Presented by some as a cure, demand for monoclonal antibodies is high in less vaccinated places in Alaska, but it does not replace a vaccine


Jyll Green walked early Friday morning between green cots after a snowy drive from her home in Girdwood to a storefront at Tikhatnu Commons in Anchorage.

Green is the director of operations for the state-contracted facility that administers hundreds of infusions of monoclonal antibodies each week to COVID-19 positive patients at high risk for serious complications from the disease.

The pace and demand for these treatments has skyrocketed in recent weeks as the delta variant spreads furiously across the state, pushing hospitals into crises and infecting thousands of people.

The treatments have been noticed recently because they were pushed by local health authorities for their benefits, but some providers have said they have heard from people seeking the treatment instead of the vaccine – which is not recommended.

Statewide, the areas with the lowest vaccination rates – Anchorage, Mat-Su, Fairbanks and the Kenai Peninsula – have the highest demand for treatments, said Coleman Cutchins, state pharmacist.

Health officials are making treatment an important part of the response to COVID-19, as they are successful in preventing serious illness in many cases, but with certain limitations.

But they say it doesn’t replace inoculation against the virus.

“I just want to be very clear that this is by no means a form or a form close to a substitute or an alternative to a vaccine,” Cutchins said.

Monoclonal antibodies are proteins made in the lab that work by mimicking the ability of the immune system to fight viruses and, in this case, blocking the virus from binding and entering human cells.

Some research shows that it can reduce the risk of hospitalization and death by 70% and shorten the duration of symptoms by about four days. But it’s not always the case.

Treatments are like a safety net 10 feet under a steep cliff while vaccines are like a tall fence preventing someone from falling in the first place, Cutchins said.

At a press conference on Wednesday, Alaska Governor Mike Dunleavy called for several measures to protect against COVID-19. He stressed the importance of vaccination as well as the use of monoclonal antibodies.

Chief medical officer Dr Anne Zink also stressed the importance of the drug, especially getting it early, as treatment is best used in the first five days of illness.

Brittany Blake is a nurse at Urgent Care at Lake Lucille, a clinic in Wasilla that has been extremely busy in recent weeks providing treatment. She and a doctor at the clinic, Dr Louis Packer, worked long hours to maximize the number of patients that could be seen: both made more than 130 infusions in just three weeks.

“People are panicking and we are trying to get them in as fast as possible,” she said.

The clinic is located in the Matanuska-Susitna district, which has some of the lowest vaccination rates in Alaska. The clinic is one of the only places in Wasilla to offer sometimes life-saving treatments.

[Alaska coronavirus Q&A: What to know about monoclonal antibody therapy]

Most patients who contact this clinic and meet the criteria can be treated within days, Blake said.

The majority of the patients they see are those who meet specific eligibility criteria – they have very recently tested positive, have had symptoms for less than 10 days, and are at higher risk for serious illness from COVID-19 in because of age or a chronic health problem. . But the clinic has also offered the treatment to patients who live with elderly family members or as a preventative measure on a case-by-case basis, Blake said.

She said she wanted more people to understand how antibody therapy works – that it’s something Alaskans should look at properly when they test positive for the first time, not when they’re so sick. that they must be hospitalized because it is then too late.

“We’ve had people who are really frustrated because they haven’t realized the urgency of getting the treatment within one to 10 days, and unfortunately we can’t give it to them after that because that can be harmful, ”Blake mentioned.

Dr Leslie Gonsette, a hospitalist at Alaska’s largest hospital, Providence Alaska Medical Center, said he received a call regarding a 20-year-old patient who had become significantly sicker despite monoclonal antibody treatment and would likely need treatment. a non-invasive ventilator for the last time. the week.

Monoclonal antibody treatments are critical now because they can prevent some from being admitted to hospital as the state’s healthcare system is under heavy strain with critically ill COVID-19 patients and staff shortages, said Cutchins.

[Impossible choices inside Alaska’s inundated hospitals]

Treatments are mostly delivered in private clinics, tribal health facilities, emergency rooms and emergency care across the state, Cutchins said.

The government provided the treatment drug for free most of the time, Cutchins said. Most treatment sites charge for insurance and generally do not charge for uninsured patients. The cost of the treatment is around a few thousand dollars, he said.

At the Tikahtnu clinic, Green said they don’t charge patients for any insurance and that she is able to refer people for treatment even if they don’t have a provider.

On average, center staff infuse around 30 people a day and up to 50 more recently, Green said. His phone rings constantly, sometimes one call per minute. The night before, Green was screening patients at 11 p.m.

They treat unvaccinated and vaccinated people alike, focusing on one endpoint of those at high risk of serious complications.

Green said she often hears from people who are against the vaccine, but instead seek antibody treatment.

“At least twice a day I get a call from someone who is still anti-vaccination saying, ‘Well, that’s not a vaccine, is it? Because I don’t want anything to do with this vaccine.

[She’s an Anchorage nurse. Her brother died of COVID-19 at the hospital where she works.]

She responds by telling people that, just like the vaccine, monoclonal antibody therapy is also subject to emergency use clearance from the Federal Food and Drug Administration. And the vaccine is the best way to get antibodies against the virus.

“We don’t have that level of conspiracy theory and concern (around monoclonal antibodies) that a lot of people had with the vaccine,” Green said. “This is cognitive dissonance at its best.”

Green said she can usually tell who didn’t get the vaccine and who did, based on the illness of unvaccinated patients. She points out to them that after 90 days, they can still get the vaccine.

“It’s night and day between someone who’s vaccinated and unvaccinated who comes in for an infusion,” she said.

Sometimes people leave and Green says she thinks “I hope she lives”.

Green is concerned that the antibody supply may start to dwindle amid supply chain problems. Beyond the drug itself, even the supplies needed to make the infusion have also been lacking in recent times.

And that’s difficult – Green can’t treat everyone. If a person’s oxygen level is below 94, the disease is too advanced. Basically, it’s too late. At this point, they tell the patients to go to the hospital. Once someone arrived with an oxygen level of 58.

“It’s sad,” Green said. “I always say, I can’t stop to think about everything I see in a day, or I would be overwhelmed and overwhelmed and I would just stop.”

Staff at the center wear full Tyvek suits and face helmets much like these firefighters wear a whirring hip respirator for ten hours a day. It’s noisy and stressful.

But still, Green stressed the importance of treatment for those in need. She said she wanted to keep it fresh on people’s minds.

As the rate of COVID-19 cases in the state has increased, the number of monoclonal antibody treatments administered by staff at the Chief Andrew Isaac Health Center in Fairbanks, which is part of the nonprofit Tanana Chiefs Conference, which serves the interior of Alaska, has increased.

[Alaska health workers face anger and threats from COVID patients and public, chief medical officer says]

Dan Nelson, director of the pharmacy there, said he felt some had the idea that they didn’t need to be vaccinated because the treatment was available.

Nelson described a patient who received the antibody treatment, then encouraged his friends and family to say that “it’s a wonder drug, you don’t really need to get the vaccine because it’s available,” he said. Nelson said.

“It’s really disheartening to hear these kinds of stories,” he said.

In Wasilla, Blake said his clinic’s ultimate goal in offering the treatment was to prevent people from being sick enough to need hospitalization and to protect the capacity of understaffed and overwhelmed hospitals. Mat-Su and Anchorage.

“This is our end goal: to keep people out of the hospital,” she said.

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