You’d be hard pressed to bump into anyone these days who doesn’t have something to say about the COVID-19 vaccines.
Ask instead what they know about treatments for the coronavirus, and the conversation would be less robust. Some might recall hearing about an experimental cocktail that President Donald Trump got back in October that included Regeneron’s monoclonal antibody.
But too few know that it's been authorized for use, that Carilion Clinic has monoclonal antibodies, and that if given within the first days of an infection, it keeps the disease from progressing in people most at risk for entering the hospital and dying.
The Food and Drug Administration in November approved both Regeneron's product and one made by Eli Lilly. Carilion has had both monoclonal antibody treatments since early December.
Dr. Dorothy Garner, interim chief of infectious disease for Carilion Clinic, said both of the treatments are working well for people most at risk for severe illness, but they have to get it in the first 10 days of illness, and the sooner they get it, the better it works. A third, even more promising combination of monoclonal antibodies just won FDA approval and should also be available.
“It’s important to get the therapy rapidly. So when we get a referral of a patient, we have typically gotten them infused within 24 hours, and the same day if we can,” she said.
Garner said Carilion on Dec. 4 infused its first patient, an older man who’s been battling cancer for several years, is on chemotherapy and has emphysema.
“He never had to be hospitalized with COVID. I was impressed,” she said. “Typically, somebody like that you would have expected would have ended up in the hospital with supplemental oxygen, potentially would have gotten so sick that he needed to go on a ventilator, and likely would never have come off the ventilator.”
At least 106 patients have gotten the treatments in Roanoke and the New River Valley. Garner is sure that more older people and younger ones with certain medical conditions could benefit from the monoclonal antibodies infusion, if they knew to ask.
“We are begging for help to get the word out,” she said.
Two of her patients, Russell and Ellen Miller, want everyone to know how well it works.
The Millers live on the Pittsylvania County side of Smith Mountain Lake.
She’s 70 and he’s 65. She’s in better health than he, as he has heart disease and high blood pressure.
“One of the reasons we were considered [for monoclonal antibodies] is our body mass index is quote, unquote, high,” he said.
“We’re overweight,” she said.
They fit COVID’s most-likely-to-have-a-poor-outcome profile.
So for all of 2020, they did all they could to avoid catching it. They wore masks and gloved up when they’d make rare trips to the store. They stayed mostly at home enjoying the lake view, and when they socialized, they did so outside on their boat, or at a distance around their fire pit.
So when Ellen Miller on Jan. 11 told her husband she had a low-grade fever and pain in her lower right abdomen, neither was thinking about COVID. They were thinking appendicitis.
He drove her to Rocky Mount and waited outside Carilion Franklin Memorial Hospital, while she got the workup.
“When all the tests came back and suggested I was fine, they said, 'OK, we’ll send you home, but we should give you a coronavirus test,' and I said, ‘Of course. Please do.'” Ellen Miller wondered whether she had overreacted in going to the emergency room. But she just didn't feel like herself.
The next morning, Russell Miller had a bit of a cough, a runny nose, nothing much. The following day, Ellen’s test result was in: She had COVID. Russell called their family doctor, Vishal Patel, who told him to drive immediately to Velocity Care at West Lake to be tested.
“By Friday morning the 15th, I had a positive test result. I talked with Dr. Patel and we kicked around what we should do.” Miller said he asked about the treatment that he read had been successful for Trump; his lawyer, Rudy Giuliani; and former New Jersey Gov. Chris Christie.
Patel told him he’d check, and by 4 p.m., Gardner had called.
“She said, 'You know, I’ve looked at your chart. You are an excellent candidate to receive Regeneron’s treatment. I’m going to set you up for tomorrow morning in the Roanoke hospital.' I said, ‘Great. What about my wife?’”
Gardner said she’d check and within an hour had called back, emailed fact sheets and set them up for 9 a.m. Saturday.
They arrived; got the infusion, which took an hour; stayed another two hours so a nurse could check to make sure they wouldn’t have a reaction; and then went home.
Both ran high fevers, which they were told to expect, and felt fine within 24 hours.
“By Day 7, I was without any symptoms. Cough, fever, hacking were all gone. No question the Regeneron hastened our recovery and probably saved us from all kinds of horrible things,” Russell Miller said, adding he thought they would have ended up in the hospital.
“We cannot know that,” his wife said.
Garner said that while they don't know for certain what would have happened to the Millers or the others who were infused, she does know that none was hospitalized.
“I fully believe it has saved some lives,” Garner said. “I have had a number of patients with very high risk because of cancer, because of immune suppressive meds, because of uncontrolled diabetes, because of severe lung diseases, and because of advanced age, that I truly believe would not have survived COVID had they not gotten this treatment.”
The infusions are not for everybody. Supplies are limited, though Garner said Carilion has enough. Monoclonal antibodies are reserved for people with a high risk of being hospitalized or dying from COVID, and can be given to children as young as 12. But they must be given before the disease progresses.
The drugs are under an emergency-use order and were distributed without cost across the country. There could be a small fee for the infusion procedure that is billed to insurance.
Dr. Jason Faulhaber, director of Carilion’s Infectious Disease Fellowship Training Program, said people need to be tested early for COVID so that they can get the treatment quickly and allow their immune system to build a defense.
“The monoclonal antibodies are engineered and are very, very specific to the spike protein on the virus to prevent it from entering new cells,” Faulhaber said. “All of those are helping your immune system because the presumption is, early on in infection, your immune system hasn’t had enough time to mount a response to fight off the infections.”
It gives an extra boost to fight progression of the disease.
“The most important message to people is to not delay finding out whether you have COVID,” Garner said. “If you are someone with any of these risk factors, the sooner you get tested, the sooner we can get this monoclonal antibody therapy to you, and the more likely you are to not be hospitalized with COVID, not to have severe disease, not to die from COVID."