Westfield Public Health Bulletin: Antibody infusion may treat, not cure, COVID-19
Infections are usually viral, bacterial, fungal or parasitic. They are treated with antivirals, antibacterials, antifungals and antiparasitics respectively. Many patients mistakenly think they need an antibiotic for an infection. Antivirals are not as commonly used as antibiotics. Most patients are not as familiar with drugs for viral illnesses as they are with antibiotics.
Antibiotics kill bacteria. Treatments against viruses decrease the severity of symptoms and possibly shorten the course.
Most viruses exhibit a classic and specific set of symptoms with some difference in severity and minor difference in each individual. SARS-CoV-2 presented itself to this world as a virus with a range from no symptoms to a variety of respiratory, gastrointestinal and other symptoms, all the way to death. Patients present with symptoms that last a day to weeks, months to chronic symptoms. There is no classic presentation, like most viruses.
There is no “cure” for COVID-19. Research has shown that several treatments can help outpatients with symptoms, especially those with underlying health conditions. Vaccines, antivirals, and monoclonal antibody infusions have all been used to prevent symptoms. There are other therapies for hospitalized patients.
Monoclonal antibody therapy consists of lab-grown antibodies given by intravenous infusion or under the skin to help boost the immune system to fight the coronavirus. Several have received emergency approval from the FDA. REGEN-COV, which contains casirivimab and imdevimb, was initially used. Because the omicron variant did not respond well, sotrovimab was used almost exclusively. Sotrovimab is only administered intravenously. Their approval is for the treatment of people 12 years and older with mild to moderate disease who are at high risk of developing a severe form of COVID-19. Proteins made in the lab bind to the virus to prevent it from infecting cells. It can reduce hospitalizations and deaths by 80%.
This treatment is not new. Ebola, respiratory syncytial virus (RSV), rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis and other illnesses have been successfully treated with monoclonal antibody therapies.
The price range is $1,000 to $2,000 per treatment. The federal government, reimbursements and drug companies currently cover this. This does not cover school administration costs and co-payments. The cost of the fully FDA-approved COVID-19 vaccine is only about $20 and also covered by the federal government.
Monoclonal antibody treatment is given within 10 days of the onset of symptoms and on the recommendation of a healthcare professional. It is offered in outpatient centers, hospitals and urgent care offices. There was a lack of availability. Many institutions have teams that assess and triage references. The US Department of Health and Human Services has an infusion locator on its website.
Although the infusion itself is administered in half an hour. The patient visit is longer and includes vital signs, assessment of current condition, time the pharmacy has to prepare once ordered, and then a one-hour post-infusion observation period to monitor a reaction.
Side effects are listed as hypersensitivity reaction, rash, itching, anaphylaxis, chills, dizziness, fever, and infusion-related reaction. Some have reported worsening COVID symptoms, but it’s unclear whether this is a worsening of the disease process or an infusion. It may start working within hours for some, but it’s not guaranteed to work for everyone.
Some oral antivirals have been approved for emergency use. Paxlovid and molnupinovir, given within the first five days of symptoms, are also thought to decrease deaths and hospitalizations. Other antivirals are used to shorten the duration and decrease the severity of viruses such as influenza, shingles, herpes, and other viruses.
The biggest problem with all of this is the limited availability. They are for anyone with immune deficiencies, high body mass index and other conditions that put them at higher risk. Depending on location and availability, some who would benefit the most may not be able to get treatment.
None of these treatments are designed to replace the vaccine. Vaccines are known to prevent serious illnesses and diseases. Although monoclonal antibody therapy is a useful outpatient treatment for some, full vaccination is more useful for everyone except those for whom it is contraindicated.
With the number of cases declining, we remain cautiously optimistic. We are still in the midst of a pandemic. People are still sick and testing positive daily. As this pandemic progressed, more and more therapies emerged. The goal is to reduce hospitalizations and deaths. We continue to recommend every precaution to save lives and end this pandemic.
Take care of yourself and someone else.
Dedicated members of the health department have worked tirelessly throughout the pandemic, along with Board of Health members Juanita Carnes, FNP, Margaret Doody and Stan Strzempko, MD We continue to work to protect you.