Ambulance transports elderly to COVID vaccination
Ambulance transports elderly to COVID vaccination United Hatzalah

Bamlanivimab (BAM). is a monoclonal antibody against the spike protein of the Corona virus which causes Covid-19 disease. Eli Lilly has FDA approval for emergency use of the drug, and has received Ministry of Health (MOH) approval as of January 12,2021. These approvals were based on the Blaze-1 study published in print in the New England Journal of Medicine on Jan. 21, 2021( but e-published much earlier, on Oct. 28,2020- which formed the basis of early use of the drug in the US in 2020). Blaze-1 showed that BAM cuts hospitalizations by 75%.

That MOH approval itself was problematic, as it gave" preference to dialyzed patients in hospitals who have Covid, as to Emergency Room patients who have transplants (kidney, liver, heart, lung)". No such limitations were noted in the inclusion criteria of Blaze-1.

Worse, the MOH recommended to not treat those 75 years old and above- which account for some 20% of all Israeli hospitalized patients. Worst of all, the MOH ordered only some 650 doses of the drug.

And the Israel Society of Infectious Disease (ISID) released a position paper on January 10, 2021 that was highly negative. It begins:

"This is a substance with restricted clinical efficacy that presents logistical problems in locating suitable patients, preparing places to give the drug to ambulatory patients, and in getting Covid-plus patients to the treatment centers".

This is not the case. Israel tests 100,000+ people a day, and on some days there are five to 6,000 positive Covid patients. Of these, half are asymptomatic. 45% will have mild to moderate disease, and they are targets for BAM therapy. 5% will need hospitalization, and just under 1% have been dying. But there is no problem in identifying the target patients. Thus, at least 2,000 targets a day for the drug (total 650 doses are in the country!).

The obvious best places to give the drug are ER's – but the drug has not been given, despite availability. I will explain that later.

Finally, the ISID says that a Covid + patient cannot have his Covid – family member drive him to the ER. But data from ACEP (Am. College Emergency Physicians) says that a Covid patient has been spreading virus for at least two days before symptoms begin. Add a day for testing. That means a wife has been breathing this patient's virus for at least 72 hours- so what is another 30 minute trip to the ER?

Talking to ER personnel in Jerusalem, the drug is not being used. At Hadassah Ein Kerem, the ER director has OK'd its use, but in actuality it is not ordered.

The question is: Why?

It's not because of the cost to the hospitals. MOH provides that free. Each dose of the drug costs $1,250. Not cheap, but cheaper than hospitalization. In the US, at least 9 different states and 30 medical centers have been helped by donations of money and personnel by the Covid Plasma Initiative, which is a group of Jewish religious doctors(from Medical Centers like Mayo's, Johns Hopkins, LA Cedars Sinai) and laymen( including Hatzalah) to provide the treatment. Tens of thousands of doses have been given in the US . Physicians from CPI have turned to the MOH and various Israeli hospitals to offer help of drug and personnel, and wonder why they have gone unanswered.

It seems that every Israeli hospital has been studying their pet drug and refuses to use the American. Eli Lilly BAM. Ichilov just announced their monoclonal antibody against c-24 antigen- on THIRTY patients. Hadassah has had Allocetra since October. Rambam and Zif have theirs. Perhaps all this drugs will be ready in3-4 months, when the citizenry will be 90% vaccinated. Meanwhile, in January , 2021 , Israel had 1,421 deaths from Covid.; 3 months of that is 4,000 dead Israelis, and many hospitalized, some maimed for life (permanent ventilators, or oxygen for life, or strokes, or heart attack victims).

Lilly can ship tens of thousands of doses TODAY.

I implore whoever reads this, to please do all in your power to change this situation. Please write MK's and the MOH-

MOH must be pushed to purchase Bamlanivimab to treat at least 50,000 (one month of patients) Israelis. The MOH must stop the age (and other) limitations: A 50 year old is 4 times as likely as a 20 year old to be hospitalized by Covid- and 30 times as likely to die; a 65 year old getting Covid is 5 times as likely to be hospitalized, and 90 times likelier to die. The ER's must stop pushing only their own projects, and must be mandated to start giving BAM.

Help from volunteers in the US cannot be ignored. The public deserves it.

Rabbi Dr. Aryeh Hirsch is a physician residing in Beit El who works at Hadassah Hospital. He recently completed Rabbinical ordination of the Chief Rabbinate of Israel through an adult study program at Yeshivat Merkaz Harav