Alabama at Birmingham.
Manufacturing doses with a new formula would have also delayed the rollout of boosters.
Moderna and Pfizer are studying boosters tweaked for the delta and other variants to be ready if one's ever needed. Health authorities would have to decide if and when a vaccine formula swap would be worthwhile.
"What we don't know," Goepfert noted, "is if you have a delta vaccine compared to the regular vaccine, does it actually work better in preventing transmission or asymptomatic infection?"
The U.S. has authorized booster doses of the Pfizer, Moderna and Johnson & Johnson vaccines for certain people, and a few other countries also are using boosters of those shots or other COVID-19 vaccines.
Can at-home COVID-19 tests make holiday gatherings safer?
Yes, combined with vaccination, home test kits for COVID-19 can add a layer of safety and reassurance by providing on-the-spot results during this second year of pandemic holidays.
"We will be using rapid tests to doublecheck everybody before we gather together," says Dr. Emily Volk, president of the College of American Pathologists, who is planning a holiday meal with six vaccinated family members. "We'll be doing it as they come in the door."
Home kits are not as accurate as the PCR tests done in hospitals and at testing sites, Volk says. But they have the advantage of giving results within minutes instead of days.
Testing kits are available at drugstores without a prescription, and a box with two tests typically costs about $25. Swabs, testing solution and instructions are included.
Adults and teens can test themselves. An adult can test a child as young as 2. How-to videos on product websites can be helpful.
Most tests require swabbing about a half inch inside both nostrils, so it may tickle but doesn't hurt. You will get a positive result if the test detects a viral protein in your sample.
Home tests will miss some infections and in rare cases mistakenly indicate an infection. One popular test misses around 15 out of 100 infections — these are called "false negatives" — and gives a false positive result in about 1 in 100 people who aren't infected.
Test shortages were widely reported during the last COVID-19 surge, but new options have recently hit the market and major manufacturers such as Abbott Laboratories have ramped up production.
The Centers for Disease Control and Prevention offers other tips on ways to enjoy the holidays safely. Vaccination remains the best way to protect against the coronavirus.
How will the world decide when the pandemic is over?
There's no clear-cut definition for when a pandemic starts and ends, and how much of a threat a global outbreak is posing can vary by country.
"It's somewhat a subjective judgment because it's not just about the number of cases. It's about severity and it's about impact," says Dr. Michael Ryan, the World Health Organization's emergencies chief.
In January 2020, WHO designated the virus a global health crisis "of international concern." A couple months later in March, the United Nations health agency described the outbreak as a "pandemic," reflecting the fact that the virus had spread to nearly every continent and numerous other health officials were saying it could be described as such.
The pandemic may be widely considered over when WHO decides the virus is no longer an emergency of international concern, a designation its expert committee has been reassessing every three months. But when the most acute phases of the crisis ease within countries could vary.
"There is not going to be one day when someone says, 'OK, the pandemic is over,'" says Dr. Chris Woods, an infectious disease expert at Duke University. Although there's no universally agreed-upon criteria, he said countries will likely look for sustained reduction in cases over time.
Scientists expect COVID-19 will eventually settle into becoming a more predictable virus like the flu, meaning it will cause seasonal outbreaks but not the huge surges we're seeing right now. But even then, Woods says some habits, such as wearing masks in public places, might continue.
"Even after the pandemic ends, COVID will still be with us," he says.
The AP is answering your questions about the coronavirus in this series. Submit them at: FactCheck@AP.org.