Respiratory equipment and protective equipment were rationed at the start of the coronaviruses epidemic in 2020. Treatments to stave off severe Covid-19 are coming under tight controls as the Pandemic rages into its third year.
There is a greater selection of Covid pills and infusions now than at any point in the past. The Omicron variant has very limited supplies of those that work against it.
State health officials and doctors nationwide are in a difficult position of deciding which patients get potentially life-saving treatments and which don't. Some people who are at high risk of Covid are turned away because they arevaccinated.
Some hospitals have run out of certain drugs, while others only have a few dozen treatment courses on hand. Staff are giving vitamins instead of drugs. Others are trying to figure out who gets who treatments.
There isn't enough to meet the needs of everyone who is going to have Covid in the next few weeks and be at risk of serious problems. I don't think there is a way to make sure it gets to the right people.
At Family Health Centers of San Diego, a network of clinics for low-income patients, staff have had to turn away about 90 percent of the people who are calling daily and eligible for Covid treatments.
Dr. Christian Ramers, an infectious disease specialist there, said it makes him feel like he is making a decision with this limited resource.
A plentiful supply of effective treatments would be a powerful weapon. The number of Covid cases has soared to record highs, and the number of hospitalized patients has increased, though Omicron tends to cause milder illness than other variant.
Most of the time, the primary option for patients with recent infections is the use of monoclonal antibodies. The two most common types of the antibodies don't seem to work against the Omicron variant, which is the world's dominant version of the coronaviruses.
There is a third treatment that is potent against Omicron. Many of the treatment courses ordered by the federal government have not yet been delivered by Glaxo.
Two weeks ago, the Food and Drug Administration authorized the use of a new pill developed by Pfizer that shows promise in fighting Covid and Omicron cases.
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A shipment of Pfizer's Covid pill, Paxlovid, arrived in Israel last week.
The Paxlovid pill is being given to states by the federal government, and they have to decide where to send it.
Supplies are already low. A spokesman for Alto Pharmacy said that New York City used up its Paxlovid supply within a week. Paxlovid is not in stock in New York City.
Paxlovid will not be plentiful until April, but the U.S. government doubled its order on Tuesday.
The goal is to get Paxlovid to as many of the most vulnerable people as possible, with a particular focus on those with weakened immune systems.
Unvaccinated people are more likely to be hospitalized or die from Covid. Matthew K. Wynia, the director of the Center for Bioethics and Humanities at the University of Colorado, said that giving priority access to treatments leaves people feeling like you are rewarding intransigence.
Some states, like Ohio and Nevada, have sent Paxlovid to the pharmacy that serves nursing homes. Many states, including Virginia, Pennsylvania and Arizona, have sent most or all of their initial Paxlovid supplies to pharmacy chains.
It was intended to make the pills more accessible. The system rewards patients who have the time to chase down treatments.
On New Year's Eve, a sports radio host woke up with burning throat. He was positive after being vaccined that day. He decided to seek out Paxlovid because he was concerned that his diabetes increased his risk of becoming seriously ill.
A doctor wrote a prescription for him. He needed to find a pharmacy with Paxlovid. He said he called 18 pharmacies, including one that was within driving distance. None of them had the pills.
Paxlovid was in stock at a nearby Walmart. The battle was not over. He was told that he would have to pay for the treatment. He had to see a second doctor because of a problem with his prescription. His wife had to go to Walmart again to get the pills. He took the first three tablets of the regimen on the evening of January 2.
He worried about patients who weren't able to navigate the obstacles like he could. It should be easy for everyone.
It is hard to find the GlaxoSmithKline treatment.
The staff at the University of Pittsburgh Medical Center has reduced the number of treatments from 2000 to 3000 before Omicron rendered two of them useless. Demand has gone up, but the hospital doesn't have enough to meet it.
The hospital has to save the drug only for the most severely immunocompromised patients.
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On Tuesday, the U.S. government doubled its order for Paxlovid.
After he tested positive for the virus, a Miami retiree tried to get an anti-viral injection. He has a heart condition and has diabetes, all of which would make him eligible to get an anti-tumour treatment.
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The global surge. The Omicron variant of the virus produces less severe illness than earlier waves, but the last days of the year brought good news. Governments are focusing more on expanding vaccination than limiting the spread.
Mr. Shantzek had a bad cough, fatigue, and aches. He had received three vaccine doses and was considered to be relatively low risk, but his daughter was told he couldn't get an antibody injection because he had received three vaccine doses.
Mr. Shantzek said that it was like being told, "You're doing everything you're supposed to do, but we're not going to help you."
Hospitals and doctors have had to make painful treatment decisions in the past because of scarce supplies. Hospitals had to restrict the use of remdesivir because it became so popular. The treatment for patients who are already hospitalized with severe Covid is the only one used.
Drug makers say they are working quickly to produce more treatments.
When the F.D.A. authorized the use of the treatment, the federal government did not immediately order supplies. The country had an abundance of other treatments.
The British company had already committed to fulfill orders from other buyers, so they were able to provide the maximum amount of 450,000 doses. The U.S. government plans to buy 600,000 more treatment courses.
Paxlovid was developed by Pfizer in less than two years. It takes up to eight months to make the pills. Large quantities of the drug are starting to become available, though Pfizer started manufacturing them before the trial began.
Hospitals are imposing restrictions on treatments.
In western Indiana, officials at Sullivan County Community Hospital had to restrict eligibility for antibody injections after weeks of receiving far fewer doses than they had ordered. They decided to exclude vaccine people.
It can be difficult to have some restrictions in place, for example, if your family member doesn't meet the requirement, or your child's teacher at school, said the hospital's chief nursing officer.
The University of Texas health system's chief of infectious diseases said that doctors and their staff have been calling a lot of pharmacy to see who has Paxlovid in stock. Patients will be sent on a wild-goose chase if they are sent by a pharmacy that only received 20 Paxlovid treatment courses.
The director of the Sunflower Rural Health Clinic in Ruleville, Miss., arrived on Monday to find a line of patients waiting in the cold for Covid tests and treatments.
Ms. Rizzo said her clinic had not received any Paxlovid since December 24. She said employees at the clinic gave vitamins and over-the-counter medicines.
The infectious disease specialist at the University of Washington spent last weekend poring over the charts of Covid patients to figure out who should get scarce treatments. The three hospitals have tens of thousands of patients, but only 60 courses of Paxlovid. Some patients who received organ transplants are getting the pills.
Dr. Kelly Gebo, an infectious diseases and epidemiology specialist, said that employees at the university are rushing to develop new ways to allocate scarce treatments. Workers are falling ill making it harder to deliver resources-intensive treatments.
She said that it was demoralizing to be a health care worker when they couldn't deliver optimal care.
Sharon LaFraniere was involved in reporting.
