SAN DIEGO (KGTV) – There is only one authorized treatment designed to keep high-risk COVID-19 patients out of the hospital, but hundreds of thousands of doses of the same experimental therapy administered to former President Donald Trump are stored.
Crowded hospitals have been slow to administer monoclonal antibodies because of what an infectious disease specialist called the “perfect storm” of complicating factors. Some healthcare providers have declined the doses completely.
These challenges include limits on staff and space during case escalation, the time it takes to administer an infusion, and the short window providers have to reach patients who qualify for treatment.
Still, federal and state health officials urged providers to expand access to experimental therapy, which was promising in the initial tests. A clinical trial with the cocktail of monoclonal antibodies by Regeneron found that hospitalizations dropped to 3%, compared with 9% in the group that received the placebo.
At the San Diego Family Health Centers, they converted a dental office and some unused medical facilities into a monoclonal antibody infusion clinic.
“My feeling is that we need to do everything in our power to prevent our hospitals from becoming overloaded,” said assistant medical director, Dr. Christian Ramers.
Dr. Ramers said he and two assistants are infusing about five patients a day with antibodies produced in the laboratory, four days a week. They plan to expand the operation to serve up to eight patients a day, but the clinic for low-income patients is already making more infusions than some large hospitals.
“Interestingly, the problem is not supply. This is another case where there are hundreds of doses of this drug deposited in refrigerators across San Diego County, ”he said.
At the end of last month, the Department of Health and Human Services said 378,000 doses of monoclonal antibodies were distributed to hospitals and clinics across the county. Only 20% of the supply was used.
Regeneron and a second company, Eli Lilly, obtained emergency use permits in November to treat people at high risk of serious illness in outpatient settings, before an individual was admitted to a hospital.
The drug itself is free, with thousands of doses paid for by the federal government.
“Everyone thought it would be purchased as soon as they went to the centers. But, unfortunately, due to a perfect storm of things. In fact, it didn’t catch that much, ”said Dr. Peter Chin-Hong, an infectious disease specialist at the University of California at San Francisco.
Some hospitals avoid treatment because the data is limited. The National Institutes of Health says there is “insufficient data” to recommend for or against the drugs. Clinical trials are still ongoing.
Infusions take two hours for the patient, plus some additional preparation time to thaw and mix the solution. This is a challenge at a time when the team is tight.
“This is the middle of a wave right now and there are not many people to move,” said Chin-Hong. He said that UCSF is doing about two to four infusions a day.
There is also a narrow window of time for administering treatment. According to the FDA’s emergency use authorization, qualified patients must receive antibodies within 10 days of the onset of symptoms.
Dr. Ramers said the average patient can wait a few days for a test and then wait a few more days to get the results. At this point, “you’re already pushing the end of the window, so there’s a lot of work to be done to identify people quickly”.
The Family Health Centers have developed an algorithm to scan their positive tests for the best candidates, so that they can quickly contact these patients and try to schedule an appointment for the lengthy treatment.
They target people over 65 or with risk factors such as obesity, diabetes, lung disease and other conditions.
Because of the need to quickly analyze medical histories and test results, Family Health Centers can only offer monoclonal antibodies to existing patients who test positive at one of their clinics, Ramers said.
But he said other providers are offering the treatment. Patients only need to know to ask.