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Hospitals Puzzled With How To Administer Monoclonal Antibodies To COVID-19 Patients


Hospitals around the country are starting to use new drugs that are designed to keep COVID-19 patients out of the hospital, but it's not clear how well these monoclonal antibodies work. And some hospital administrators are wondering how long their staffs will be able to give this time-consuming treatment as emergency rooms and beds fill up. NPR science correspondent Richard Harris spoke to doctors in New Mexico and Wisconsin as they launched their treatment programs.

RICHARD HARRIS, BYLINE: The Food and Drug Administration has granted emergency authorization to two monoclonal antibody formulations. These drugs are supposed to prevent the coronavirus from invading cells. They're specifically for people with mild to moderate disease who are not in the hospital. And it's not just a shot or a pill. They have to be given by IV infusion, a process that takes two hours or more.

PETER NEWCOMER: Like everything in today's world during the pandemic, our biggest challenges are around staffing.

HARRIS: Dr. Peter Newcomer is chief clinical officer at University of Wisconsin Health in Madison. He says his hospital is giving the drug after hours in an infusion center so infectious COVID patients don't cross paths with cancer patients and other vulnerable people. A special plea went out for nurses to take on yet another shift, even as the hospital struggles with rising COVID cases. The hospital can initially handle eight patients a night. Newcomer says they started with three patients on Tuesday night.

NEWCOMER: Our advertising campaign to the community went out kind of Monday and Tuesday, so we're going to see more tonight and then fill up all of our slots real soon.

HARRIS: If everyone who qualifies for this treatment asks for it, the hospital will quickly run out of drugs. So UW Health set up a system to identify people who would most likely benefit; primarily people over 65 and with underlying health conditions. They will randomly pick from that pool if there isn't enough drug to go around.

NEWCOMER: It's basically a lottery-type system with an allocation that is done as equitably as we can.

HARRIS: Informed consent for this includes telling patients that it's not clear just how well these drugs actually work. The National Institutes of Health put out treatment guidelines, saying there's simply not enough information to know if they are effective. Company studies suggest doctors have to treat 10 to 20 patients to avoid a single hospitalization. Dr. Newcomer wishes he could tell how well the huge investment in staff time will pay off.

NEWCOMER: As long as we can continue to provide this treatment, we plan on it. It's going to have to be an ongoing evaluation of what we can afford to do from a staffing standpoint.

HARRIS: The drugs could help hospitals if they can keep their patient loads down. In Santa Fe, N.M., Dr. David Gonzales is keeping a close eye on the capacity of CHRISTUS St. Vincent's hospital, where he's the chief medical officer.

DAVID GONZALES: We're currently entering crisis-level stage with bed capacity.

HARRIS: That's throughout the state of New Mexico. His hospital is directing people most likely to benefit from the new treatment to the hospital's emergency room for the infusions.

GONZALES: We have a portion of our emergency room that's dedicated to COVID-positive patients.

HARRIS: CHRISTUS St. Vincent's hospital infused its first patient Tuesday using one of the eight initial doses of the drug allocated by the state of New Mexico. After the hour-long infusion, nurses monitor patients for one to six hours to make sure that there are no serious side effects. And Gonzales says that monitoring continues once patients leave the hospital.

GONZALES: We're able to follow the patients at home and obtain their vital signs, and they can go through a questionnaire in which we ask them if they're experiencing specific symptoms.

HARRIS: More than 2,400 medical facilities nationwide have been allocated some of these drugs, and many are - like these in New Mexico and Wisconsin - now starting to figure out how to make it all work.

Richard Harris, NPR News.

(SOUNDBITE OF LOUPO'S "I'M READY") Transcript provided by NPR, Copyright NPR.

Award-winning journalist Richard Harris has reported on a wide range of topics in science, medicine and the environment since he joined NPR in 1986. In early 2014, his focus shifted from an emphasis on climate change and the environment to biomedical research.