ALBANY — The COVID antibody cocktail then-President Trump said worked wonders for him in October now has a growing number of Capital Region fans.
The clinic dedicated solely to antibody infusions at the former Albany Memorial Hospital surpassed 450 patients treated this past week. These are the COVID-positive people most at-risk from the virus, those whose underlying conditions put them in danger of extended or even life-threatening illness.
Many are reporting substantial improvement in symptoms a day after getting the drugs, some of which are made by Regeneron Pharmaceuticals just three miles away, in East Greenbush.
St. Peter’s Health Partners has now expanded the infusion program to the nursing homes it operates, so that residents need not leave the facility.
The human body’s immune system produces its own antibodies to fight infection, but the process can be weak in those who have immune system problems or already have chronic health problems at the time of infection.
Eli Lilly and Regeneron each have developed therapeutic drugs using cloned antibodies; this monoclonal antibody therapy received emergency authorization from federal regulators in late November.
On Dec. 3, SPHP went live with the dedicated clinic at Samaritan Hospital’s Albany Memorial Campus. The infusion is an IV drip, not complicated. But it’s a slow drip that takes an hour, as per current regulations, and the patient needs to be monitored for adverse reactions during the entire hour, plus an hour afterward.
Just as important — the patients getting the infusion are often very sick.
For these reasons, the decision was made to isolate the infusion patients from the rest of the hospital population, and isolate the nurses caring for them from the distractions of the hectic emergency room environment.
Dr. Melissa Fiorini, an emergency department doctor who’d been heavily focused on COVID care since the start of the pandemic, has been running the antibody clinic the last two months with a team of five to six nurses.
They’ve begun to catch their breath recently after some very busy days.
“We are not at capacity,” Fiorini said. “We were about to go 12 hours a day and five days a week” when the recent infection surge subsided.
At its height, the situation was bad enough that SPHP moved to set up overflow wards in an old, unused portion of the county-run nursing home, but it hasn’t had to use them.
Nonetheless, the work still carries risk for the clinic’s nurses, who are hands-on with infected and contagious patients.
They’re swathed head-to-toe in personal protective equipment as they work.
“They have to stay in that all day long, which takes some Zen,” Fiorini said.
Fiorini herself is not just care coordinator but gatekeeper, fielding referrals, getting the patients treated, arranging followup care, and even, in the case of homeless patients, connecting them with social workers to arrange temporary lodging after treatment.
Federal authorization allows use of the therapy only within 10 days of symptom onset, and she does follow that guidance. But she also works to get people in as the 10-day window is about to close.
When patients delay seeking treatment or testing until the cutoff date is near, she orders a rapid test and sends them next door to the emergency room for infusion if need be — the clinic is closed at night and on weekends.
“One of the take-home points is, if you have symptoms, get tested,” Fiorini said. “There’s times when I’m checking Friday morning, right up to 10 a.m.”
PAIN AND FEVER
Annie Mirochnik of Guilderland got into the clinic within the time window, though it wasn’t easy — she was terribly sick and didn’t know exactly where the facility was.
“The fact that I had to walk around the Albany Memorial perimeter in the freezing cold when I was sick — it’s just amazing to me that this drug is not in every single hospital,” she said.
She was alternately freezing and broiling with fever and reliving the back labor she’d had during two very difficult childbirths in the last four years.
“It was incredible, I can’t tell you the amount of pain,” Mirochnik said. “When I was having the body aches and the pulsating joints I could not even sleep properly because I was in so much pain.”
Despite all that, and despite having Type I diabetes, she wasn’t worried about her own safety — she’s young and strong and fit. She was worried about her family.
“I was terrified for my husband and I was terrified for my children,” she said.
Still, she needed the pain to stop.
Mirochnik heard about the clinic and learned she’d qualify for the therapy because her diabetes is an autoimmune disorder. She got a referral and hopped in the car without knowing exactly where to go.
“I drove to Albany Memorial in hope of finding someone that could direct me to someone that could prescribe it, give it, dole it out.”
The staff let her bring in her own heating pad for her back, which she had hoped but didn’t expect they would.
“I had this one nurse, Ingrid, and she was lovely, so nice and accommodating,” Mirochnik recalled.
And the drug? Amazing.
“Within 24 hours of receiving it I was 95 percent better,” she said.
Mirochnik said she is largely recovered now. As she spoke with The Daily Gazette on Thursday evening, she got another call — the most recent blood work showed her liver enzymes to be slightly elevated but also showed she retains antibodies, a month later.
The arrival of the COVID vaccine, which can prevent a future infection, stole a bit of the thunder from the monoclonal antibody therapy, which can knock down an existing infection.
To Mirochnik’s point about more hospitals not using the therapy, Dr. Fiorini said there are practical considerations. Between intake, treatment and post-treatment observation for allergic reaction, each patient needs about three hours of fairly close individual attention. That has been a huge ask in recent months in much of the United States, where hospitals have been stretched or even overwhelmed by an influx of people sick with COVID.
“We were very fortunate in having a hospital system and a spot to do this,” she said.
Also helpful: The supply of Lilly’s bamlanivimab and Regeneron’s casirivimab/imdevimab cocktail has increased, allowing SPHP to ramp up its use.
“At first we were close to running out,” Fiorini said. “The nation’s only using about 20 percent of what’s available. There was plenty left over for us.”
As the medical community hits the one-year mark in treating COVID patients, this therapy is part of an expanded body of knowledge and tools available, Fiorini said.
“We know better what to do when [patients] are hypoxic,” she said. “We slowed the curve, so we have the beds available.”
And there are better protocols now, such as when best to administer steroids.
The antiviral drug remdesivir was approved for treatment of COVID in October and has shown promise, Fiorini said.
There’s also convalescent plasma therapy, an old technique that gained new prominence last spring.
It’s a beautiful gesture — a recently recovered COVID patient extending a helping hand with a donation of antibody-rich plasma for patients who are still battling the disease. And it can be effective. SPHP doctors have administered these donations more than 250 times.
But potency can vary from donor to donor, Fiorini said. “Some antibodies may have left the system, maybe there weren’t as many to begin with,” she explained.
By contrast, the antibodies cloned and cultured in a laboratory are consistent from batch to batch.
There are signs for optimism as the regional, state, and national rates of new COVID infections have been on the decline for nearly a month. But the danger is still there: The national daily average for the seven days ended Feb. 4 was nearly 130,000 new infections and more than 3,200 deaths.
Fiorini had to treat one of her own colleagues with the monoclonal antibody therapy: Dr. Steven Bosco, SPHP’s director of emergency medicine.
Bosco said his fever broke the night after he got the infusion and he began to feel better the next day.
He was acutely aware of the vulnerabilities his underlying conditions presented to the virus, and he recognized the symptoms when they developed.
“If you slip up just once, that’s all it takes for you to be exposed,” he said.
To receive monoclonal antibody therapy at St. Peter’s Health Partners’ dedicated lab, patients must:
- Have a positive SARS-CoV-2 PCR test
- Weigh at least 88 pounds
- Have a physician referral; those who don’t have a primary care physician can obtain one though the SPHP website: https://www.sphp.com/health-and-wellness/covid-testing-locations-and-clinics#monoclonal
Patients must also be at high risk for hospitalization or severe COVID-19 illness because of one of the following factors:
- Age of 65
- Body mass index greater than 35
- Chronic renal disease
- Immunosuppressive disease
- Currently receiving immunosuppressive treatment
- Are at least 55 years of age and have cardiovascular disease, or hypertension, or chronic obstructive pulmonary disease/other chronic respiratory disease