Omicron undermines Florida’s strategy to combat coronavirus

In the battle against COVID-19, Florida’s Department of Health has identified its weapon of choice: monoclonal antibody therapies.

“Monoclonal antibody therapy is widely available in Florida,” the agency touts on its website, prominently displaying a feature indicating where residents can go for treatments that can “prevent severe illness, hospitalization, and death.”

Yet despite those claims, which are continually amplified by state health officials and Gov. Ron DeSantis, mounting evidence suggests these same treatments are losing their effectiveness in the fight against the mutating virus.

Federal health agencies temporarily halted shipments of two COVID-19 treatments late last month after evidence indicated they no longer provide protection against the omicron variant, which now accounts for more than 97 percent of new infections in the Southeast, according to the Centers for Disease Control and Prevention.

Two papers released last month found the two halted treatments, developed by Regeneron and Eli Lilly, were unable to recognize the omicron variant.

Both studies found a third antibody treatment called Sotrovimab, developed by GlaxoSmithKline, remains effective, but that can’t help most COVID-19 patients getting treated in Florida hospitals.

That’s because the GlaxoSmithKline treatment accounts for less than 13 percent of the millions of doses purchased and distributed by the federal government. Florida hospitals administered 140 doses of Sotrovimab in the past 7 days, and still have over 4,400 doses on hand as of Tuesday, according to federal data.

By comparison, Florida hospitals administered 2,737 doses of Regeneron in the past week, and still have nearly 7,700 doses available. None of the 1,700 doses of Eli Lilly’s treatment available to state hospitals were administered during the same period. These treatments may still work for people infected with the delta variant, but that’s become an increasingly small fraction of cases as the omicron variant spreads.

“There’s no justification for giving out these products that are ineffective against 90 percent of cases out there,” said University of South Florida virologist Michael Teng.

Since the omicron variant has taken over as the dominant strain in the state, Teng said, “the use of giving out Regeneron is zero.”

‘No longer going to work’

How did a treatment, touted by the state’s political and health establishments as one of the most powerful weapons against COVID-19 become so unreliable?

Blame a virus that continues to change in unpredictable ways.

When an individual is vaccinated or infected with COVID-19, their immune system creates thousands of antibodies that target different parts of the virus. Monoclonal antibody therapies like those created by Eli Lilly and Regeneron pick out one or two of those antibodies that are best able to stop the virus from infecting healthy cells.

There’s some element of luck in selecting the right antibody, said New York University virologist Celine Gounder, but it’s a moving target as the virus evolves.

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“The antibodies are targeting the spike protein, which is the part of the virus that is going to mutate the most quickly,” Gounder said. The spikes allow the coronavirus to penetrate and infect a host cell, which is why monoclonal antibody therapies go after that part of the virus.

“But it’s a liability when your immune responses are only against one very specific strain of spike protein,” she said. “Because if that changes it can mean that the monoclonal antibody that is being manufactured is no longer going to work.”

It’s the same reason the omicron wave has had so many breakthrough cases. The three vaccines approved in the U.S. were all developed based on the original SARS-COV-2 virus and most people with naturally acquired immunity were infected with a previous variant. The antibodies created by the body still work at neutralizing omicron, but are less efficient than before until the body learns how to fight the new variant.

The therapies developed by Eli Lilly and Regeneron targeted parts of the spike that changed a lot in the omicron variant, Gounder said. Sotrovimab, meanwhile, proved to be more robust to the new variant.

Yet Florida’s governor continues to emphasize the treatments, ignoring the studies that show Eli Lilly and Regeneron are no longer effective.

“We don’t have the data to definitively say it doesn’t work,” DeSantis said. “(Eli) Lilly and Regeneron may be not quite as effective as it was for delta, but if it’s 50 percent effective, and you’re somebody that’s high risk, that’s something that you’d want to see.”

That’s not how monoclonal antibody treatments work, Gounder said. “The virus has changed so much that the monoclonal antibodies (developed by Eli Lilly and Regeneron) do not recognize the omicron virus,” she said, “and so they simply do not work.”

‘Expensive placebo’

Creating new versions of the monoclonal antibodies that work against omicron is no easy feat. Researchers will need to go through thousands of antibodies to arrive at a new formulation that can combat the omicron variant.

Regeneron CEO Leonard Schleifer told CNBC last month that it may take until March to get a new version of their treatment to market.

Until then, the state will continue to provide the disproven COVID-19 treatments. DeSantis has asked the federal government for 30,000 to 40,000 additional doses of antibody therapies. On Friday, he announced that Florida had secured 15,000 doses for immediate use.

“We will rapidly deploy the 15,000 doses that we have now secured,” DeSantis said in a statement issued Friday. “But the (President Joe Biden’s) Administration is still obstructing the state of Florida’s ability to manage our own supply of monoclonal antibodies and I will continue to seek additional doses for Floridians.”

There’s no medical harm in administering an ineffective antibody treatment, Teng said, but “it’s a pretty expensive placebo and an uncomfortable one too.”

Florida, the virologist said, should instead focus on strategies that have proven more effective against the virus: vaccination and prevention.

Vaccines and masks, both downplayed by DeSantis and his administration, are low-cost and readily available, Teng said, “(antiviral therapies) are a kind of last resort.”

• • •

How to get tested

Tampa Bay: The Times can help you find the free, public COVID-19 testing sites in Citrus, Hernando, Hillsborough, Manatee, Pasco, Pinellas, Polk and Sarasota counties.

Florida: The Department of Health has a website that lists testing sites in the state. Some information may be out of date.

The U.S.: The Department of Health and Human Services has a website that can help you find a testing site.

• • •

How to get vaccinated

The COVID-19 vaccine for ages 5 and up and booster shots for eligible recipients are being administered at doctors’ offices, clinics, pharmacies, grocery stores and public vaccination sites. Many allow appointments to be booked online. Here’s how to find a site near you:

Find a site: Visit vaccines.gov to find vaccination sites in your ZIP code.

More help: Call the National COVID-19 Vaccination Assistance Hotline.

Phone: 800-232-0233. Help is available in English, Spanish and other languages.

TTY: 888-720-7489

Disability Information and Access Line: Call 888-677-1199 or email DIAL@n4a.org.

• • •

More coronavirus coverage

KIDS AND VACCINES: Got questions about vaccinating your kid? Here are some answers.

BOOSTER SHOTS: Confused about which COVID booster to get? This guide will help.

BOOSTER QUESTIONS: Are there side effects? Why do I need it? Here’s the answers to your questions.

PROTECTING SENIORS: Here’s how seniors can stay safe from the virus.

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