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Posted on: September 17, 2021

Clinician Alert--COVID-19: Interim Triage of Limited Supply of Monoclonal Anti-SARS-CoV-2 Antibodies

September 17, 2021 

Clinician Alert--COVID-19:
Interim Triage of Limited Supply of Monoclonal Anti-SARS-CoV-2 Antibodies

Note: This alert modifies implementation of previous guidance issued on this topic earlier in the week.

Requested Actions

  • Please triage referrals for monoclonal anti-SARS-CoV-2 antibody (mAb) administration in accord with prevailing guidelines of the National Institutes of Health (NIH) for prioritization when there are logistical constraints, including the current lack of supply.
  • To prevent ineligible patients from incurring emergency department (ED) charges related to a federally required medical screening exam for ED arrivals, please do not refer patients whose circumstances fall outside these criteria. This should also help mitigate infection control risks at referral centers.


A recent change in mAb allocation policy and supply chain management by the federal government has resulted in mAb procurement running through the Washington State Department of Health (DOH), with geographic allocation going forward being based on COVID-19 incidence and mAb utilization. For at least the current time, this has led to a shortage of mAb supply in Snohomish County and statewide. While we wait for further statewide guidance from DOH on triage of access and as a measure to optimize utilization of the limited available supply, the Health District in coordination with the county’s mAb providers requests that you follow these guidelines on an interim basis when considering referrals for administration of mAb:

  • Defer use for post-exposure prophylaxis until further notice.
  • Among fully-vaccinated COVID cases, limit use to those who are ≥70 years* of age OR who are moderately-to-severely immunosuppressed.
  • Among not fully-vaccinated COVID cases, limit use to the following groups:
  • Older age (e.g., ≥65 years)
  • Hypertension
  • Obesity (BMI ≥35* kg/m2, or if age 12-17, BMI ≥85th percentile)
  • Chronic lung diseases
  • Pregnancy
  • Sickle cell disease
  • Chronic kidney disease
  • Neurodevelopmental disorders
  • Diabetes
  • Complex genetic or metabolic syndromes
  • Immunosuppression
  • Severe congenital anomalies
  • Cardiovascular disease
  • Medical-related technological dependence
  • Administration within ≤7 days* of onset offers the greatest yield in preventing severe disease.

*In consultation with local medical leadership, these three asterisked and italicized criteria were added to or further tailored NIH guidance in order to optimize allocation of this currently scarce resource in Snohomish County as part of the declared emergency with respect to COVID-19.

The Health District will update you when the supply of mAb permits broader implementation. Meanwhile, thank you for your patience with this and other frequent and short-term changes in COVID-19 guidance.

Christopher Spitters, MD, MPH Health Officer

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