Plea for at-risk persons with COVID-19 to use monoclonal antibodies 

By Aaron Humes: As the United States faces record hospitalizations from COVID-19, some health professionals are urging more usage of a heretofore ignored solution: monoclonal antibodies.

But as NBC News’ Erika Edwards reports, a lack of time, resources and awareness has combined to stall efforts to put the solution to greater use.

“This is the first time during the pandemic that I can recall when our resources far exceed demand,” Dr William Fales, medical director of the Michigan Department of Health and Human Services, said Thursday during a media briefing organized by the U.S. Department of Health and Human Services. Fales estimated that just 10 per cent of COVID-19 patients in the state who are eligible for the therapy had received it.

Monoclonal antibodies are lab-made drugs meant to mimic natural antibodies to SARS-CoV-2, the virus that causes COVID-19. They’re recommended for people who are at high risk of getting very sick from the virus, including anyone over age 65 and people with underlying health conditions. At least one study showed that the therapy can lower the amount of virus in a person’s system. But no gold standard research proves that monoclonal antibodies do, indeed, provide this benefit. Most reports are anecdotal.

Dr Andrew Thomas, chief clinical officer at the Ohio State University Wexner Medical Center, suggested Wednesday during a media call that use of monoclonal antibodies has eased strains on the hospital system. Thomas said his system “ramped up” use of monoclonal antibodies quickly. “I’d like to think it’s why our hospitalizations have come down,” he said. Dr Jonathan Parsons, head of the monoclonal antibody treatment efforts at the Ohio State centre, said, “Anyone who gets tested through our swabbing program is entered into an electronic medical record.” Parsons’ staff then contacts the primary care providers for patients who test positive, asking whether they’d like to refer patients for monoclonal antibodies.

And New Jersey’s state epidemiologist, Dr Eddy Bresnitz, said monoclonal antibodies may have played a role in a recent levelling off of the state’s COVID-19 hospitalizations. “It’s worth the effort to get it,” Bresnitz said during a media briefing Thursday.

But setbacks to greater usage of monoclonal antibodies include timing; it must be given soon after a person has tested positive. “These medications work best when given early,” Surgeon General Jerome Adams said during Thursday’s briefing.

The two monoclonal antibody products that have been authorized for emergency use by the FDA, from the drug makers Eli Lilly and Regeneron, must be given within the first week of illness.

Dr John Redd, the chief medical officer for the office of the assistant secretary of health and human services for preparedness and response, said patients need not have a PCR test to qualify; a rapid test is sufficient despite it having great numbers of false negatives.

Those who have obtained the treatment, given intravenously, say it takes at least an hour as part of a full three-to-four-hour appointment – too much time for some, not to mention the stigma associated with the disease.

Health and Human Services Secretary Alex Azar put the onus for pursuing monoclonal antibodies on patients, who “should be asking their doctors or health care providers why they aren’t being offered these antibody therapies.” But its own online tool lacks data on monoclonal antibody treatment in a majority of states, including Alabama, Kansas, Michigan, New Jersey, New York, North Carolina and Washington. The site is scheduled to be updated.

Here in Belize, resources had been gathered for plasma treatment for Drs Kevin and Kenneth Guerra after they fell ill with COVID-19 last year, but both men died before the treatment could begin. It is not clear if the Ministry of Health and Wellness continues to pursue the use of this treatment for hospitalized patients as the numbers come down from the peak of the pandemic in the third and fourth quarters of 2020.

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