Another Valuable Tool in Managing COVID

"[In Ontario a] substantial [fall wave is anticipated although] we do not expect to see the same proportion of severely ill cases in the vaccinated]."

"Among the unvaccinated, we do expect to see a rapid increase in the number of seriously ill people needing hospital care as workplaces and education reopen in September."

Ontario's COVID-19 Science Advisory Table report

"Let's say you're at work and you find out that Bob down the hall is COVID positive and he's been talking to everybody at the coffee break."

"In theory you could say everybody who was talking to Bob is at high risk. Those people might benefit from prophylaxis. But those studies are hard and expensive to do."

"If you have more than that [high-risk people] -- you start requiring oxygen or hospitalization -- not only is there no benefit in terms of survival from these monoclonal antibodies, there may even be a signal of increased risk of death, though it's hard to know if that's simply because those people were already too sick to begin with."

"The thing about COVID is that it can progress rapidly. You can literally go from sitting in your bed eating to, an hour or two later, requiring high amounts of oxygen. If you have to transport yourself to a setting where you have to wait in line and get triaged and get a monoclonal antibody, that window can close quickly."

Dr.Donald Vinh, infectious diseases specialist, McGill University 

"These are valuable tools not being used in Canada, and should be."

"Across the provinces, they're looking at where and when to use them. How do you figure out who's eligible and who is not? What are the criteria? How do you identify and notify them? We don't really have great systems in place for that."

"Are there going to be some people who avoid vaccination and just get this? I anticipate there will be. It's a shame. It's like the difference between quitting smoking and saying if I get lung cancer, I'll get an operation."

"The truth is that everyone who has forgone vaccination by now, the majority of them have no plans to get vaccinated in the near future. I'm not sure that they're banking on a monoclonal as a way to avoid future vaccination."

Dr.Andrew Morris, infectious diseases specialist, Mount Sinai Health System, Toronto

A man enters a monoclonal antibody treatment clinic in Pembroke Pines, Florida. Photo by Chandan Khanna/AFP via Getty Images

Florida and other U.S. states responding to record numbers in COVID-19 case surges represent a case study in the rapid utilization of laboratory-produced antibodies by ordering truckloads of them to avoid having to face and deal with more serious cases of COVID-19, threatening the health-care system with overburdening and collapse. Monoclonal antibody therapies have been recognized as a mode of treatment capable of ensuring that those struck with mild to moderate symptoms don't graduate to hospitalization, or even death. It's a treatment that famously worked for Donald Trump when he was president.

More recently, a Canadian-led study assessed that a single dose of an antibody treatment reduced the risk of COVID progressing from mild to serious in high-risk people by 85 percent, in comparison with a placebo. It has presented as an excellent argument for Canada to begin using what is being recognized as a 'valuable tool' against the worst excesses of the SARS-CoV-2 virus. "Importantly, in the test tube, this antibody retains activity against multiple variants", a recent White House briefing by Dr.Anthony Fauci was informed.

 

 The use of this treatment does nothing to present as an alternative to vaccination; it is an additional, and badly needed treatment in the prevention of severe disease appearing in those infected by COVID. Monoclonal antibodies are not viewed as a magic formula treat-all. Well tolerated, but as with all drug formulations there are side effects such as diarrhea and rash appearing in some, not all patients with its use. It is not simple to apply, requiring a medical space with ample ventilation, personal protective equipment and skilled staff able to infuse the drug while monitoring patients for potential reactions.

 

Demand for sotrovimab has risen in the United States close to 300 percent in the past month according to the Washington Post. There's a steep cost attached to these treatments administered mostly through IV infusion, which must be administered within five to ten days of positive testing for COVID. The disease progress is slowed by blocking the virus from invading new cells and replicating. Typically the cost is $2,000 each dose.

 

Clinics specializing in administering the monoclonal antibody infusions, state-operated in Florida, have been swamped with COVID patients who were unvaccinated, looking for the free treatments. There the drugs were authorized as a 'post-exposure' prophylaxis meant for people in close contact with those infected with COVID who have not  yet exhibited symptoms but are at risk of being infected. All the more so if they are unvaccinated, or their immune system failed to mount a strong enough reaction to inoculation.

 

Health Canada gave authorization to Glaxo-Smith-Kline's sotrovimab in July and the company is "in active discussions with the federal government to secure supply of sotrovimab by early fall 2021", according to GSK -- with the intention that appropriate patients have access to the drug without cost to the patient. An earlier drug produced by Eli Lilly for antibody cocktails -- bamlanivimab -- turned out to be less effective against certain variants. Lilly issued a statement its produce is not effective "against the variants currently at play in Canada".

High-risk people; those with obesity, diabetes, neurological problems, asthma, heart failure or chronic kidney disease and those over age 55 who have mild to moderate disease, have been proven to benefit from monoclonal antibodies.

Health workers prepare injections of Regeneron at the monoclonal antibody treatment site in Tampa. Patients receive four shots of the antibody cocktail    Florida Department of Health in Hillsborough County

"Before somebody gets hospitalized with COVID, there isn't all that much. [By treating early], we're preventing the cascade of events that includes viral replication and the body's inflammatory response."

"We're attacking before we get to that inflammatory response stage."

Dr.Anil Gupta, lead investigator, sotrovimab trial, William Osler Health System

"But the payoff is huge. There is probably a big cost benefit here, in preventing ventilator days and ICU days and hospitalization, to really scale this up as much as possible to mitigate the spread of the fourth wave, especially amongst people that are unvaccinated."

"This therapy is being used in the United States. It's being used in places in Europe. It definitely can be done -- I don't think there's anything to say we can't do this."

Dr.Zain Chagla, infectious diseases specialist, associate professor of medicine, McMaster University