The COVID-19 mantra in Massachusetts has been vaccinate, vaccinate, vaccinate. And that unrelenting priority has protected many people from getting seriously ill.
But the push for shots in arms has left this state behind in one key area: ready access to a remarkably effective COVID treatment that uses monoclonal antibodies. Some Southern states with much lower vaccination rates than Massachusetts — and with political leaders like Florida Governor Ron DeSantis — have taken the lead in using the therapy to keep COVID patients out of the hospital. Meanwhile, many Massachusetts patients can’t get the treatment at all.
Now, as infections continue to climb, and hospitals across the state are stretched thin, Massachusetts is racing to catch up.
“The best strategy to remain protected from the worst of COVID-19 is to get fully vaccinated,” Dr. Marcella Nunez-Smith, chair of President Biden’s COVID-19 Health Equity Task Force, said in a recent White House press briefing. “But if you get COVID-19 and you’re at high risk . . . the monoclonal antibodies work. They are safe. They’re free. They keep people out of the hospital and help keep them alive.”
The drugs, which are typically delivered by infusion, are laboratory-made proteins that mimic the body’s immune system and stop the virus, keeping people with COVID from getting seriously ill, if taken within 10 days after symptoms appear. Research that has not yet been peer reviewed indicates the treatments can reduce the risk for hospitalization and death by about 70 percent, and can shorten the average duration of symptoms by four days (down from 14 to 10 days), compared to patients who did not receive the treatment.
“That’s really astonishing and comforting to see as an infectious disease doctor, compared to the beginning of the pandemic when we didn’t have many things in our arsenal,” said Dr. Sandeep Jubbal, who runs a monoclonal antibody treatment clinic that UMass Memorial Medical Center in Worcester opened in mid-July
But many Massachusetts hospitals have limited ability to offer the life-saving treatment, in part because the infusions require significant space and staff commitments. Massachusetts public health and hospital officials placed a much higher priority on setting up vaccination clinics rather than specialized treatment centers.
Currently, the UMass clinic alone administers roughly half of the 210 monoclonal antibody doses reported weekly in the state, according to data from the US Department of Health and Human Services. Jubbal said the free clinic is drawing patients from as far away as Maine.
Former president Donald Trump brought wide attention to treatment with monoclonal antibodies last October when he was hospitalized with COVID and received infusions of the experimental drugs. The next month, the Food and Drug Administration issued an Emergency Use Authorization for Regeneron’s monoclonal antibody treatment.
At that time, with limited data available about the drug’s effectiveness, overwhelmed health leaders in Massachusetts mostly stayed away from the therapy. Many last winter noted the daunting process for administering the drug, typically given intravenously over 20 minutes in an outpatient setting, followed by an hour of monitoring for adverse side effects.
But several states where a higher percentage of residents have declined to get vaccinated than in Massachusetts began pushing monoclonal antibodies as a way to reduce the danger of COVID. DeSantis may be better known for blocking public schools from imposing mask requirements, but he also set up 21 monoclonal antibody centers that his office estimates have treated 30,000 patients so far.
Mounting infections here, combined with increasing evidence of the drugs’ success, is prompting some Greater Boston hospital networks to open or greatly expand monoclonal antibody clinics.
“By the first week of August, it was clear that demand [for antibody treatment] was going to outpace our capacity very soon,” said Dr. Ron Walls, chief operating officer at Mass General Brigham, the state’s largest health care network. “The demand tripled between the second week of July and the second week of August.”
Mass General Brigham is poised to more than double its capacity later this month to administer the treatment across its system, from 41 to at least 95 doses weekly, and if that still doesn’t meet demand, it can expand to 140, Walls said.
The system’s hospitals, like many in Massachusetts, are bulging with patients who deferred care for other problems during the pandemic and are now seriously ill. That’s in addition to the recent rise in COVID patients.
“Treating people early with monoclonal antibodies and reducing the likelihood they end up in the hospital, or are not as sick if they need to be hospitalized, is the right thing to do, for the patient and for resources system wide,” Walls said.
Fueling demand is the FDA’s action in late July to greatly expand eligibility for the treatment. In addition to people 12 and older who test positive for COVID-19 and are considered high risk for complications, the drug can now be given to those who have merely been exposed to someone with COVID and are at high risk for severe illness and hospitalization, such as people with a compromised immune system, or who are obese, elderly, or have chronic kidney disease.
However, demand is running so high that Mass General Brigham currently only treats high-risk patients who have tested positive. Beth Israel Lahey Health system has also similarly limited treatment, but Dr. Richard Nesto, Beth Israel’s chief medical officer, said plans to open a second treatment site at its Burlington medical center next week may allow the system to offer it to more patients.
“We had a big supply of medication and no demand three or four months ago,” Nesto said. “But the surge [in cases] has dramatized the demand for this.”
Now, health officials find themselves walking a tightrope. They still want people to get vaccinated, yet they also need to promote a drug that can save patients — even if they don’t get their shots.
“These strategies are not competitive; they are complementary,” said Dr. Howard Koh, a former Massachusetts public health commissioner and assistant health secretary in the Obama administration who is now a professor at the Harvard T.H. Chan School of Public Health. “Monoclonal antibodies prevent those with high risk or early disease from getting sicker, while vaccination prevents people from getting disease in the first place.”
At Tufts Medical Center, nearly 500 patients have been treated with antibodies since December and just seven of them ultimately required hospitalization, said Dr. Helen Boucher, an infectious disease physician at Tufts.
“It’s made a lot of difference in patients’ lives,” Boucher said. “But vaccination is still our most important tool.”
Like Tufts, Boston Medical Center also is reporting a rise in demand for the treatments, though it only has sufficient space and staff to administer antibodies to two patients a day. While most have been over the age of 55, there have been some younger patients seeking the treatment more recently, a hospital spokeswoman said. Sixty-four percent of the patients are from lower-income neighborhoods.
Amid the recent spike in COVID infections in many nursing homes, the state’s health department last month urged nursing home leaders to promptly seek monoclonal antibody treatments for infected residents and said the state would provide the medication.
But Dr. Asif Merchant, chief of geriatric medicine at Newton-Wellesley Hospital and partner of a company that runs medical services for 45 nursing homes in Massachusetts, said too many facilities lack skilled nurses to administer the treatments, so the drugs are not being widely used.
“The state has tried to be helpful, but simply offering the drug without staff who can administer it doesn’t work,” said Merchant, who recently partnered with a pharmacy to administer the treatments for free to nursing homes. “This is a drug we know can save lives, but there are too many hoops to go through.”