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For the wealthy and linked, COVID-19 is a wholly totally different illness

The death rate from COVID-19 in the US is 1.8%. That number has slowly declined despite two large increases since the 3.5% figure that defined the initial wave of fall. The main reason for this decline isn't that we've learned anything new about treating COVID-19 patients – although the increased use of non-inflammatory steroids in patients receiving respiratory care has made some difference. The biggest improvement is simply that nowhere are hospitals as overwhelmed as they were in New York City.

As the death rate has decreased, the percentage of patients admitted to hospital has also decreased slightly, but that's not a good thing. The reason for this slight decrease in the number of COVID-19 patients being hospitalized is not because fewer patients are becoming seriously ill. It is that overcrowded hospitals are raising the bar for admission. The more the health system is overrun, the higher the bar.

In areas where the health system is under pressure during normal times, such as color communities and poor rural areas, that bar becomes very high. This means that people who are seriously ill are not receiving adequate care. The result can be clearly seen in the ages of those who die from COVID-19. Blacks, Latinx, and Native Americans die from COVID-19 at a younger age than whites. The difference is decades and represents a huge difference in the availability of health care. From the beginning it was clear that there was a difference in the death rate in communities of color and white communities. This is not an effect of the virus against the race. This is simply because there are fewer color beds, fewer intensive care beds, and less adequate care available for people of color, especially poor people of color. For black Americans, this means they will die from COVID-19 about a decade younger than white Americans. For Indians this means that they will die twenty years younger.

The reason for this is simple. While the hospitalization rate for COVID-19 decreases with age, with those over 60 being hospitalized nearly three times as likely as those over 30, all hospital ages are at similar risk when it comes to the need goes transfer to the intensive care unit and breathing support. About a third of those who have to be hospitalized because of COVID-19 require care at the ICU level. This also applies to 2.5% of COVID-19 patients who were hospitalized under the age of 18.

While the overall death rate from COVID-19 has dropped to 1.8%, the death rate from untreated COVID-19 remains around 10%. The more the community health system is burdened, the closer the mortality rate is to this maximum number. Black, LatinX, and Native Americans are dying younger because the health care available to them is simply inadequate.

What does all this have to do with monoclonal antibody treatment? Just that. Monoclonal antibodies to COVID-19 are given as soon as symptoms appear. And they reduce hospital stays by 70%. That doesn't mean 70% of monoclonal antibodies stay outside of the hospital. It's much, much better than that. Take a patient Trump's age. Hospitalization rates for COVID patients between 70 and 75 are around 12%. With monoclonal antibodies, this number drops to around 3%.

Here's another point of view: with treatment with monoclonal antibodies, a 75-year-old man has roughly the same chance of being hospitalized for COVID-19 as someone who is 18 years old without treatment. That is the extent of the difference this treatment can make.

For patients who have access to monoclonal antibodies, COVID-19 is a completely different disease. You have a slim chance of being hospitalized. Since they have a slim chance of being hospitalized, they have an even smaller chance of being rushed to an intensive care unit. And they have a vastly reduced chance of either dying or of having serious long-term health consequences.

Why doesn't everyone get monoclonal antibodies? Because it's rare and expensive. Both Regeneron and Eli Lilly together have only produced around 300,000 cans worldwide. It's also expensive – around $ 1,500 per treatment. Trump may have promised to make this treatment "free to everyone," but in fact the government has only ordered 300,000 doses, about half of which have been dispensed so far. Nobody is speeding this up for patients anywhere. There are barely enough doses to treat all people who test positive in the United States in a single day. Doses have been distributed and states have to decide who receives treatments, but they are both infrequent and unevenly distributed.

Could monoclonal antibodies are only stored for those who are under the worst of circumstances? They don't work like that. To be effective, the antibodies must be given early. Aside from trying to spread it to those at high risk, little can be done to target treatment to those who could benefit most from it. In fact, the EEA doesn't even allow the FDA for these drugs to be given to patients in need of respiratory assistance … which makes it strange that Trump received his while he was also in need of oxygen.

So who gets it? The answer is: the rich, powerful, and connected. Sure. Rudy Giuliani gets it. Chris Christie gets it. Ben Carson gets it. And absolutely Trump gets it. In fact, Trump received the equivalent of four normal doses.

The result of all this is that the political choices of COVID-19 are being made by people who are essentially immune to the consequences. For them, the disease is really not much more threatening than the flu. They are older men to whom the disease poses no greater threat than to their grandchildren.

You can laugh about it. With you.

You can design guidelines that will melt color communities whose health care was inadequate during normal times. And they can absolutely know that when it comes to vaccines, they will come first.

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