The COVID-19 pandemic has magnified longstanding healthcare and social inequities, resulting in disproportionately high COVID-19–associated illness and death among members of racial and ethnic minority groups. Equitable use of effective medications could reduce disparities in these severe outcomes.
Racial and ethnic disparities in SARS-CoV-2 infection risk and death from COVID-19 have been well documented. Analysis of data from 41 healthcare systems participating in the PCORnet, the National Patient-Centered Clinical Research Network found lower use of monoclonal antibody (mAb) treatment among Black, Asian, and Other race and Hispanic patients with positive SARS-CoV-2 test results, relative to White and non-Hispanic patients.
Equitable receipt of COVID-19 treatments by race and ethnicity along with vaccines and other prevention practices are essential to reduce inequities in severe COVID-19–associated illness and death.
Monoclonal antibody therapies against SARS-CoV-2, initially received Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA) in November 2020. mAbs are typically administered in an outpatient setting via intravenous infusion or subcutaneous injection and can prevent progression of COVID-19 if given after a positive SARS-CoV-2 test result or for postexposure prophylaxis in patients at high risk for severe illness.
Relative differences in treatment with dexamethasone and remdesivir were less apparent in hospital settings, which might be attributed to ease of medication access. mAb treatment must be administered by intravenous infusion or subcutaneous injection by a healthcare provider, typically in outpatient settings, soon after receipt of a positive test result and within 10 days of symptom onset.
The finding of mAb treatment disparities is consistent with previous studies. A single-center study of kidney transplant patients found that Black and Hispanic patients infected with SARS-CoV-2 were less likely to receive mAb and more likely to be hospitalized. mAb treatment disparities might reflect systemic factors such as limited access to testing and care because of availability constraints, inadequate insurance coverage, and transportation challenges; lack of a primary care provider to recommend treatment; variations in treatment supply and distribution; potential biases in prescribing practices; and limited penetration of messaging in some communities about mAb availability and effectiveness to prevent disease progression.
Additional reasons might include hesitancy about receiving treatment; a previous study found patients who were non-Hispanic White and English-speaking accepted mAb treatment more often than did those who were non-White and Hispanic.
In inpatient settings, Black inpatients received remdesivir more often, and Black, Asian, and Hispanic inpatients received dexamethasone less often than did comparison groups. This could indicate racial and ethnic differences in clinical indications for medication use (e.g., age distribution and prevalence of comorbidities) or could be reflective of varying prescribing practices, protocols, and drug access by institutions that serve populations of different racial and ethnic distributions.
Reducing racial and ethnic disparities in COVID-19 treatment requires patient and clinician awareness of the problem and its solutions; resources; and action from government, private entities, and community- and faith-based organizations to implement effective interventions.
Bringing healthcare to populations facing barriers in access to mAb via a mobile infusion unit or via telehealth providers has been shown to increase mAb use, decrease severe outcomes, and reduce costs. These examples of meeting persons in community venues can be helpful in delivering outpatient treatments, addressing pandemic disparities, and managing underlying chronic conditions affected by social determinants of health.
Moreover, disparities in COVID-19 treatment are the latest example of longstanding unequal treatment of many medical conditions. Multicomponent, multisystem programs and policies can support health equity.
One such program is the COVID Response and Resilient Communities initiative, which places community health workers in communities to reduce long-standing disparities and deliver interventions to manage COVID-19. Future studies of COVID-19 treatment disparities should account for persons with high-risk conditions and include newer medications, such as the oral antiviral agents Paxlovid and molnupiravir, as well as sotrovimab, which is the only mAb treatment currently available for early treatment of patients infected with the SARS-CoV-2 B.1.1.529 (Omicron) variant.
