Doctors: COVID patients must seek monoclonal antibodies before becoming severely ill By Dennis Pillion | dpillion@al.com

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Doctors: COVID patients must seek monoclonal antibodies before becoming severely ill

By Dennis Pillion | dpillion@al.com

5-6 minutes

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Alabama physicians have promoted monoclonal antibody treatments as “the answer” for the state’s overflowing hospitals, but the treatment does have limits. And one key limitation is that patients must act fast, seeking out treatment soon after testing positive and well before becoming sick enough to go to the hospital.

“When given early in the course of an infection -- that is day one, two or three of symptoms, certainly before day six -- you get the maximum benefit,” said Dr. Michael Saag, an infectious disease physician at UAB Hospital. “And what it does is it shortens the duration and reduces the severity of illness significantly, keeps people out of the hospital.

While the treatment is effective when given early in the course of an infection, it’s not perfect. The treatment reduces the likelihood of having to go to the hospital by about 70 percent. That’s why doctors recommend people still get the COVID-19 vaccine and get tested quickly if they think they might have COVID.

“The messaging to patients is number one, get vaccinated, and get it done now,” Saag said. “The second thing is for them all to monitor for symptoms, and if they have any symptoms they think even have a hint that it might be COVID, get tested right away.”

Saag made the comments during an online COVID update session along with four other physicians, including Alabama State Health Officer Dr. Scott Harris, hosted by the Medical Association of the State of Alabama.

Harris said Alabama hospitals are approaching their peaks from January, and that there are more intensive care patients in the state than intensive care beds to hold them.

The hope is that the monoclonal antibody treatment can ease those burdens on hospitals and save lives if given to patients early enough after they catch the disease. Roughly 88 percent of Alabama’s current hospitalized COVID patients are unvaccinated.

“The data from the study show that about 70-75% of people who were caught early and treated that way [with monoclonal antibodies], did not need to be hospitalized and that’s huge, especially as you heard the data from Dr. Harris that our hospitals are becoming overwhelmed.”

Harris said there are more than 150 clinics, hospitals and centers where the treatment is available in Alabama.

Dr. David Thrasher, a pulmonologist from Montgomery, said during the call that he is on pace to administer up to 2,000 monoclonal antibody treatments in August, but reiterated that the treatment is not effective once a patient’s illness puts them in the hospital.

“Once you’re in the hospital I don’t have a lot of bullets in my gun,” Thrasher said.

“If we can get them in that first 10 days, we’ve got really great chance. Most people will not have to be hospitalized and very few of them will die.”

Saag said previously many providers were using stricter guidelines for giving the monoclonal antibodies, reserving them for older patients or those with pre-existing conditions that made them more likely to have dire outcomes. However, as the treatment showed continued good results, they have begun offering it to nearly everyone they can treat within those first few days of showing COVID symptoms.

“The old rules that had people over the age of 55 or 65, most of them have been vaccinated in our state, so we don’t see many of them anymore unless they’ve got a significant underlying disease,” Saag said. “But it’s really meant for most anyone who has an underlying condition of any sort. And so we’ve really liberalized the the eligibility criteria.”

The federal government purchased a large number of the antibody treatments for use in hospitals, but many hospitals are facing staffing shortages and logistical hurdles that make it harder to administer the treatment to all who request it.

Because the treatment is most effective when given early, Thrasher said the goal is to administer it to as many patients as possible, as soon as possible after they test positive.

“It’s sometimes hard to predict who’s going to get really sick,” he said. “The young folks who don’t have a whole lot of problems, they can still get really sick. So, I don’t turn down many folks.”

Thrasher also said that he’s seen a lot of misinformation about the treatment on social media sites. He said in particular that he’s seen postings that cite a real scientific study claiming the treatment is ineffective. He said that study was conducted on patients who were already severely ill with COVID.

“We tried to see if this works in the hospital,” Thrasher said. “We found it does not work in a hospital for the reasons Dr. Saag said. You have to use it early, and that’s the first 10 days, preferably the first five days of symptoms, and by the time you get in the hospital, it’s usually past that.”

You can watch the full briefing below.

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