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The Story Behind a Complex But Lifesaving COVID-19 Treatment


Despite the apparent success of vaccination, the COVID-19 danger is by no means over. People are still contracting the virus and at risk; some people can’t be vaccinated or missed getting vaccinated; occasionally, someone doesn’t develop immunity.

What was true at the beginning of the pandemic is still true more than a year later: Older adults are at a far greater risk of hospitalization and death as a result of coronavirus.

But there’s a treatment that has had lifesaving effects: Monoclonal antibody treatments, or mAb. Studies show that when administered early in the course of infection, these outpatient infusions are 87 percent effective in impeding disease progression and preventing hospitalizations. It’s not a cure, but it far minimizes the complications and seriousness of a case of COVID-19 and helps lead the body to recovery.

“Preventing hospitalizations”—that’s a top goal for senior living, particularly during the pandemic, when a hospitalization can leave a resident at risk of further infections, isolated, stressed, and worse.

Another key phrase is “administered early”—treatment should be administered as soon as possible after symptoms start in order to be successful. This requires a test with a short turn-around time.

Antibodies cannot be given more than 10 days after symptoms start.

But mAb treatment requires specialized procedures, training, knowledge, and access to the medication itself. These are not typically available in a senior living community. And a senior living staff handling highly demanding work during a pandemic simply doesn’t have the capacity to stretch that far.

That’s where public-private partnerships leapt in to fill the gap. The goal was to have trained assistance, pharmacies, and community capabilities converge ASAP to deliver treatments—riding to the rescue, so to speak.

I think something we do quite well is partner very closely with the medical entities around us and coordinate resources. I encourage other senior living providers to not think they can do it all on their own,” says Meredith Mills, senior vice president and COO at Country Meadows.

What is mAb treatment?

Monoclonal antibodies are antibodies made in the lab. They’re modeled after natural antibodies, then customized to attack specific threats. When mAbs made to attack COVID-19 are given to a person testing positive for COVID-19, they home in on the spike proteins on the virus—those spiky bumps you see on the pictures of enlarged viruses posted seemingly everywhere—and wipe them out.

Different types of monoclonal antibodies target different spikes; recently, using a combination of types was found to be more effective. Changes in the types of antibodies and combinations used are ongoing with the emergence of variants and new research. Before senior living residents could benefit from mAb treatment, several obstacles needed to be overcome.

It’s new. In November 2020, mAb treatments were authorized by the U.S. Food and Drug Administration, under an emergency use authorization (EUA). But an EUA status requires significant documentation—proving eligibility and consents—and preparation that must be followed to the letter.

It requires special handling. Obviously, lab-made products need special handling to be used safely. The mAb treatments themselves had to get to pharmacies serving long-term care communities, and then to communities, all according to procedures.

It requires special skills. The treatment is done by infusion, and infusion requires training and expertise, usually from a registered nurse. The professional administering the treatment needs to be able to insert an IV and observe and assist as needed during the one-hour infusion time.

The professional also must monitor the patient for an hour after the infusion. But assisted living settings often don’t have infusion professionals. And if a patient has to go to the hospital to receive mAb treatment, it defeats the purpose.

It sometimes requires education. As with all action around COVID-19, using these treatments means helping residents and families get a clear and accurate understanding. Getting permissions and handling billing and reimbursement can be complicated as well.

But with lives at stake, solutions soon abounded.