Monoclonal antibodies: I’m high risk and have COVID. What now?

Monoclonal antibodies are an IV administered treatment therapies for use in COVID-19 infection...
Monoclonal antibodies are an IV administered treatment therapies for use in COVID-19 infection cases.(Storyblocks)
Published: Sep. 2, 2021 at 5:36 PM AKDT
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ANCHORAGE, Alaska (KTUU) - Monoclonal antibodies are being strongly encouraged for those at high risk for severe illness from COVID-19, once they’re infected or exposed as a close contact.

The list of conditions that put a patient at high risk for serious COVID-19 illness hasn’t changed much throughout the pandemic, but those conditions, on top of being unvaccinated, may make patients eligible for treatment with the emergency use authorized treatment.

While some people, both vaccinated and unvaccinated, may have other risk factors that qualify them for the treatment, if someone doesn’t have risk factors, “we presume that your immune system is robust enough that you’ll be able to make your own antibodies and fight COVID-19 so that you don’t develop the severe symptoms, so you’re not a candidate,” said Jyll Green, who runs the state’s monoclonal antibody infusion center in Anchorage.

The goal of the treatment is to keep patients from getting more sick, and from needing hospitalization, though health professionals say the best way to stem the flow of COVID-19 patients into hospitals is to get vaccinated.

Read more: Monoclonal antibodies available and effective, but don’t replace vaccine, doctors say

“We are tired. We’re happy to do this, this feels like the right thing to do, so we’re really happy to be here and provide this service, but we really want people to get vaccinated,” Green said, before describing the 12-hour days, seven days a week she and her team are working. “That would just do us a huge favor right now. It’s so important to get vaccinated, and we just don’t know how long it’s sustainable.”

Monoclonal antibodies’ effectiveness

This week, the Mayo Clinic released a study on the effectiveness of monoclonal antibodies at keeping COVID-19 patients out of the hospital and ICU, and from dying. The study, which looked back at nearly 1,400 of the clinic’s patients, showed mixed results. While high-risk patients receiving the treatment showed a markedly lower risk of being hospitalized with COVID-19 — 60-70% lower — once a patient was admitted, the rate of ICU admissions and deaths between those who received monoclonal antibodies and those who did not was not pronounced. The study covered a time period between December and April, before the delta variant comprised 99% of U.S. COVID-19 cases, as it does today.

State health professionals say that study is in line with other research done on the treatment.

“My takeaway from it is, it really supports the other studies that have been done looking at monoclonals if you give them early, really within that first few days,” said Dr. Coleman Cutchins, a clinical pharmacist with the Alaska Department of Health and Social Services. “If you aren’t hospitalized, you’re not going to get worse.”

Before getting an infusion

Of importance, doctors say, is to get monoclonal antibody treatment soon. The treatment works best within the first 10 days of illness, but if the virus replicates too much in your system, the treatment isn’t effective. That also means getting tested early.

“There’s that such narrow window where they’re effective,” Cutchins said. “Patients really need to be testing at the first sign, as soon as they test positive going in to get monoclonal (treatment).”

He said he’s heard many stories of people who didn’t feel too bad and didn’t want to get a treatment under emergency use authorization, or didn’t want an IV treatment.

“They want to wait it out and then by the time they get worse and show up in the E.R., it’s too late. The drug isn’t going to work anymore,” he said.

“If you’ve gotten to that point of where the virus has replicated into the millions and tens of millions of copies, at that point, the damage is done,” Cutchins said.

Green, at the infusion center, says she’s sent patients to the hospital who were too ill.

“If you’re too sick, if you are eligible for hospitalization, due to low oxygen saturation, we will send you to the hospital from here, and we’ve done that a few times,” Green said. “When your disease is so severe, this is not the right treatment for you.”

The process of monoclonal antibody treatment

Monoclonal antibody treatments must be prescribed by a doctor — for that, the state health department highly suggests patients speak to their primary care provider first.

Some clinics are even offering the treatment themselves; the drug, Regen-COV is available free from the federal government. If not, people can call the state’s help line to get a referral from the health professionals who run the state’s monoclonal antibody centers. They’ll screen people for those high-risk conditions.

To get into the monoclonal antibody infusion center run by the state health department in Anchorage, one must ring a doorbell. An employee, dressed in a full hooded PPE suit, greets the person at the door and gets them a cot. They take a patient’s vital signs, including oxygen levels. Some patients, Green said, have come in with oxygen levels so low she’s sent them to the emergency room instead.

“This looks a lot different than it did last December and January,” said Green, who gave the infusions during the state’s first big wave of COVID-19 cases last winter. “People are getting more sick, more quickly it seems. There’s no hard study to say that, but what we’re seeing is people are sick and they’re sick fast, within two to three days of onset of symptoms, they’re not looking very well at all.”

The infusion itself lasts 20 minutes. Some patients are so ill that it can only be given by four subcutaneous injections in the stomach. Those inject the solution into the tissue layer between a person’s skin and muscle. Health workers have to observe the patient for an hour to monitor for adverse reactions.

Green said the reactions they’re watching for are similar to those of concern after a vaccine: low blood pressure, allergic responses, hives, itching or redness. She said she has not seen any adverse reactions at the clinic so far, but that the staff is prepared with epinephrine and emergency gear in case of a reaction.

After the infusion?

“They go home,” Green said. “I tell them when you leave here, ‘You don’t feel this big wow, I’m cured.’ It’s kind of a slow evolutionary process.”

Green says they follow up with most patients at the four-to six-week mark, and most say that they started to feel better the second day after infusion.

Infusion patients have to wait 90 days before they can get a COVID-19 vaccine, though Green said many ask for it when they come in already feeling very ill.

“There is a huge marked difference that I’ve seen here between vaccinated and unvaccinated people,” she said. “Again, both qualify for the monoclonal antibodies if they’re in that high-risk category, but unvaccinated individuals really do come to us looking a lot more ill and generally the first question they ask is when can they get vaccinated, and the answer to that is 90 days after a monoclonal antibody infusion, you can get vaccinated.”

To find out more information on the COVID-19 vaccines and monoclonal antibody treatment, or to find out whether you qualify for the treatment, call the state’s COVID-19 help line at (907) 646-3322.

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