Top doctors at HealthAlliance, Northern Dutchess Hospital and Vassar Brothers Medical Center say monoclonal antibodies can be a very effective treatment for patients early in a COVID-19 infection who are not yet hospitalized.
Dr. Marc Tack, HealthAlliance’s Director of infectious Disease, who has cared for patients at HealthAlliance for 25 years said the hospital has been using monoclonal antibody treatments for COVID-19 patients since they were first approved under a Food and Drug Administration (FDA) emergency order. Tack said monoclonal antibodies are also used at HealthAlliance parent WMC Health’s Mid-Hudson Regional Hospital in Poughkeepsie, while patients from Margaretville Hospital who need monoclonal antibodies are transported to HealthAlliance in Kingston.
Tack said the treatments, administered through an infusion, have been around for between 10-15 years. They assist in creating an antibody to help fight a virus or bacteria, he said.
According to Tack, monoclonal antibodies were already developed for use in fighting sepsis, and drug makers like Lily and Regeneron were able to reprogram them to target COVID-19 instead of bacteria. “Since they were using some of the same technology they were preparing these quickly,” he said. The FDA opened up the use of monoclonal antibodies for more subsets of patients on July 30, Tack said, opening the treatment to any patient doctors feel is at risk for progression to hospitalization to serious illness. Before that it was limited to those 65 and older or those with a select set of medical conditions like having elevated BMI, having an immunosuppressive disorder or being diabetic.
Dr. William Begg, vice president of medical affairs at Nuvance Health’s Vassar Brothers Medical Center in Poughkeepsie, which treats on average anywhere from a handful to a dozen patients a day with monoclonal antibodies, said it can reduce the risk of patients needing hospitalization or progressing to serious illness by up to 70 percent.
Dr. Andrew Wilson, vice president of medical affairs at Northern Dutchess Hospital, also part of Nuvance said as of Thursday, September 4 it has administered 280 monoclonal antibody treatments during the course of the pandemic. “Monoclonal antibodies are an important tool we can use to try to prevent hospitalizations and deaths,” Wilson said in an emailed statement. “The treatment still only has emergency use authorization by the FDA and its safety and effectiveness continues to be studied, but has shown promising results.”
At HealthAlliance, the number of treatments varies widely day to day, Tack said, adding on a recent Friday morning that it was shaping up to be a busy day.
So far very few patients who’ve received monoclonal antibodies progress to serious illness, Tack told Hudson Valley One. “That’s not to say there aren’t instances of people ending up in hospital.”
With the treatment being so new, Tack cautioned there are still few peer-reviewed studies on it. “This is from experience hearing colleagues across the country,” Tack said.
Still, both Nuvance doctors cautioned there are still some situations where doctors do not use the treatment and that includes on patients who are already hospitalized with COVID-19.
“This treatment is for patients with early, symptomatic COVID-19 who have risk factors for progression to severe illness,” Wilson said.
“One of the reasons we don’t give monoclonal antibodies late in care, and what gets patients in trouble is their body’s secondary response,” he said. “Their body has an overwhelming response to infection that causes the patient’s lungs to fill up with fluid…The idea is that the antibodies should be used within a week to 10 days of patients getting sick.” He added that ideally the treatment should be done within two to three days of it being ordered by a doctor.
The longer the wait, the longer the process takes and the higher chance the patient stands of progressing to serious illness, he said.
The administration of the treatment varies from hospital to hospital.
At HealthAlliance patients are scheduled for the treatment and they come to the hospital and are escorted through a secured area with people in appropriate PPE, Tack said. Only once they are inside a room set up to handle COVID-19 can they receive the treatment through an infusion. “Those assessed to not need further medical care are then escorted through the same process,” he said.
He said one of the challenges all institutions face is a desire to get these medications into patients quickly, but as of right now this needs to be done in an outpatient hospital setting and the hospital needs to have isolation rooms, along with a process and staff that can handle infusing medication into COVID positive patients.
“This is a complex process, to take someone COVID positive to a hospital facility, bring them in safely, treat them, get them home safely without exposure,” Tack said. “But our staff is incredibly committed and HealthAlliance hospital can handle this and does a great job.”
He said HealthAlliance has spent years preparing for outbreaks in the areas such as isolation, area decontamination, patient decontamination and access control.
Over at Vassar Brothers, monoclonal antibody treatments are administered in a specific section of the medical center away from other hospitalized patients.
As for why such treatments can only be given in hospitals as opposed to urgent care centers or primary care doctors’ offices, we were told it requires sophisticated setups like an IV bag along with the ability to offer treatments in an isolated area.
Begg said the best bet for patients seeking to get the treatment is to talk to their regular doctor who will go through a checklist to see if they fit the criteria for monoclonal antibodies. “The other thing the doctor community does is make sure the patient has COVID or has a high-risk exposure,” he said. “Or perhaps one of the family members has COVID, but is not starting to get sick.” The doctor then orders it, and the patient is scheduled to come over. He said doctors can also call the scheduling center and fax in the order.
One thing patients should not do is show up in the ER and try to get monoclonal antibodies
“They don’t administer the medication, it’s in a separate area with special nurses,” Begg said. “Usually once you go to the ER you are sick enough to be admitted.”
He added that it can be a challenge when a patient doesn’t have a primary care doctor, but in that case, they can go to a walk-in care center and get a COVID test and find a Vassar doctor or a doctor that has privileges at Vassar.
Wilson said patients seeking the treatment at Northern Dutchess should also see a physician first to be sure they meet the criteria which include being at high risk for severe COVID-19.
“Typically, these patients are evaluated by their primary care, urgent care, or emergency department if they believe symptoms are severe,” Wilson said.
Tack and Begg both said while the treatment itself is free under a federal program, patients could still face other fees such as those for administering the drug or seeing a doctor.
While Begg and Tack both believe monoclonal antibodies can be a very effective tool for fighting COVID-19 in certain circumstances they asserted it’s no substitution for preventative measures like vaccination and mask-wearing as cases surge locally and ICU usage has increased.
“The next surge has arrived, not only an option,” Begg said. “Vaccination is still really important, as is the consideration of wearing a mask in crowded areas.”
He said while there have been stories of vaccinated people being admitted to the hospital, especially with the rise of the highly contagious Delta variant that has caused a large spike in active COVID-19 cases across the region this summer, those vaccinated are without a doubt much less sick and not the ones dying from COVID-19.
Begg painted a much bleaker picture for the unvaccinated, “They get really sick and sometimes even die,” he said
“Prevention is always better than trying to treat,” Tack said. “We’d rather prevent cancer than treat cancer, prevent a heart attack than treat a heart attack…This is not a substitute for vaccine hesitancy,” he said. “Vaccination and prevention are the primary way to go.”
That said, Tack said studies are underway to see if this treatment could be used on those who really can’t get a vaccine due to medical reasons.
“That’s not approved yet,” he said.
Tack said he feels officials are not doing a robust enough job of getting info out about monoclonal antibodies and finding people who are good candidates for the treatment access to it. “The most frustrating event is when someone comes to the hospital sick, and was a good candidate days earlier but didn’t reach out,” he said. “Perhaps they went to CVS, got a home test, got tested, but didn’t reach out to the system or their primary care doctor due to lack of awareness.”
That closes the door on doctors having the chance to intervene before people become very sick, Tack said.
And Begg, an ER doctor who sees patients himself, said when people stay healthier they are less likely to spread the highly contagious virus around to other family members or friends. “If you’re not coughing because of monoclonal antibodies and you’re not as sick, you’re less likely to give COVID to everyone else,” he said.
And every patient who ends up in the ICU or on a ventilator comes with huge costs that are exponential and go beyond medical care, said Dr. Tack, senior director of WMCHealth’s Network Strategic Communications. “The lost ability to work has an impact on their family and their companies,” he said. “Every one of these avoided cases can have a huge impact on the entire system, not just the hospital.”