It's no vaccine, but monoclonal antibody treatments can prevent severe COVID-19. Why is it so hard to find in the Inland Northwest?

click to enlarge Regeneron's monoclonal antibody cocktail can be effective against the delta variant.
Regeneron's monoclonal antibody cocktail can be effective against the delta variant.

Last year, former president Donald Trump called monoclonal antibodies a "cure" for COVID-19 and vowed to make them available for all Americans. After all, they were part of Trump's own treatment that helped him recover from a serious case.

Today, monoclonal antibody treatments may not be some miracle cure, but they are authorized by the FDA for emergency use, and Regeneron's REGEN-COV antibody cocktail has worked against the delta variant. In Florida, more than 30,000 treatments have been administered at state-run sites, according to Gov. Ron DeSantis. Across the Wasington border in Idaho, Kootenai Health has been offering monoclonal antibody treatments since November, and last week Gov. Brad Little launched more antibody treatment centers.

But in Washington, the treatments remain scarce.

Only 1,260 doses had been used by providers as of July, state health department officials tell the Inlander, though they note that data might be incomplete. That's out of 5,000 doses that have been sent to the state overall.

Providence Sacred Heart Medical Center, the Inland Northwest region's largest hospital, is not currently offering monoclonal antibodies for COVID-19, although there are plans to do so soon, according to a spokesperson. MultiCare has only recently started to offer REGEN-COV for a small group of patients, a spokesperson says.

The lack of use has puzzled some health experts like Bob Lutz, COVID-19 medical adviser for the state and the former Spokane regional health officer.

"Vaccination is always our first and foremost recommendation," Lutz tells the Inlander. "But in case you get a breakthrough infection, or you haven't been vaccinated for some reason, well, there is a treatment."

Last month, he made an urgent request to medical providers in the state: Consider the REGEN-COV treatment for COVID-19. Right now, he says, people who are eligible for the treatment aren't able to receive it, only because health care systems aren't providing it.

"The reality is that we're not seeing it as widely used as we want to see it," Lutz says.

WHY THE DELAY?

Monoclonal antibodies are proteins made in a laboratory that, when administered by an injection or IV infusion, stimulate the immune system to help fight COVID-19. The treatments only work in a brief window after infection or after exposure in order to prevent more serious illness. When used that way in clinical trials, REGEN-COV reduced hospitalizations by up to 70 percent, research has shown.

Monoclonal antibodies have been approved by the FDA for emergency use since November.

So why are hospital systems just now starting to offer them?

Providence refused to offer any explanation when asked by the Inlander. But Lutz thinks it's partly because until recently the evidence wasn't overwhelming that the treatment worked. While there were some positive signs in the spring, it wasn't until this summer that the National Institutes of Health outwardly recommended the treatment.

But health experts remained more focused on a more effective preventative measure: vaccines. The vaccines have been shown to reduce hospitalizations and deaths by 95 percent. They also reduce the risk of getting infected and spreading the virus to others.

"We will always focus on prevention, because vaccines prevent disease and prevent severe disease," Lutz says.

Still, he argues that treatment options should be available, too. He says he recently spoke with someone who lives near Seattle who had a breakthrough infection and would have qualified for the monoclonal antibody treatment, but he couldn't find one.

Jennifer Tyler, administrator at Tumwater Family Practice Clinic near Olympia, says for a while there was a feeling that focusing on treatment options instead of vaccinations was a political statement. She didn't want to be leading the clinic giving people something as experimental as, say, a horse dewormer.

"We had to do research — is this something experimental like Ivermectin? Is this in that category? " Tyler says. "It's not. It is a real treatment."

There are other logistical reasons, too. Until June, the treatments could only be administered through an IV. Only certain medical personnel could do that.

"That was more complicated than what most of our staff could handle and are able to handle," she says.

Once REGEN-COV became available through injection, that was a game-changer. Her medical assistants can give injections, just like they do for vaccines. Now, the Tumwater clinic is among a select few locations in Washington offering the treatment.

"Why is it not more widely available? I don't know," Tyler says. "I do know that everybody in health care is overwhelmed."

Indeed, the reality of the pandemic on medical staffing has played a role. Health care systems may be reluctant — or simply unable — to dedicate time and staffing to these treatments when the hospital is overwhelmed.

That's what happened at Kootenai Health recently, says chief physician executive Karen Cabell. While they've offered monoclonal antibody treatment since November, Kootenai Health had to pause the clinic in early August because they needed space for the influx of COVID patients. Only last week were they able to open the clinic again, as part of the on-campus field hospital dedicated to the COVID patient surge.

The priority, health officials stress, remains vaccination.

"This therapy can be extremely effective, but it's not a replacement for vaccination," Cabell says. "We encourage the community to get vaccinated to break the virus's chain of transmission. We see the evidence every day in our hospital that the vaccine is both safe and effective."

ASK YOUR DOCTOR

The Washington Department of Health wants patients all over the state to have access to monoclonal antibody treatments. Right now, patients are eligible if they are 12 or older and are at high risk of serious COVID-19 illness that could cause hospitalization or death.

Being "high risk" can mean you're 65 or older, obese, or pregnant, or have diabetes or other underlying conditions. Lutz hopes that as interest in this treatment picks up and health care systems see that there's a legitimate treatment option, everyone who falls into the high risk category can have access to it if they ask. In some cases, a person can get the treatment before even testing positive for the virus, as long as they were exposed to it.

The REGEN-COV treatments are free, too — though patients may first want to check whether their insurance covers a clinic's administration fee.

"There should be no limiting factor in preventing somebody who meets the criteria for administration to receive this," Lutz says.

But will patients seek out the treatments?

Tyler, at the Tumwater clinic, says that if people are worried about the vaccine, some may have similar fears about the REGEN-COV treatment. The injection itself is a significantly larger dose of medicine, and if it's not administered through an IV, it's administered through four injections at the same time. Patients then need to stick around for an hour to make sure they don't have a reaction, though reactions are rare.

Tyler guesses that some vaccine-refusers may falsely think they won't get COVID, and then when they do get sick, they may jump at the opportunity for a treatment.

A person like that would have been better off being vaccinated in the first place, Lutz says. The monoclonal antibody treatments should simply be seen as another weapon, he says.

"Now, at least, we have something else in our quiver," Lutz says. ♦

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About The Author

Wilson Criscione

Wilson Criscione, born and raised in Spokane, is an Inlander staff writer covering education and social services in the Inland Northwest.