A persistent lack of appointment slots at health systems across the metro is forcing patients to drive far from the Twin Cities to receive a promising treatment for COVID-19.

Infusions of monoclonal antibodies, an outpatient treatment for patients within 10 days of first symptoms, became available in Minnesota during late 2020. From the start, health care providers in the seven-county metro area have provided a disproportionately small share of the statewide total — less than 10% of the doses administered, according to the Minnesota Department of Health.

Now, the shortfall in the Twin Cities is being felt more widely because demand for the antibodies has skyrocketed. Health officials worry patients in the metro are going without the treatment as a result, because they can't travel to medical centers in greater Minnesota up to 138 miles away.

When Dolly Ludden was sickened with COVID-19 in mid-September, she found appointments in Litchfield, Sleepy Eye and Mankato but none closer to her home in St. Paul. She wound up driving to the Mayo Clinic in Rochester.

"I brushed my teeth, put on my clothes and flew out the door so I could make it in time," Ludden said of the 75-mile trip. "Fortunately I was not so sick that I could not drive myself."

The state is trying to address the problem by opening a new center in Ramsey County that would provide infusions of monoclonal antibodies, the emerging COVID-19 treatment cleared last year for emergency use.

Health systems in the metro are opening more appointment slots, as well, but say they can't fully satisfy demand because they're struggling to find enough staff.

There's still a healthy supply in Minnesota of the antibodies, which are purchased by the federal government and were part of former President Donald Trump's treatment regimen when he had COVID-19. But a growing number of people from the seven-county metro are taking treatment slots in greater Minnesota, much like this spring when more privileged patients in the Twin Cities drove hours to distant pharmacies for scarce COVID-19 vaccines, said JP Leider, a public health researcher at the University of Minnesota.

"It's not fair to greater Minnesota that metro health systems continue to not offer this at scale," said Leider, who leads the Minnesota Resource Allocation Platform that connects patients with health care providers offering the treatment. "And it's not fair to metro patients, many of whom have more transportation and other challenges to get to greater Minnesota if they're told, 'Hey, you've got a spot, but you've got to drive three hours [round trip].' "

While acknowledging that staffing problems are a significant challenge for Twin Cities hospital systems, Leider urged them "to figure out how to offer what has become the standard of care in COVID treatment. … There is a shortage of appointments in the metro but not in the state."

Patients with mild to moderate COVID-19 symptoms and certain risk factors are eligible for monoclonal antibodies, as long as they seek treatment within 10 days of their first symptoms.

Statewide, demand for the treatment has skyrocketed from just 23 infusions during the last week of June to 1,262 infusions during the third week of September. Health systems in the Twin Cities have been adding capacity, but the treatment supply remains far short of the demand from patients in the metro, said Alexandra Waterman, the medical surge coordinator for the state Health Department.

"If we tell someone who doesn't have a vehicle the closest place you can get this is 30 miles away and you're COVID-positive and we don't recommend you ask a friend who has a car drive you — that's really not helpful," Waterman said. "Equitably, we understand that that is not ideal for many, many people. So that's why we've continued to try to increase the metro capacity."

Health systems say there has been fluctuating demand for antibodies, since they scaled down infusion operations when patient interest in the treatment was almost nonexistent in June.

"Suddenly, in the last six weeks, the demand has skyrocketed," said Dr. Venkat Iyer, vice president for medical specialties at Allina Health Group. "But it always takes time to build up capacity."

Allina has increased its volume of infusion treatments to about 30 per week, Iyer said, and expects to add more.

"The problem is too few of us are giving this treatment," he added.

Another challenge is the treatment usually requires infusion center facilities that also care for patients with compromised immune systems and other serious health problems, said Dr. Andrew Olson, the chief of COVID hospital medicine at M Health Fairview. So health systems either must create entirely separate infusion centers for COVID-19 patients or somehow adopt practices within existing centers that separate those with active infections.

M Health Fairview has expanded capacity and is providing 30 infusion treatments per week in patients' homes, but it's been difficult to grow the service while also finding enough staff to handle the very high volume of non-COVID patients this fall, Olson said. At the same time, there's been a surge in recent weeks of COVID-19 hospitalizations and a need for health systems to administer additional doses of COVID-19 vaccine.

"The staffing and capacity challenges that every health care system in Minnesota is facing right now are extremely challenging," he said, "and are as bad as they've been since we began this journey in the pandemic."

Statewide, there are about 80 medical centers that provide monoclonal antibody treatments for COVID-19. Hennepin Healthcare and North Memorial Health in the metro haven't been providing any infusions for outpatients. However, the Mayo Clinic in southeast and south-central Minnesota has been providing about 315 treatments per week in September, with a number of patients traveling from the metro.

During one recent week, only 1 in 4 patients from the Twin Cities received treatment within the metro area, state figures show. The migration of patients has put pressure on treatment slots elsewhere, including St. Cloud-based CentraCare and Duluth-based Essentia Health.

The new center in Ramsey County being funded by the state will bring the metro total to 10 health care providers.

"We hope this site will have the highest capacity of all sites located in the metro region and will aid in alleviating the inequities," Waterman said via e-mail.