The Inova Health System has a new tool in its toolbox in its battle against the COVID-19 pandemic.
The hospital system is now offering monoclonal antibody infusions to treat COVID-positive patients. The treatment helps the medical staff address what had been a nagging problem—once diagnosed with COVID, how do you prevent the progression to hospitalization, particularly for the elderly and high-risk population? Monoclonal antibodies are one treatment option that, thus far, has been shown to be successful, said Dr. Edward Puccio, the medical director of the Department of Emergency Medicine at Inova Loudoun Hospital.
“What they have shown in people who are all comers that get sick with COVID in the studies is [monoclonal antibodies] decrease emergency department visits or hospitalizations from 4% to 2%. In those people that are high risk it brought it from 9% to 3%. That is primarily what we’re using it for right now,” he said.
“[The treatment] targets the spike protein on the outside of the virus. It targets that and acts like your own antibodies do in your body to inactivate the virus and keep it from penetrating cells,” he said.
There have been a couple of monoclonal antibodies approved under the FDA’s Emergency Use Authorization—Regeneron, a combination drug with casirivimab and imdevimab; and another combination drug referred to as BAM, or bamlanivimab. Before being admitted to the hospital for his own bout with COVID, former President Donald J. Trump received an infusion of Regeneron, Puccio noted.
At Inova, individuals who have tested positive for COVID and fall into the high-risk category either because of age (65 and over); weight (body mass index over 35); or have chronic illnesses or medical conditions like asthma, kidney disease, diabetes, or immunosuppressive disease, are eligible to receive the treatment. Individuals age 55 and over with heart disease, high blood pressure, or a respiratory condition, including COPD, are also deemed high risk. Even COVID-positive children between the ages of 12 and 17 are eligible for the infusion treatment, if they are in the 85th percentile for their weight or have other medical conditions that deem them high risk.
Puccio explained that infusions take 30 minutes to an hour and look just like receiving a bag of saline from an IV. Following the infusion, patients remain for another hour to be monitored for any adverse reactions, which Puccio said he has yet to see.
“We infuse [the antibodies] into you and it gives your immune system a jumpstart. It can start fighting the virus, it decreases the viral load, it decreases the number of viral particles that can get into the cells and start doing damage, until your own system can rev up. So the sooner you can give it [to a patient] the better,” he said. Playing the waiting game if you fall into one of the high risk categories is not advisable, and could eliminate the infusion treatment as an option. Patients who need to be admitted to the hospital and require high-flow oxygen or steroids are not candidates for the treatment. To be effective, monoclonal antibody treatment must be given within 10 days of symptom onset.
“Once your system is overwhelmed by the virus and you need to be hospitalized or on oxygen, that boost of monoclonal antibodies hasn’t been shown to be effective. The viral load is just too much and it’s not going to be impactful,” he said.
The treatments do not prevent an individual from getting COVID again, and do nothing to prevent a patient from getting it in the first place, so it is not an option for individuals who are not COVID-positive, Puccio said.
“It only attacks the virus in you right now. If you don’t have COVID, it is useless,” he said.
While they are encouraging anyone who has recovered from COVID to receive the vaccine, Puccio said any individual who has had the antibody treatment should wait at least 90 days before getting vaccinated.
“We don’t want the monoclonal antibodies working against the vaccine,” he explained.
While it’s a new tool to fight COVID, monoclonal antibody treatment is not new. Puccio said the concept has been around since the 1970s and has been performed in medical use since the 1990s, catching on more each decade since. Monoclonal antibodies can be found in popular anti-inflammatory drugs, like Stelara and Humira, and can be successful in antiviral uses, such as stopping the progression of COVID.
“Some people are worried this is some new experimental drug. It’s been around for decades, different kinds of antibodies target cancer cells or other viruses or inflammation. It’s a relatively new treatment, but not just since COVID,” he said.
Since Inova expanded its use of rapid tests, where medical personnel can know within minutes if an individual is COVID-positive, it has allowed doctors to use the infusion treatments for any eligible patients who visit its hospitals system wide, including its emergency rooms in Loudoun. But you don’t have to visit an emergency room to get the treatment, Puccio said.
Inova has infusion clinics in Lorton, Reston and Fairfax, where COVID-positive individuals who fall into the eligible categories for treatment can fill out an online referral form to be scheduled for treatment. That referral form is available at inova.org/covidclinic. Patients can self refer, or be referred by their primary care doctor.
Systemwide, Puccio said Inova has conducted more than 1,000 infusion treatments, but it’s only been a little more than a month since the treatments were able to be done in emergency rooms, not just in the infusion clinics. He encouraged any COVID-positive individual who falls into the high-risk categories to seriously consider getting the treatment.
“Even if you’re having mild symptoms, if you test positive and you’re high risk you can get monoclonal antibodies. We don’t want you a week later to be hospitalized. Catch it early,” he said.
Inova is also continuing to accept donations of convalescent plasma from those who have recovered from COVID. Appointments to donate plasma can be made at inovablood.org.