Florida is Misusing Expensive Monoclonal Antibodies

Why has Governor DeSantis spent so much time since early August pitching $2,100 Monoclonal Antibodies (MAB) as his solution for the pandemic when there are cheaper and more effective solutions such as $20 vaccines and $0.20 masks that have been used by a thousand times more people safely to reduce SARS-Cov-2 infections and deaths?  MAB does have a very useful purpose: they serve to help high-risk patients who have been infected as a second line of defense; they are expensive and should not be given as frontline defense until cheaper and more durable versions are made.   

The original reason seemed to be that Governor DeSantis wanted to do his biggest donor a favor.  But now that the country has run out of Regeneron MAB and everything is backordered, and states are on allocation, he continues to complain and push a false and dangerous narrative.  Does he really think that he is fighting for the average Floridian by doing this?  Today he boasted that since he has been promoting MAB Florida has given out 100,000 MAB doses at a cost of $210M to the Federal government.  He claims that hospital admissions have been reduced by 60%.  True statements but one has nothing to do with the other.  Adult hospital admissions (red curve in the figure below) have historically shown a strong correlation with total cases (blue) especially over the last 8 months: about 10% confirmed COVID-19 cases result in hospitalizations.  The data has continued to show the same high correlation over the last 6 weeks that he has been pushing MAB. 

There was a brief three week period associated with school reopening when the number of kids 19 and younger constituted more than 30% of all cases and caused the total number of cases to blip up.  But since then the two curves resumed matching each other very closely.  If MAB had a real beneficial effect one would expect the red curve to drop significantly below the blue curve.  The reason that this has not happened is that there was no requirement for MAB users to have tested positive for COVID-19; they received MAB on the basis of a self-claimed exposure to COVID-19.  There was also no requirement to show proof of vaccination, or a doctor’s prescription to prove that the person is a high-risk patient.  This allowed many Floridians to use MAB as a substitute for vaccination.  This is totally wrong.

There are 10M Americans who are immunocompromised.  Most of them have been vaccinated and many of them have received a third shot.  Yet a significant percentage of them have not gotten strong protection from the vaccines due to their weakened immune system.  For millions of these people masking and isolation is a fact of life.  Unfortunately, many of them get COVID-19 nevertheless.  It is believed that many of the 10,000 breakthrough hospitalizations over the last 8 weeks are associated with this immunocompromised population and older people who generally have weakened immune systems.  100,000 breakthrough cases associated with the 10,000 hospitalizations (using the 10:1 ratio of cases to hospitalizations found above) could have used the MAB and could have been spared a trip to the hospital.  Instead, Governor DeSantis deprived them of their only path to safety and allowed unvaccinated and low-risk people to use up the available supply of MAB.  I take this insult personally because I am one of the 10M immunocompromised Americans who may now have to wait for supply to catch up with demand or die in the interim. 



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