A laboratory-manufactured class of drugs that can protect high-risk COVID-19 patients from critical illness is significantly underutilized, experts say.
Monoclonal antibodies that can neutralize SARS-CoV-2, the virus that causes COVID-19, are strongly recommended for those over 65 years of age or with underlying medical conditions that put them at risk for serious diseases. President Donald Trump received the Regeneron antibody treatment shortly after being diagnosed with COVID-19.
On Thursday, public health officials asked health care practitioners across the country to take advantage of the abundant supply of these monoclonal antibodies that are currently the only approved treatment that can keep Americans out of hospitals and halve admission time.
“This is the first time I can remember during the pandemic when our resources far exceeded demand,” said Dr. William Fales of the Department of Health and Human Services in Michigan said according to NBC News.
Experts believe that there are several reasons why monoclonal antibodies are no longer widely used. First, it should be administered shortly after a person has tested positive for COVID-19 during the first week of illness. While some states, particularly Ohio, are adopting an electronic recording system that alerts healthcare professionals when patients’ swabs are positive again, other states do not have such a rapid response system.
Second, the hour-long infusions of both the Regeneron and Eli Lilly monoclonal antibodies must be administered intravenously, and appointments can take between 3 and 4 hours, according to NBC News. Because COVID-19 patients can infect others, they must be kept in a separate room. This can seriously impede the administration of drugs in a local clinic or even in a doctor’s office.
Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco, cites public transportation as another barrier to treating antibodies. For COVID-19 patients, there is no question of a shared ride, and some patients cannot afford to spend half a day, not family commitments and work.
And then there are the costs. Because the treatment is administered 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 cause huge refunds even for people who are insured.
According to NPR, the federal government has said it is delivering more than 300,000 doses of monoclonal antibody drugs to medical facilities nationwide. While Chin-Hong says its plant used only 20% of the supply, some healthcare systems have overcome the logistical barriers to drug administration.
At Houston Methodist Hospital, doctors have opened special clinics that give between 50 and 70 high-infusion patients every day, who are eligible and use them as soon as they arrive. Experts believe that setting up similar infusion centers may be the answer to the use of the resources, but this may be an unreasonable question for some health systems already under the weight of the pandemic.
“If we had this pandemic under control, we could set up infusion centers,” said Dr. Pieter Cohen, associate professor of medicine at Cambridge Health Alliance, said according to NBC News. “We can test quickly. But we do not have those resources. We are completely overwhelmed with sick patients. ”
Chin-Hong agrees, adding that patients eligible for monoclonal antibody treatment are generally well. “You want to focus on the sick patients,” he said.
Another factor that hinders the widespread use of this therapy may be the lack of awareness. Alex Azar, secretary of health and human services, said on Tuesday that “patients should ask their doctors or healthcare providers why they are not being offered these antibody treatments.” HHS has an online map showing some, but not all, of the sites that received monoclonal antibody supplies.
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