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Utah eliminates race and sex as factors in monoclonal antibody COVID treatments after ‘legal concerns’

The move comes even as new state data show a stronger link between race and serious illness.

(Chris Samuels | The Salt Lake Tribune) A new treatment center for monoclonal antibodies is shown to media on Thursday, Sept. 23, 2021 in Murray. The Utah Department of Health, which operates the facility, will no longer use race and sex as a factor in determining who gets limited treatment for COVID-19.

After complaints by right-wing media personalities, Utah is eliminating race and sex as factors in allocating its limited supply of monoclonal antibodies and antiviral treatments for COVID-19.

Based on clinical data that showed men and patients of color were at a heightened risk of being hospitalized or dying from COVID-19, state health officials previously had included both markers as risk factors in determining who is eligible for the popular but vanishingly scarce COVID-19 treatments.

But the Utah Department of Health on Friday announced that it was now eliminating race and sex in its determinations, citing “legal concerns.”

The move comes less than two weeks after Fox News talk show host Tucker Carlson falsely claimed that health officials in Utah and other states were giving priority to people of color in order to “punish” white people. Carlson, though, did not object to allocation rules that gave priority to men.

Two days after that, America First Legal — a conservative advocacy group founded by former White House staffer Stephen Miller — threatened to sue Utah for including race and ethnicity in its risk calculator. Like Carlson, AFL did not object to priority given to men.

Now both factors have been removed from the criteria Utah is using to calculate patients’ “risk score,” which determines whether they are eligible for the treatments.

“As with the protected class of race, providing additional points based on gender raises legal concerns,” UDOH spokesman Tom Hudachko wrote in a news statement Friday afternoon. Hudachko also noted that new data, requested by UDOH, showed a weaker link between hospitalization risk and sex.

But at the same time, the updated data appear to show an even stronger link between the risk of serious illness and race.

Earlier this month, UDOH reported patients of “non-white race” or Hispanic ethnicity were 35% to 50% more likely to be hospitalized due to the coronavirus. On Friday, updated figures showed an increased hospitalization risk of at least 40% for Latino patients, 50% for Asian Americans, 80% for Indigenous people and 130% for patients who are Native Hawaiian and Pacific Islander.

“Instead of using race and ethnicity as a factor in determining treatment eligibility, UDOH will work with communities of color to improve access to treatments by placing medications in locations easily accessed by these populations and working to connect members of these communities with available treatments,” Hudachko wrote.

UDOH did not identify those locations. It also did not specify the law under which the previous eligibility calculator “raises legal concerns.”

Hudachko wrote that the changes come “in response to extremely limited supplies of these treatments, to ensure that classifications in the risk assessment comply with federal law, and to new guidance issued by the National Institutes of Health.”

Higher priority for the old and unvaccinated; lower priority for the pregnant, homeless and immunocompromised

The new risk calculator also changes who automatically qualifies for the treatments.

Previously, anyone who tested positive while living in a “congregate” setting — nursing homes, homeless shelters, jails and prisons, for example — automatically qualified, without calculating a risk score. So did Utahns who were unvaccinated and pregnant, as well as all immunocompromised Utahns.

Now most of those Utahns must be scored under the risk calculator.

“Only the highest risk immunocompromising conditions will be prioritized without using the risk score calculator,” Hudachko said.

Some of those factors — pregnancy and certain immunocompromising conditions — will continue to be considered. But UDOH did not release the new scoring criteria or respond to The Salt Lake Tribune’s requests for it, so it’s unclear how much weight those carry.

Meanwhile, state officials added a new group that will automatically be deemed eligible for the treatments: unvaccinated Utahns who are 75 or older.

Because UDOH did not release the updated criteria for scoring risk, it is unclear how many “points” certain medical conditions and age groups receive or whether the thresholds to qualify for the treatments remain the same.

Previously, unvaccinated patients needed a score of 7.5 and vaccinated patients needed a score of 10. Age was the most significant criteria scoring, with a half-point added for each decade of seniority. Certain high-risk medical conditions added one or two points each; men received one extra point and patients of color received two extra points.

Treatment supplies still thin as new infections climb

Utah tightened its criteria for monoclonal antibodies and new antiviral drugs earlier this month as supplies of the treatments dwindled.

Monoclonal antibodies, as well as a new Pfizer antiviral drug, have proven successful at reducing coronavirus symptoms if administered shortly after infection. The treatments have been especially popular in areas with low vaccination rates.

But now, the available supply of those treatments is far less than what it was only a few weeks ago, health officials have said. That’s in part because, of the three versions of monoclonal antibodies that had been available, only one is effective against the omicron variant. That treatment has been in short supply nationwide as the highly transmissible variant infects more and more high-risk patients.

In previous months, Utah had been able to order up to 1,300 treatment courses per week. In recent weeks, those allocations have dropped to 500 to 800 courses. As of Friday, there were more than 500 active cases among residents at Utah’s nursing homes alone.

“While these treatments are promising for people at highest risk of hospitalization, the supply of these treatments is scarce,” said Dr. Michelle Hofmann, deputy director of UDOH, in a statement. “Vaccination, including booster doses, remains the best path forward out of the pandemic. All of us must do our part to help see our state through this crisis.”

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