A class of lab-made drugs that could protect high-risk COVID-19 patients from becoming seriously ill is being significantly underused, experts say.
Monoclonal antibodies that can neutralize SARS-CoV-2, the virus that causes COVID-19, are highly recommended for people over the age of 65 or who have underlying medical conditions that put them at risk for serious illness. President Donald Trump received Regeneron antibody treatment soon after he was diagnosed with COVID-19.
On Thursday, public health officials asked health workers across the country to take advantage of the abundant supply of these monoclonal antibodies that are currently the only approved treatment that could keep Americans out of hospitals and cut hospitalization by half, according to studies.
“This is the first time during the pandemic that I can recall our resources far exceeding demand,” said Dr. William Fales of the Michigan Department of Health & Human Services, according to NBC News.
Experts say there are several reasons why monoclonal antibodies are not more widely used. First, they should be administered shortly after a person tests positive for COVID-19 during the first week of illness. While some states, notably Ohio, have adopted an electronic registration system that alerts healthcare professionals if patients’ Pap smears come back positive, other states don’t have such a quick response system.
Second, the hour-long infusions of both the Regeneron and Eli Lilly monoclonal antibodies must be administered intravenously and appointments can last anywhere from 3 to 4 hours, according to NBC News. Since COVID-19 patients can infect others, they should be kept in a separate room. This can seriously hinder the administration of the drugs at a local clinic or even a doctor’s office.
Dr. Peter Chin-Hong, an infectious disease specialist at the University of California San Francisco, cites public transportation as another roadblock for antibody treatment. Any form of shared ride is out of the question for COVID-19 patients, and some patients cannot afford to spend half a day before treatment without family commitments and work, he said.
And then there are the costs. Because the therapy is given intravenously, a single dose costs $ 1,250, according to published reports. Although the federal government has agreed to distribute the drugs for free, the infusion alone can cost $ 1,000, which can result in hefty out-of-pocket payments even for people who are insured.
According to NPR, the federal government said it has provided more than 300,000 doses of monoclonal antibody drugs to medical institutions around the country. While Chin-Hong says his facility has used only 20% of its supply, some healthcare systems have overcome the logistical hurdles of administering the drugs.
At Houston Methodist Hospital, doctors have opened special clinics that administer between 50 and 70 infusions daily to high-risk, eligible patients, and use their supplies as soon as they arrive. Experts say setting up similar infusion centers could be the answer to using the resources we have at our disposal, but it could be an unreasonable demand for some health systems that are already under pressure under the weight of the pandemic.
“If we got this pandemic under control, we could set up infusion centers,” says Dr. Pieter Cohen, associate professor of medicine at Cambridge Health Alliance, according to NBC News. “We could set up rapid tests. But we don’t have those resources. We are completely inundated with sick patients. “
Chin-Hong agrees, adding that generally, patients who are eligible for monoclonal antibody treatment are doing well. “You want to focus on the sick patients,” he said.
Another factor hindering the widespread use of this therapy may be lack of awareness. Alex Azar, Secretary of Health and Human Services, said Tuesday that “patients should ask their doctors or health care providers why they are not being offered these antibody therapies.” HHS has an online map showing some, but not all, locations that received monoclonal antibodies.
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