Michigan can’t meet demand for COVID-19 monoclonal antibody treatments from Detroit Free Press
December 18, 2021
By Kristen Jordan Shamus
The sick make their way to a Detroit parking lot, unroll the car window, and push up their sleeves for infusions of a medical cocktail to help them recover from a modern scourge, COVID-19.
Monoclonal antibodies are pumped into their arms intravenously at Wayne Health’s drive-through clinic on Mack Avenue, staged outdoors to reduce the risk of spreading the virus.
For those most vulnerable to severe illness from COVID-19, treatment can mean the difference between life and death, said Dr. Phillip Levy, professor of emergency medicine at Wayne State University and chief innovation officer for Wayne Health.
“COVID testing and vaccinations remain our pillar, but we’re also very heavily engaged in monoclonal antibody infusions, which are a great way to prevent people who do contract COVID — particularly high-risk individuals — from getting sick to the point where they require hospitalization or at risk for dying,” said Levy, who also is assistant vice president for research.
“Michigan requested additional allocations … from the federal allocation team and received 800 additional courses of RegenCoV based on that request.”
At Grand Rapids-based Spectrum Health, as many as 1,000 calls a day streamed in for monoclonal antibodies at peak demand in late November. But the hospital system could only give 400-450 treatments a week.
“That’s a pretty significant mismatch,” said Dr. Darryl Elmouchi, president of Spectrum Health West Michigan, which aims to increase the number of infusions it delivers to 500 a week.
“There’s two limiting variables for monoclonal antibodies. No. 1 is the supply of monoclonal antibodies, which for the most part has been our biggest limitation. But No. 2 is to have enough staff to be able to administer it because it is labor intensive.
“You need health care providers who can do infusions. … Staffing, it’s hard. It’s a hard job and you’ve got to find people who are qualified to do it.”
Demand outpaces supply
Nurses typically administer the treatment, which takes about an hour-and-a-half from start to finish. But there’s a statewide nursing shortage as the pandemic stretches into its second year and many hospitals are beyond capacity limits.
As of Friday, eight hospitals reported they were 100% full, while another 30 were filled to 90% or more, state data showed.
“We’re redirecting all of our staff to our hospitals, and we have shut down clinics and surgeries and so many things,” Elmouchi said. “That’s our first priority because we have to take care of the sickest people first, but we want to keep this going as best we can.”
Dr. Bruce Muma, president and CEO of the Henry Ford Health System Physician Network, is feeling a similar pinch.
Detroit-based Henry Ford got about 2,000 requests for treatment in the last week, but was able to administer about 725 infusions.
“By hook or by crook, we’re expanding our capacity every week,” Muma said.
“One of our infusion centers expanded their hours to 3:30 in the morning … because there was a subset of ER nurses who were so concerned about what they were seeing in the ER that they wanted to start doing something to prevent patients from needing to be in the hospital. So they are … coming in four hours early for this shift.”
Levy said when the virus attacks the body, it’s like an internal war in which coronavirus particles are the invaders pitted against the antibody soldiers a person’s immune system has called to defend it.
“If you picture this being a battle in your body between virus particles and antibodies trying to neutralize or get rid of those virus particles, the more antibodies you have, the better the odds are of winning that battle,” he said.
“The monoclonal antibodies basically are a pharmaceutical version of the antibodies your body would produce anyway to fight off the virus. And by taking these antibodies and sort of bolstering your natural immune system, you get more soldiers, more fighters against the virus.”
There’s a waiting list at Beaumont Health for the therapy. About 600-700 requests for treatment come in each week, but the health system has been able to administer only about 145, said spokesman Mark Geary.
At Michigan Medicine, there are more than 380 weekly requests for treatment, but the health system is only able to administer about 150 doses a week.
“We are limited by workforce shortages and are prioritizing patients who are at highest risk for hospitalization,” said spokesperson Kelly Malcom.
To be eligible for monoclonal antibodies, patients must have a positive COVID-19 test, be within a 7-10 day window of symptom onset and be considered high-risk for severe disease. That includes anyone who is:
- 65 or older
- overweight or obese
- diabetic or with chronic kidney disease
- taking immunosuppressants or who has an immunosuppressive disease
- diagnosed with cardiovascular disease or high blood pressure
- diagnosed with chronic lung diseases such as COPD, asthma or cystic fibrosis
- diagnosed with sickle cell disease
- diagnosed with a neurodevelopmental disorder such as cerebral palsy or other conditions
- dependent on medical devices such as tracheostomy, gastrostomy or positive pressure ventilation.
- infants younger than age 1
But when demand is so high, health systems can further restrict the eligibility criteria.
“All of the health systems … are at the breaking point,” Muma said. “Every hospital I’ve talked to, every ER, is full of patients waiting for beds. There are no beds. People are sitting in the ER for days sometimes.
“I don’t know how much we can take and you know, with omicron on the horizon, this could be devastating. If we have yet another surge on in the middle of this surge, I don’t know what’s going to happen. I really don’t.”
State health department leaders have asked the federal government to send teams of health care workers to Michigan to help administer monoclonal antibodies, Sutfin said, and to help strained hospitals.
“We are also working to mobilize federal funding from FEMA (Federal Emergency Management Agency) to assist current and future sites,” she said. “This will also depend on the ability for Michigan to obtain sufficient medication supply to facilitate distribution to current and future sites to meet the demand.”
Sutfin said Michigan health officials have asked that any surplus doses of monoclonal antibodies not used in other states be reallocated to Michigan.
“Monoclonal antibodies are a great therapeutic option but does not negate the need for COVID vaccination,” Sutfin said. “We urge all Michiganders ages 5 and older to get the safe and effective COVID-19 vaccine as soon as possible and to get their booster dose as soon as they are eligible.”
Omicron variant changes the equation
The rise of the omicron coronavirus variant — which is doubling in prevalence every two days in the U.S., according to the U.S. Centers for Disease Control and Prevention — is likely to make an already tight supply situation for monoclonal antibodies even worse, Muma said.
There are likely to be more patients sick with the virus who need the therapy, and an even tighter supply.
That’s because lab studies suggest two of the three monoclonal antibody products on the market in the U.S. — those made by Regeneron and Eli Lilly — may not work well against the mutations found in the omicron variant, even though they were very effective in treating people who had the delta strain of the virus. More testing is under way.
The only monoclonal antibody therapy that has so far been shown to neutralize omicron in lab tests is a drug called sotrovimab, which is made by Vir Biotechnology and GlaxoSmithKline.
“We’re kind of bracing for that,” said Muma, who also is the clinical leader of the monoclonal antibody program.
Genetic sequencing of coronavirus test samples to determine which strain of the virus a person has can take a week or more to complete. Yet the window for administering monoclonal antibodies is just 7-10 days. That makes targeting the therapy based on variant type nearly impossible.
“We have no way of knowing what strain anyone has,” Muma said. “So the emergency use authorization … states that once a variant exceeds 5% of the prevalence of that variant in the community, then at that point in time, you should stop using the the monoclonal antibody product that may not work against that variant.”
Earlier in the week, the CDC reported that the omicron variant made up an estimated 3% of all cases in the U.S., but was doubling every two days.
At that rate of growth, omicron could be dominant in Michigan and across the nation before the new year.
“We’ve been operating with knowing that delta was 100% the variant for the last couple of months,” Muma said. “So the omicron will come into the community. In the earliest stages, obviously, our surveillance will probably underestimate its prevalence. And so we’re going to have to make decisions at some point, if indeed, it grows as rapidly as it appears to be.”
Still, he said, Henry Ford is continuing to expand the number of doses it can give each week.
So far, the health system has mostly been able to handle the volume of patients who are referred by their doctors for monoclonal antibody treatment. And it has opened a hotline — 313-874-7575 — so patients can call directly during regular business hours to ask for the therapy.
“Any patient who finds out they are COVID-positive by a test can call this number and get treatment. … But that line has become impossible for us to fully manage,” Muma said.
“Our hold times can be as long as 30-45 minutes, so (patients) abandon the call. We scheduled 100 patients through our direct patient line (Monday), which was a record. We’re doing everything we can to take care of everybody who needs treatment, but we’re just not able to keep up with demand completely.
“We’re worried if more volume comes through because of omicron and possibly less supply of medical antibody through not being able to give (Eli Lilly’s monoclonal antibodies) — which is the one we have the most of, the one that’s in greatest production right now — that’s going to significantly limit the ability to administer these therapies.”
‘We’re in a danger zone’
Given that an already tight supply of one of the best weapons in the medical arsenal to fight the virus is about to get even more stretched as the omicron variant gains ground, Muma said it’s vital for the unvaccinated to get vaccines, and for others to do all they can to avoid getting sick.
“Be careful,” he said. “This isn’t a time to need to go to the hospital because the hospitals are overflowing. The … fact that we’re having this prolonged surge is placing so much strain on our health care systems, we’re in a danger zone … so we just need to be aware of that.”
Each health system has its own approach to administering monoclonal antibodies, he said, and it’s “highly variable by hospital or by health system.”
“So it’s frustrating for patients because they may or may not be able to get it from their hospital or from their doctor and then — sort of like the vaccines in the early days — people are scrambling to try to find the monoclonal antibody and are calling around,” Muma said. “It seems disjointed to some extent.”
Wayne Health has a call-in line — 313-448-9813 — for its drive-up monoclonal antibody treatment for people with COVID-19. Levy said people who don’t have vehicles also can walk up and get an infusion in an outdoor heated tent.
The therapy is also available at Wayne Health as a preventive treatment for people who are very vulnerable to COVID-19, such as transplant recipients, people with cancer and others who are immunocompromised but are in close contact with a person with the virus.
Jane Foster, 58, of Macomb Township, and her husband, Tom Foster, also, 58, got the treatment soon after they were diagnosed with the virus.
Both of the Fosters were fully vaccinated against COVID-19, but neither had gotten a booster dose. They were feeling congested, tired and had lost their ability to taste.
Tom Foster said he also had headaches.
“I think we were blessed because we had the vaccines,” said Jane Foster, who retired from a teaching job with L’Anse Creuse Public Schools.
“When I called my physician, his assistant said, ‘If you can get it, do it,’ ” she said of monoclonal antibody therapy.
They made appointments and rolled into the Wayne Health parking lot Nov. 19 in their black Chevy Silverado.
They rolled down the windows and the medical team brought out IV poles to start their infusions.
“You could actually feel it going through your body,” Tom Foster said, “just from the standpoint that they keep it chilled. … So when they inject it into your body, it’s cold going into warm. There’s no pain or anything like that; it was just sensation.”
By the next day, the Fosters said their symptoms were reduced “dramatically,” and they’ve since made a full recovery.
“We’ve seen people who’ve gotten the infusions feeling much better,” Levy said. “We’ve seen people who were not feeling well with fevers and lying horizontal on one day, get the infusion and feeling well enough to do a light workout the next day.”
To find monoclonal treatment options in your area, consider contacting:
- Your primary care doctor and ask for a referral
- The Henry Ford Health System direct patient line at 313-874-7575
- The Wayne Health Mobile Unit line at 313-448-9813
- The federal Combat COVID Monoclonal Antibodies Call Center at 877-332-6585.
For additional details about the treatment, go to bit.ly/33EKQuH.
Read, “Michigan can’t meet demand for COVID-19 monoclonal antibody treatments” from Detroit Free Press
Visit our Wayne Health Mobile Unit page to find a time and location near you to receive your COVID-19 vaccine.