A class of lab-made drugs that could protect high-risk COVID-19 patients from becoming critically ill is being significantly underutilized, experts say.
Monoclonal antibodies that could neutralize SARS-CoV-2, the virus that causes COVID-19, are highly recommended for those over the age of 65 or who have underlying medical conditions that put them at risk for severe illness. President Donald Trump received the Regeneron antibody treatment shortly after he was diagnosed with COVID-19.
On Thursday, public health officials asked healthcare practitioners across the country to take advantage of the plentiful supply of these monoclonal antibodies that are currently the only approved treatment that could keep Americans out of hospitals and slash hospitalization time by half, according to studies.
“This is the first time during the pandemic that I can recall when our resources far exceed demand,” said Dr. William Fales of the Michigan Department of Health & Human Services, according to NBC News.
Experts say that there are several reasons why monoclonal antibodies are not more widely used. Firstly, they must be administered soon after a person tests positive for COVID-19 during the first week of illness. While some states, notably Ohio, have put an electronic recording system into use that alerts healthcare practitioners if patients’ swabs come back positive, other states do not have such a rapid response system in place.
Secondly, the hour-long infusions of both the Regeneron and Eli Lilly monoclonal antibodies must be given intravenously, and appointments can last between 3 to 4 hours, according to NBC News. Since COVID-19 patients can infect others, they must be kept in a separate room. This can seriously hinder the administration of the drugs in a local clinic or even in a physician’s office.
Dr. Peter Chin-Hong, an infectious disease specialist at the University of California at San Francisco, cites public transportation as another roadblock to the antibody treatment. Any type of shared ride is out of the question for COVID-19 patients, and some patients cannot afford to spend half a day for treatment away from family obligations and work, he said.
And then there is the cost. Since the therapy is given intravenously, a single dose costs $1,250, according to published reports. Even though the federal government has agreed to distribute the drugs free of charge, the infusion alone can cost $1,000, which may result in hefty copayments even for people who are insured.
According to NPR, the federal government said it delivered more than 300,000 doses of monoclonal antibody drugs to medical facilities nationwide. While Chin-Hong says his facility has used only 20% of its supply, some healthcare systems have overcome the logistic hurdles of administering the drugs.
At Houston Methodist Hospital, doctors have opened special clinics that give between 50 to 70 infusions daily to high-risk, eligible patients and are using their supply as fast as it arrives. Experts say that setting up similar infusion centers may be the answer to using the resources we have on hand, but it may be an unreasonable demand for some health systems that are already strained 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, according to NBC News. “We could set up rapid testing. But we don’t have those resources. We are completely swamped with sick patients.”
Chin-Hong agrees, adding that the patients who are eligible for monoclonal antibody treatment are generally well. “You want to focus on the sick patients,” he said.
Another factor that is impeding the widespread use of this therapy may be lack of awareness. Health and Human Services Secretary Alex Azar said on Tuesday that “patients should be asking their doctors or healthcare providers why they aren’t being offered these antibody therapies.” HHS has an online map that displays some, but not all, of the locations that have received monoclonal antibody supplies.