On Monday, one of my patients called me to tell me that she had tested positive for the coronavirus. The patient, who has sickle cell anemia and has had a bone marrow transplant, lives several hours from the hospital where I work in New York. Because she is at extreme risk of complications from Covid-19, I started trying to get the best medicine to prevent serious illness: monoclonal antibodies.
Monoclonal antibodies are made in the lab and are designed to mimic the immune system’s ability to fight off invaders like viruses. Different monoclonal antibodies are used to treat many diseases. They have been shown to be effective in treating people at high risk for complications from Covid-19, and last fall the Food and Drug Administration approved their emergency use to treat the disease. But at the present time, it is too difficult for patients to get this treatment.
After calling several hospitals near my patient’s home, I found one that could administer monoclonal antibodies. She went to the hospital and was in the emergency room for over 24 hours, untreated because doctors did not believe her condition warranted treatment. While she was waiting, she developed a sickle cell pain crisis which was no doubt caused by her panic over the test result and the uncertainty as to whether she would receive the treatment I recommended. On Tuesday evening, she had a fever and a cough, and her treatment was finally started.
As a clinical hematologist caring for people with weakened immune systems, I have watched in horror as the Covid-19 ravages my patients. I have lost three colleagues and over 20 patients to the disease. I contracted Covid-19 last March, before a useful treatment was identified. Despite advances in vaccinations, the coronavirus remains a persistent and even growing problem in New York City, where around 4,000 new cases of Covid-19 are identified every day and thousands of people remain hospitalized.
When President Donald Trump fell ill with Covid-19 in October, he received monoclonal antibodies, as did several senior officials around him. All of them survived, as did almost 90% of high-risk patients who are treated early with this drug.
But despite the extraordinary effectiveness of monoclonal antibodies, this life-saving treatment is often difficult for ordinary people to obtain. When I tried to get insurance approval for monoclonal antibody treatment for another patient, I was told that the person, who was also at high risk for complications from Covid-19, did not was not sick enough to warrant treatment, although some people at risk of severe Covid results receive monoclonal antibodies before symptoms appear.
Over the past month, I have given monoclonal antibodies to three high risk patients who were newly diagnosed with Covid-19. Two have cancer and are 80 years old, and the other is a 55 year old who recently had a bone marrow transplant to treat lymphoma. Two of the patients presented with mild symptoms. The other was not feeling well but had no symptoms of Covid.
All three patients responded well to treatment, but each case required me to seek approval from the infectious disease, pulmonary medicine, pharmacy, and emergency departments of the hospital, which I usually do not have. not to be done as primary attending physician. Each time, I stayed with the patient until late in the evening to make sure that the planned treatment was accomplished. Since monoclonal antibody therapy can only be given in an outpatient setting such as an infusion center or emergency room, in one case I had to persuade the admissions team to release a patient. from the hospital so that she could send him to the emergency room to receive the care he needed.
A colleague and I recently called all hospitals in New York’s five boroughs to find out if they offer monoclonal antibodies to high-risk patients with Covid-19. Only three said they could provide the therapy to a high-risk patient without symptoms. Some said they should assess a patient in their emergency room, and others were unfamiliar with monoclonal antibodies or would not discuss a referral.
The federal government has provided more than 750,000 courses of monoclonal antibody therapy nationwide, and Medicare has waived co-payments for patients who receive it. But insurance companies only reimburse hospitals for drug administration costs. This process takes time, as the drug is infused over several hours; and since these patients have active Covid-19 infections, they should be isolated. All of this makes the delivery of monoclonal antibodies a logistical and costly challenge for the supplier.
The Biden administration has pledged to make monoclonal antibody therapy more available, with a $ 150 million plan to provide it to more patients who need it. This is a welcome development, but so far in the field we have not seen any tangible change in access to treatment.
Vaccines against the coronavirus prevent infections and serious illnesses. For people already infected with the virus and at risk of hospitalization or death, doctors can now intervene to improve their chances of survival. The Trump administration has reassured the medical community that a ventilator will be available for every patient who needs it, but many Covid-19 patients on ventilators are dying. Now the doctors have a better option. Hospitals and insurance companies should be committed to making this effective treatment available to anyone whose life it can save. Vaccination may not be effective in patients with weakened immune systems, but monoclonal antibodies work.
Perry Cook is a hematologist and oncologist at NewYork-Presbyterian Brooklyn Methodist Hospital and Weill Cornell Medicine in New York.