Monoclonal antibodies can save lives. But Bay Area sees few takers worryingly

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Most of the time, Total Infusion, an Oakland clinic that administers monoclonal antibody therapy to patients with COVID-19, is calm – too calm, says the centre’s director of infusion therapy, Kee Conti.

“Our chairs are empty,” Conti said. “My refrigerator is full of therapeutic products, and there are patients who need them and just don’t get the message. “

In November, Total Infusion gave monoclonal antibodies to less than 100 people, even though it has the capacity, staff and supply to double that. Meanwhile, more and more people across the Bay Area and the state are testing positive for COVID in what appears to be preparation for a winter flare, and are likely candidates for treatment.

The problem, Conti said, is that too few people know the treatment exists or how to access it. Public health officials and clinic directors like Conti are desperate to spread the word so that more doctors know how to refer their patients for treatment, and more patients seek it themselves. Time is running out, as the medication must be taken within 10 days of the onset of symptoms, and the sooner the better.

A COVID monoclonal antibody dose freezer awaits at Total Infusion in Oakland.

Don Feria / The Chronicle Special

While public health officials have aggressively let the public know they should get the vaccine, communication has been less clear when it comes to therapeutics, some clinic officials said. Some people may be skeptical of monoclonal drugs because they associate the drug with former President Trump, who received the treatment in late 2020, due to his track record of promoting unproven COVID treatments like hydroxychloroquine. A general lack of knowledge of what treatment and when it should be sought “has been a problem,” said Dr Kathleen Clanon, medical director of the Alameda County Health Services Agency.

“We still have more capacity today than we have customers,” she said. “This is despite the fact that we know that every day more and more people are diagnosed with COVID.”

Some people may think that if they don’t have severe symptoms, it seems overkill to seek IV therapy, Clanon said. But it can make a big difference, especially for the elderly, immunocompromised, or others at particular risk, if taken early enough. Clanon herself received the treatment in August after having a breakthrough infection.

There are three monoclonal antibody treatments available in the United States, produced by drug makers Regeneron, Eli Lilly, and Vir Biotechnology (a San Francisco company) along with GlaxoSmithKline. They are given intravenously and take two to three hours to start from start to finish, including the one hour observation period afterwards to make sure the patient does not have an allergic reaction. . These are the only treatments in the United States for people with mild to moderate COVID symptoms and are intended to prevent symptoms from getting worse. Clinical trials show they reduce hospitalizations and deaths by 70%, and doctors who regularly treat patients with the drugs say patients report high cure rates.

Nurse Elayne Meadows watches Nurse Macy Sun prepare a COVID monoclonal antibody test at Total Infusion in Oakland.

Nurse Elayne Meadows watches Nurse Macy Sun prepare a COVID monoclonal antibody test at Total Infusion in Oakland.

Don Feria / The Chronicle Special

The infusion gives the patient antibodies made in the lab that mimic those the body would make on its own after an infection or vaccination. The antibodies bind to the virus spike protein and prevent the virus from infecting human cells.

There are certain limits as to who is eligible. But infusion clinic leaders say those rules are broad enough now that many people qualify, as long as they have tested positive for COVID, are at least 12 years old or weigh at least 88 pounds, and take the drug in. the 10 days following the start. symptoms of COVID. Technically, you need to have at least one underlying condition that puts them at high risk of progressing to serious illness, but there are so many conditions covered by the clearance from the Food and Drug Administration that it’s pretty much almost anyone, Conti said: 65 years old or the elderly, high blood pressure, cardiovascular disease, pregnancy, chronic lung disease, a body mass index of at least 25, auto disease -immune and many other conditions are considered high risk. It does not matter whether a person has been vaccinated or not, even if not being vaccinated carries a much higher risk of serious illness.

An apparent lack of awareness and hesitation about treatment is leading some providers to lower doses, California health officials said.

Used vials of COVID monoclonal antibody doses are thrown away at Total Infusion in Oakland.

Used vials of COVID monoclonal antibody doses are thrown away at Total Infusion in Oakland.

Don Feria / The Chronicle Special

“We don’t know if there is enough awareness out there,” state epidemiologist Dr. Erica Pan said during a recent COVID briefing with the California Medical Association. “Some places have refused products. … we have to make sure we have enough sites and acceptance, provider awareness, patient acceptance. This is what we really want to convey with monoclonal products.

The federal government allocates doses to the states, which then allocate them to local health departments. The California Department of Public Health did not specify which providers refused treatment, asking local health departments.

To raise awareness of the treatment, health officials in Alameda County are posting posters and handing out flyers at COVID testing sites, directing people to information about monoclonal drugs. The county has set up a telephone number and website where residents can learn more, including links to themselves for treatment.

The UCSF Respiratory Screening Clinic has contacted public health departments – some as far as the Central Valley – to let them know that UCSF can treat their patients if they cannot find a site closer to home. them, said Dr Paul Nadler, director of the clinic, which administers treatment to about 20 COVID patients per week.

The federal government has made the cost of the drug free for all patients. But there are also service or administration fees associated with the treatment that federal regulators have set at around $ 300 to $ 600, depending on the region. People with public health insurance should be paid these fees, but people with private health insurance plans may have to pay additional fees if they have a high deductible.

The omicron variant, which represents a small but rapidly growing proportion of cases in the United States, appears to make some of the treatments less effective. Regeneron, which makes the most widely used monoclonal drug in the United States, said this week that its product has “reduced power compared to omicron“But that it is developing on a” new generation “version that works against omicron. Early laboratory studies in Germany indicate that Eli Lilly’s product may also be less effective against omicron. Vir and GSK said last week that their product remains effective against omicron.

Nurse Elayne Meadows (left) watches Nurse Paige Yang scan Johnny Preston's arm at Total Infusion in Oakland.

Nurse Elayne Meadows (left) watches Nurse Paige Yang scan Johnny Preston’s arm at Total Infusion in Oakland.

Don Feria / The Chronicle Special

The emergence of the variant does not change the day-to-day operations of infusion clinics, although they may soon need to know which variant of the virus it is before proceeding with treatment, as Dr Robert Wachter, director of the department of medicine at UCSF, noted on Twitter. Delta still accounts for the vast majority of cases, and all three drugs work well against him. But Stanford University is asking the state for doses of sotrovimab, the product made by Vir and GSK, as part of its “preventative planning” for omicron, said Dr Upinder Singh, who oversees the outpatient antibody clinic. Stanford monoclonal. The center has already seen an increase of about 30 to 40% in the number of patients seeking monoclonal antibody treatment since Thanksgiving – an increase that coincides with an increase in the number of new cases during the same period in Santa County. Clara.

“You have to plan ahead and be prepared to pivot if necessary,” Singh said.

Catherine Ho is a writer for the San Francisco Chronicle. Email: [email protected] Twitter: @Cat_Ho



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