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Editorial: New therapy helps, but shots still best

Hawaii is ramping up access to the treatment known as monoclonal antibody therapy, which is unmitigated good news in a state in which the hospital system is bearing up under severe stress from the latest pandemic surge.

Monoclonal antibodies already have been an established option in the care for certain cancer patients. But variations on this treatment have been given emergency authorization for COVID-19 by the Food and Drug Administration since last fall because it’s been found to be effective in many test cases — including that of former President Donald Trump when he became infected by the virus.

The Federal Emergency Management Agency is dispatching a team of 30 clinicians, due to arrive here Sunday. This will greatly expand the access to a therapy that already has been administered in Hawaii medical settings. In cooperation with staff from hospitals and federally qualified health centers, the crews on loan from FEMA will administer the antibodies by injection.

This is an outpatient intervention that, above all, is intended to help patients recover more successfully without hospital admission, thereby also avoiding compounding the strain on the health-care system. After the treatment is given, the staff will monitor the patients for adverse reactions to the therapy, which has its own set of side effects.

It’s ironic that some COVID-19 vaccine skeptics, including elected officials in some mainland hot spots, have endorsed this therapy. Vaccines still offer the best course to contain the spread of this deadly disease, for numerous reasons.

They are available in greater supply and are broadly accessible; everyone age 12 and up is eligible for a vaccine that has at least emergency authorization (full FDA approval has been granted to the Pfizer vaccine for all 16 and older). The shot provides a more durable immunity than the antibody injections do.

The antibodies, mass-produced in a laboratory, are similar to what the body naturally makes in response to an infection. An infusion will interfere with the virus’ ability to replicate in the body, reducing the symptoms of the illness. That’s what’s critical, because it can enable people to recover with home care.

But not everyone will qualify for a treatment generally given to patients with high-risk factors for developing severe disease. Among them are age (65 or older), excess weight, pregnancy, various chronic diseases, and weakened or suppressed immune systems.

To access the therapy in the soon-to-launch Hawaii program, a doctor’s referral is needed.

All of that being said, the therapy is an important addition to the state’s toolkit for combating COVID-19. Infections from the virus’ ultra-contagious delta variant have spiked alarmingly, leading to hospitalizations that have approached a breaking point for the state’s health-care system.

That has pushed Gov. David Ige to suspend liability for hospitals if they have to ration care. How exactly such a triage system would work if it’s adopted isn’t clear.

A plan adopted a year ago, before vaccines were available, made age one of the tie-breaking considerations in allocating medical resources. The stunning prospect that an elder, particularly one who got vaccinated, could be on the losing end of that choice is a prospect everyone finds appalling.

But some brutal decisions might have to be made on which patient should access limited resources if a “crisis standard of care” is adopted. So the mission now should be to lower hospital admissions and make such painful choices unnecessary.

Monoclonal antibody therapy surely will help there, while the focus remains on the vaccine as the surest, most humane route to success in the war on COVID-19.

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