Early treatment options for COVID-19 have become increasingly promising as a means to keep people at high risk of developing severe illness out of the hospital and from dying, but their availability in Hawaii is in short supply.

The omicron variant, which has propelled coronavirus case numbers to record heights in recent days, has shaken up the landscape of what works and what doesn’t, leaving health care providers with limited options while they await the availability of two new drugs approved by the U.S. Food and Drug Administration just days ago.

During the summer delta variant surge in Hawaii, monoclonal antibody treatments became a more popular treatment option. But therapies developed by Eli Lilly and Regeneron don’t appear to be very effective against the new omicron variant, according to the Hawaii Department of Health. That leaves sotrovimab, but there is a huge demand for the treatment across the country and supplies are limited.

Hawaii received just 66 doses of sotrovimab last week, according to Dr. Douglas Kwock, vice president of medical affairs for Hawaii Pacific Health.

“It is available but under very limited supply,” Kwock said.

DOH said it is expecting a bigger supply in January but didn’t specify how much more that could be.

To qualify for the treatment, Kwock said individuals need to be age 12 or older and at high risk of progression to severe illness. This can include factors such as being overweight, having diabetes or suffering from heart or lung disease.

There are also two new treatments approved by the FDA this month for emergency use. Pfizer’s Paxlovid, available for people 12 and older, and Merck’s Molnupiravir, approved for those 18 and older. Both are oral antiviral drugs that are taken twice a day for five days. Both drugs are reserved for people who are at high risk of developing severe COVID-19 and must be taken early, before the disease progresses.

But these drugs also are expected to be in short supply and are being divvied out to state health departments by the federal government. This week, Hawaii was allocated 1,080 courses of Molnupiravir and 240 courses of Paxlovid, according to the U.S. Department of Health and Human Services.

DOH didn’t respond to questions about whether the state has received the drugs yet and how they would be allocated given the limited supply.

However, a spokeswoman for Kaiser Permanente said that the earliest the drugs are expected is next week.

When taken within five days of symptom onset, Paxlovid was found to reduce the risk of hospitalization and death by 88%. In announcing the FDA emergency use approval for the drug, Dr. Patrizia Cavazzoni, director of the FDA’s Center for Drug Evaluation and Research, called it “a major step forward in the fight against this global pandemic.”

Both new treatments are expected to stand up well to the omicron variant, which may already be the dominant variant in the state. Hawaii on Tuesday reported 824 new infections, while the seven-day average of new cases stood at 1,417.

Kwock said the new oral treatments are very promising “if we can get enough supply.”

“I think we knew early on in the COVID pandemic that, ultimately, a part of the end game would be finding good effective, outpatient treatments, and that is hopefully what we are developing with Paxlovid and Molnupiravir,” he said.

Kwock noted that by comparison, monoclonal antibodies are difficult to administer. They typically require a clinic visit and intravenous infusion and patients must be monitored for an hour to make sure they don’t have an adverse reaction.

Brooks Baehr, a spokesman for DOH, said people should not rely solely on monoclonal or antibody treatments and that vaccines and booster shots offer the best protection against COVID-19, including the omicron variant.

THE U.S. Centers for Disease Control and Prevention on Monday also shortened from 10 to five days the period for which it advises people to isolate after testing positive for COVID-19. If there are no symptoms at the end of the five days, the CDC said people can resume normal activities so long as they wear a mask everywhere for at least five more days.

However, if symptoms persist after five days, the CDC says people should continue to stay home.

The CDC also revised its quarantine guidance. Previously, the agency said that people who are not fully vaccinated and come into close contact with an infected person should isolate for at least 10 days. Now the agency says that only people who received booster shots can skip quarantine, so long as they wear a mask for 10 days.

Previously, anyone who was fully vaccinated, with two doses of the Pfizer or Moderna vaccines or one dose of the Johnson &Johnson vaccine, could evade quarantine.

DOH, which in the past has been more conservative in its guidance than the CDC, said on Tuesday that it is still reviewing the CDC guidance and will announce any changes in its policies.

Jessica Lani Rich, president and CEO of the Visitor Aloha Society of Hawaii, said the recent CDC guidance lowering the quarantine period from 10 to five days will make it easier on visitors.

She said she has seen a recent increase in tourists who need assistance after testing positive for COVID-19.

“For the last year and a half, we would see one or two or three cases a month,” Rich said. “In the last week, we have had nine visitor cases. We are seeing one or two a day.”

Rich said it appears that many contracted the virus while in Hawaii. “Many have found out when they have to take a COVID test to return home,” she said. “It’s a financial burden for most visitors.”

Visitors who are not hospitalized must stay in a hotel or with friends or family. They aren’t allowed to quarantine in vacation rentals.

“Many of our hotels are filled with families that were displaced by the Red Hill water contamination situation. That’s made the prices go up,” she said. “Hotels are pretty expensive right now.”

Rich said the state no longer has a designated COVID-19 quarantine hotel, but she is working with three or so properties that will accommodate visitors who need to be in isolation.

She recently assisted a young man who had gotten COVID-19 and was staying in a hostel to find a hotel.

“He didn’t have the money but his mom was able to wire the money,” she said. “We try to help as much as we can, but the costs are the responsibility of the guest.”

Rich said that’s why she recommends that visitors invest in a good traveler’s insurance policy, which can help cover medical and other costs that travelers face, including loss of income for missed work and cancellation or change fees.

In addition to financial woes, coming down with COVID-19 while on a holiday is emotionally devastating, according to Rich.

“We have volunteers contacting the visitors who have COVID each day to make sure that they are OK,” she said. “We dropped off Christmas presents for them. One man said it was the only Christmas present that he got this year.”