They Shunned COVID-19 Vaccines but Embraced Antibody Treatment
Laura Jeffery, 43, will receive an infusion of monoclonal antibodies at the Houston Methodist Hospital, Texas on Wednesday, September 15, 2021. (Brandon Thibodeaux / The New York Times)
Lanson Jones didn't think the coronavirus was coming for him. An avid tennis player in Houston who didn't even catch a cold during the pandemic had turned down a vaccine fearing it would harm his vein of good health.
But the COVID-19 infection shook his confidence in his body's defenses - so much so that with a blocked nose and lost appetite, Jones began to look for anything to save himself a nightmarish illness.
The answer was monoclonal antibodies, a 1 year old laboratory-made drug that is no less experimental than the vaccine. In a glass case at the Houston Methodist Hospital, 65-year-old Jones was one of more than a million patients including Donald Trump and Joe Rogan to receive an antibody infusion this month as the virus struck the United States.
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Vaccine-resistant Americans turn to treatment with a zeal that has sometimes puzzled their doctors, chasing lengthy IVs after turning down vaccines that are one-hundredth as expensive. Orders skyrocketed so quickly this summer - to 168,000 cans a week in late August, up from 27,000 in July - the Biden government warned this week of dwindling national supply.
The federal government, which has already covered the cost of the treatment - currently about $ 2,100 per dose - has now also covered its distribution. For the coming weeks, the government has advised the states to expect reduced deliveries due to the impending bottlenecks.
With 70% of orders in seven southern states, the new process has unsettled some of their governors, who have made antibody treatment a central part of their strategy to weather a catastrophic wave of the Delta variant.
More supplies are on the way. The federal government bought 1.8 million more cans this week, which are expected to arrive in the fall and winter. But right now, some hospitals are unsure of care, state health officials said, even as patients continue to check for doses.
"We have vendors struggling to get the product we need," said Kody Kinsley, who heads operations for the COVID-19 response in North Carolina. "I think what happened is a classic logistics topic that suddenly has a lot more demand."
Amid the noise of anti-vaccine falsehood, monoclonal antibodies have evolved into the rare coronavirus drug that has achieved near universal acceptance. The IV fluids, championed by mainstream doctors and conservative radio hosts alike, have kept the country's death toll - 2,000 a day and rising - from rising any higher.
And after months of work by President Joe Biden and the Governors of the South to promote the treatments, they have won the affection of vaccine oppositionists, who said the horrors and uncertainties of actually getting COVID-19 made them desperate for an antidote would have.
"The people you love, whom you trust, nobody said anything negative about them," Jones said of the antibody treatment. "And I've only heard negative things about the vaccine's side effects and how quickly it was developed."
Some Republican governors have set up antibody clinics while speaking out against vaccine mandates, frustrating even some of the medication's strongest proponents. Increasing vaccination rates, the scientists say, would eliminate the need for many of the costly antibody treatments in the first place. The infusions last about an hour and a half, including monitoring, and require constant nurse attention, which severely affected states often cannot do without.
"It's clogging resources, it's difficult to give, and a vaccine costs $ 20 and could prevent almost all of that," said Dr. Christian Ramers, Infectious Disease Specialist and Health Director for Family Health Centers in San Diego, a community-based provider. Squeezing antibodies while downplaying vaccines, he said, was "like investing in car insurance without investing in brakes".
The government-supplied monoclonal antibodies, manufactured by Regeneron and Eli Lilly, have been shown to reduce patient symptoms significantly and reduce their risk of hospitalization - in the case of Regeneron's antibody cocktail, by 70%. The treatments, which are done in a single session, use laboratory-made copies of the antibodies that humans make naturally when fighting an infection.
Patients and doctors overlooked the treatments during the winter wave of infections. But hospitals and health centers have now expanded their offerings, turning dental clinics, mobile units and lecture theaters into infusion centers. In states like Texas, where elective surgeries have been postponed to make room for COVID-19 patients, operating room nurses have been recruited to give IV fluids.
One factor driving demand is that many patients, including vaccine skeptics, are spreading their seemingly miraculous recovery.
"They say, 'I have COVID, I want this treatment, my friend or family told me about it,'" said Jennifer Berry, the Houston Methodist's director of nursing for IV services. "Now the word is out."
At the Houston Methodist, nurses performed nearly 1,100 treatments in eight locations in the first week of September, more than twice as many each week last winter. The hospital reduced the average time between orders and IVs that month from three days in early August to two days to give patients a better chance of fighting off infection.
Juggling the fluids with severely ill COVID-19 patients this summer forced the hospital, in one case, to relocate a monoclonal antibody clinic to the front of a mall.
But the Texas Health Department helped by providing 19 nurses to another Houston Methodist infusion clinic, said Vicki Brownewell, the hospital program's chief administrator. The Biden government has also invested $ 150 million in expanding access to monoclonal antibodies, and the Houston Methodist has used federal funds to arrange medical taxis for patients struggling with transportation.
Even so, the infusions remain inaccessible to many. Due to the high demands on staff and the need to create separate infusion rooms for infectious patients, there are no clinics in certain communities, especially in rural areas.
In San Diego, Ramers said, some large, for-profit hospitals have chosen not to give the antibodies at all because of logistical problems, so wealthy, well-insured patients will have to search for doses at his publicly funded clinic. Some of the nurses he hired for IV fluids went on short, better-paid assignments in severely affected intensive care units.
"The natural, capitalist incentives for health organizations that are for profit don't really favor this," Ramers said. "It is much work."
Of the 2.4 million doses of monoclonal antibodies shipped nationwide, at least 1.1 million were used. How many are still on the shelves cannot be precisely determined due to reporting gaps. Still, dwindling federal supplies and increasing demand from less vaccinated southern states have caused what several states have described as major supply bottlenecks.
North Carolina suppliers have requested 15,000 weekly doses, the Department of Health there said, more than double that provided by the federal government. Florida said its latest weekly allocation left clinics 41,000 short of doses than they wanted.
Previously, hospitals could order the drugs themselves. But the Department of Health and Welfare will now decide how many doses each state will receive based on the number of cases and the use of the treatment. The state governments for their part will decide on the dosages for individual locations.
The new ordering process, which the Biden government said would ensure "fair distribution," has unsettled some drug supporters. Florida Governor Ron DeSantis, a Republican, warned Thursday that state officials were unprepared for the new responsibility of handing out cans.
And in heavily vaccinated states like New York, people who coordinate treatments fear that low case numbers will cause supplies to drop and hospitals to be left with so few doses that they will end their programs. Some hospitals have recently reported an increasing number of vaccinated patients receiving IV fluids.
Diana Berrent, the founder of the Survivor Corps, which has helped patients find monoclonal antibody treatments, said engaging state governments would cause delays: "They're adding 50 new layers of red tape," she said.
Doctors have warned that antibody treatments alone cannot keep up with balloon bursts. While any single vaccination protects countless others from exposure, a single infusion will only help a single patient. Infusions must be given within 10 days of symptoms; they are not helpful for most hospitalized patients. And the one-time administration of the antibodies does not prevent people from becoming seriously ill if they later contract the virus again.
"Something like that just can't be scaled," said Dr. Howard Huang, the medical director of the Houston Methodist infusion program.
As a result, health officials have warned that vaccine skeptics may be so in love with monoclonal antibodies that they will become even more resistant to vaccination.
Within days of his IV, Jones had left the quarantine bedroom and returned to his work as a landscape architect. But he was still wondering whether to get vaccinated.
His doctor pushed for the syringe, he said. But the monoclonal antibodies had worked so well that he was tempted to simply come back for another infusion if he contracted COVID-19 again.
"If I get an IV and feel as good as I do now, man, I'd rather not have a vaccine that was being developed," he said. "That still makes me nervous."
© 2021 The New York Times Company
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