I think you're going to find my questioning much slower and more labourious.
Dr. Morris, let me start off by complimenting you for speaking out on issues of public health. I know a lot of health care workers have been afraid to do so, and for good reason.
I was still on staff at the local hospital until January. My hospital, for example, specifically told doctors not to speak to the press or politicians like myself. There certainly have been health care people disciplined or threatened with discipline, especially when they speak up on public health measures and against government policy.
Therefore, I certainly commend you for it. I disagree with these kinds of tactics from the hospitals. I think you'll agree that an ounce of prevention is worth a pound of cure. Certainly when somebody has gotten to the stage that they're on a ventilator, there's not a whole heck of a lot you can do for them medically. It makes more sense to prevent their getting on ventilators, which means good public health.
For a good doctor, it's not just a good decision to speak out; I would suggest that doctors have a duty to speak out. You might want to comment on that.
However, before I get there, I have a second question. You probably saw this coming, because we've talked about it before. It's about the use of monoclonal antibodies. It gets to the same thing: keeping people off ventilators. As I suggested last time, I think there's a growing amount of robust evidence that use of monoclonal antibodies in high-risk people, when used early on, can reduce by somewhere between 60% to 80% the number of people who go on to hospitalization.
Now, I know when we previously spoke, you felt that there wasn't enough evidence for that. You wrote the guidelines. You sit on the science table. I would like to point out that, since then, the NIH guidelines panel, in interpreting the evidence, gave a class IIa recommendation for the use of monoclonal antibodies.
I talked about some of the evidence before. With Chen et al. in the New England Journal of Medicine, there were certainly good results; and BLAZE-1, Gottlieb et al., in JAMA, is another study with very positive results. I brought these examples up in the last meeting.
Since then, real-world experience from Kumar et al., from the clinical infectious disease group from Chicago, found the number needed to treat was eight, treating eight high-risk people with monoclonal bamlanivimab before they got really sick. If you treated eight, it would prevent one person being hospitalized.
Bariola et al., a Pittsburgh group, in Open Forum Infectious Diseases, found that treatment, again with bamlanivimab, resulted in a 60% lower risk of hospitalization or mortality.
Now, to pre-empt you, I know that the FDA revoked approval in the U.S. for bamlanivimab alone, but that was based on in vitro studies showing that it didn't look like it would be effective against the California or New York variants, which we don't have much of here. The estimates have been in Ontario that 90% to 92% of the variants we have here, including the wild type, are covered by that treatment.
Even if you don't like bamlanivimab, there are the other newer monoclonal antibodies. The Celltrion phase II and phase III clinical trial showed a 64% reduction in progression to disease. On the bamlanivimab and etesevimab, there have been further studies with that in chronic care homes; the BLAZE-1 phase 3 trial; and REGEN-COV by Regeneron, which showed that patients who got infused treatment within 10 days of developing symptoms had a 70% reduced risk of hospitalization or death. More recently, in the COMET-ICE study, with GlaxoSmithKline, the independent data monitoring committee recommended stopping the trial early because results were showing an 85% reduction in hospitalization or death, so it would be unethical to continue.
Given all that, do you continue to maintain that there is not enough evidence for the use of monoclonal antibodies, and will the science table re-examine this in the treatment guidelines?
Thank you.