Amazingly, treatment with monoclonal antibodies for mild COVID-19 cases and for post-exposure prevention is the one science-based pandemic measure that virtually all Americans accept.
You may recall that after hosting gatherings where attendees later tested positive for COVID-19, our former President announced on October 2, 2020 that he also had tested positive. After being whisked off to Walter Reed Medical Center, he received a single one-hour intravenous dose of monoclonal antibodies along with steroids and the antiviral drug, remdesivir. That was seven months and many deaths into the pandemic, and three months before the first COVID-19 vaccines would be authorized. The White House doctor at the time said that the former President’s symptoms included “transient low oxygen levels.” Just three days after emergency hospitalization, the former President was discharged and ambulatory.
At that time, monoclonal antibodies were extremely expensive and not publicly available. Now, just a year later, they are considered to be the most helpful treatment for COVID-19 infection, and they are free.
Like vaccines for COVID-19, monoclonal antibodies were not developed suddenly. They rest on over a century’s research, beginning with Dr. Paul Ehrlich, who received a Nobel Prize in 1908. He intuited that there should be a “magic bullet,” or ‘Zauberkugel,’ to neutralize infectious diseases once they had invaded a patient’s body. His work led to the discovery that our bodies produce antibodies and to the insight that man-made versions of these proteins could help the body’s immune system respond better to find and attack foreign substances (antigens) attached to infectious agents.
Fast forward to the twenty-first century, where monoclonal antibodies are already used to treat diseases like cancer (as with Herceptin for certain breast cancers.) Those successes led to using a different kind of monoclonal antibody against the first SARS outbreak in 2003, and recombinant human monoclonal antibodies are now being used to assist the body’s immune response to the SARS-CoV-2 virus that causes COVID-19.
In November 2020, the FDA gave emergency use authorization to several monoclonal antibodies that decrease the risk by 70% of mild COVID-19 progressing to more serious disease requiring hospitalization. After rigorous studies showed that they could also protect people from contracting symptomatic disease 81% of the time, the authorization was amended in July 2021 to permit using them with people who had not tested positive themselves but were close contacts of others having COVID-19.
Monoclonal antibodies should not be considered a substitute for COVID-19 vaccines, which are much more easily administered, much less costly to produce, and provide broader and longer lasting immunity to SARS-CoV-2. Monoclonal antibodies are intended as “rescue” interventions for people, vaccinated or not, who are highly likely to contract COVID-19 because of exposure and high-risk medical status, or who already have a confirmed, active COVID-19 infection with mild to moderate symptoms. On the other hand, clinical trials have shown that by the time hospitalized patients with COVID-19 develop severe enough symptoms to need supplemental oxygen, inflammation and clotting problems make the use of monoclonal antibodies not only ineffective, but capable of worsening outcomes in those severely ill patients.
Timing is key to the lifesaving use of monoclonal antibodies for COVID-19. Treatment should be started as soon as possible after a patient receives a positive test result for COVID-19 and within ten days of symptom onset. In those cases, it is recommended that the administration be by outpatient intravenous infusion. If IV infusion is not quickly available, the same total dose can be given in the form of four subcutaneous shots.
Individuals at high risk of acquiring SARS-CoV-2 infection who if infected would progress to serious illness, should know that they are eligible to receive monoclonal antibodies if they have had close contact (like living in the same household) with a person having COVID-19. The recipient should be 12 years old or over, weigh at least 88 pounds, and be within ten days of initial exposure. The monoclonal antibodies in that case will be given via four injections.
It is best for people to get tested for COVID-19 as soon as they notice symptoms, and if positive, contact their doctor to ask about receiving monoclonal antibodies either for themselves or for others they have been in contact with who are at high risk. The medication itself costs nothing to patients, but depending on insurance coverage, they may be charged for the cost of giving the treatment. If a person’s doctor is not familiar with monoclonal antibodies, or if people do not have a personal physician, they can phone 877-332-6585 (English) and 877-366-0310 (Spanish) or visit the Department of Health and Human Services’ website (https://protect-public.hhs.gov/pages/therapeutics-distribution) to find a nearby treatment site. Locally, monoclonal antibodies are administered at UPMC’s Divine Providence Campus Infusion Center on Grampian Boulevard, at Evangelical Community Hospital in Lewisburg, at Geisinger Medical Center in Danville, and at UPMC/Wellsboro.
Barbara Hemmendinger, MSS, is a retired clinical social worker and family medicine educator. She is a member of the Lycoming County Health Improvement Coalition and belongs to Let’s End COVID!