ST. LOUIS — As people wait for their turn to get a COVID-19 vaccine, the St. Louis area is expanding access to monoclonal antibody treatments that can help prevent those who are newly diagnosed from getting worse and ending up in the hospital.
Several monoclonal antibody infusion centers have opened across the area since January. Candidates for the therapy must be within 10 days of first experiencing symptoms of COVID-19, referred by a doctor and at high risk of becoming severely ill, such as those older than 65 or with certain medical conditions.
“It’s important to get tested early if you think you have symptoms. You have the most options the sooner you get tested,” said Rachel Franz, clinical community pharmacist who works at SSM Health’s infusion center at St. Joseph Health Center–St. Charles. “We want to be able to treat them with everything we have in our arsenal.”
The St. Charles location opened at the start of the year and has since treated 250 people. BJC HealthCare opened its fourth St. Louis-area infusion center earlier this month and has provided the therapy to about 700 patients. St. Luke’s Des Peres Hospital opened a center on Feb. 8.
“It started off slow, but now we are treating more and more people,” Franz said. “The amount of COVID cases are down and the curve is bending, and I hope this is a part of it.”
The body naturally makes antibodies to fight infection, but it may not make the ones designed to recognize the new coronavirus. Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight viruses. They have been engineered to target the spike protein of the coronavirus and block its entry into human cells.
A vaccine also triggers the body’s immune system to make the right antibodies, but it can take weeks to develop enough of a defense, especially with a two-dose regimen. The monoclonal infusion provides the antibodies needed to fight infection immediately.
When severely ill with COVID-19, a person experiences two phases — an early phase dominated by the virus reproducing itself, which happens a lot in the lungs and leads to low oxygen levels; and a later phase where the body’s immune system has a dangerous overreaction to the infection, which causes damage to other organs.
“The early phase, when the virus is really doing most of its reproduction and a lot damage, that’s when we want to interfere with that reproduction. And that’s what these antibodies do,” said Dr. Bruce Hall, chief quality officer for BJC HealthCare.
That’s why it’s important to get tested at the first signs of illness and immediately contact a doctor, who must assess and refer patients for the infusion therapy, Hall said.
The infusion takes about an hour, and patients are observed for another hour for any adverse reactions, the providers said. The centers are designed so infected patients do not share any space or entrances with other patients, some even requiring their own elevator.
Monoclonal antibody therapies for COVID-19 made by Eli Lilly and Regeneron were approved for emergency use by the FDA in November. To ensure access, the U.S. Department of Health and Human Services purchased over a million doses of the therapies and made them available to states at no cost. Doses are free of charge to patients.
The treatments have faced barriers to getting started, however, because of the time and logistics involved for the infusions.
Hospitals were swamped with caring for patients during the hardest-hit months of the pandemic and then tasked with setting up vaccinations. Many patients also may not know about the therapies or have the perception that they are only available to the well-connected, as they gained publicity when used by former President Donald Trump and other politicians.
“It takes a little bit of effort to arrange and coordinate and manage the patients appropriately, but we think that it’s all worth it if we can keep patients out of the hospital,” said Hall with BJC, which has infusion centers at Christian Hospital in north St. Louis County, a Missouri Baptist Medical Center clinic in Sunset Hills, Memorial Hospital in Belleville, Barnes-Jewish Hospital in St. Louis, and Boone Hospital Center in Columbia, Missouri.
Studies show that for every 15 people treated, one will be saved from needing to be hospitalized with COVID-19, Hall said. So far, the BJC locations are seeing similar results.
“That’s probably a 30 to 40% reduction or more in terms of the risk of having to go into the hospital,” he said. “For a disease that can be fatal, we are reducing that need to go into the hospital substantially.”
Franz said the SSM center is also seeing good outcomes among patients.
“They report feeling better, so much so to where they are calling me back on the phone tracking down the operator to get a hold of me to thank me for offering this treatment,” she said.
Side effects include allergic reactions such as headache, wheezing, hives, dizziness and swelling of the face or throat. Some scientists are concerned the therapy could interfere with the body’s immune response to a vaccine or the body’s ability to fight off a future infection of the coronavirus. Studies have not addressed these risks.
Providers say it’s important to weigh the risks and benefits with your physician, which is why a referral is required.
Hospitalizations for COVID-19 in St. Louis-area hospitals have dropped substantially since December, but St. Louis Metropolitan Pandemic Task Force director Dr. Alex Garza warned Wednesday that the drop has stalled. “It’s a reminder that COVID has not not gone away,” Garza said.
For the past two weeks, about 50 people with COVID-19 continue to be admitted to the hospital every day, he said. About six patients die a day.
Hall said he is optimistic about the monoclonal antibody treatments, which continue to improve, because they are the only medical intervention that can help keep people with COVID-19 out of the hospital, where they are isolated from family and can continue to get worse.
“I hope the day comes rapidly when we can prevent anybody from getting this disease by virtue of vaccine …,” Hall said. “But in the meantime, this is the therapy we have for this phase of disease for this patient population, so we are really happy to be able to provide this to the community.”