When radio host Dennis Prager came to Colorado earlier this month, he was a man on a mission. A few days after returning home, he had achieved his goal: He was sick with COVID-19.
Mission accomplished?
“That is what I hoped for the entire time,” Prager, who is based in Los Angeles, said on his nationally syndicated radio show.
Prager, who had been in Colorado to attend an event with Republican gubernatorial candidate Heidi Ganahl, had long advocated for developing immunity to the coronavirus through infection, not vaccination. After testing positive, though, his treatment regimen included not just the unproven drugs ivermectin and hydroxychloroquine, both of which federal authorities have cautioned against, but also an infusion of monoclonal antibodies, according to The Washington Post.
The treatment mimics the antibodies that your immune system would produce if you had been vaccinated. (Prager has since said that he is on the mend.)
Monoclonal antibodies can be difficult to come by, both because of supply squeezes and also because of limited appointment availability and a narrow window of time to receive it after symptoms appear.
The treatment is seen as a way to keep people infected with the coronavirus from needing to be hospitalized. On Thursday, Gov. Jared Polis said the state is distributing monoclonal antibodies to urgent care and mobile clinics, hoping that wider availability will help break the surge of coronavirus hospitalizations that Colorado is currently experiencing.
But when there’s not enough of the treatment to go around, federal officials have recommended that people who are unvaccinated, like Prager, be among those who are prioritized.
Is that fair?
We asked a couple of experts about the issues and ethics surrounding monoclonal antibody treatments in Colorado. Here’s what we learned.
What exactly are monoclonal antibodies?
They are essentially lab-made versions of the antibodies that your body would have produced in response to vaccination, said Dr. Carrie Horn, the chief medical officer for National Jewish Health. Horn oversees the hospital’s monoclonal antibodies program.
“We’re giving you the antibodies instead of you making them yourself,” she said.
Similar to antibodies produced naturally following vaccination, monoclonal antibodies bind to the spike protein on the coronavirus, blocking it from entering your cells and also sending up a flag for other parts of your immune system to attack.
The big difference between monoclonal antibody treatment and being vaccinated is that the monoclonals only last for so long. After about three months, the monoclonal antibodies have petered out and there is no lasting effect. With vaccination, your body retains a memory of its foe and is able to create new antibodies if exposed again.
“Having the vaccine, even if you are exposed, you are much less likely to get sick and progress,” Horn said.
Are they in short supply in Colorado?
No.
“We have an ample supply and encourage health care providers to use this effective treatment for patients who qualify,” a spokeswoman for the Colorado Department of Public Health and Environment wrote in an email.
CDPHE also says it is working hard to make sure the treatment is distributed equitably across the state.
Horn agreed that there have been no supply shortages in Colorado.
“The limiting factor isn’t supply,” she said.
So what is the concern about access to them?
Horn said it’s a matter of timing.
Monoclonal antibodies are most effective within 10 days of the onset of symptoms or a positive test. People whose illnesses are more advanced than that — they need oxygen or they need to be admitted to the hospital, for instance — are unlikely to benefit.
In most cases, that leads to a time crunch when trying to find an open appointment to receive the treatment.
“The problem is the window,” Horn said. “The majority of referrals we get, we only have a day or two to get them in.”
How do I find them?
Monoclonal antibodies are a prescribed medicine. So a doctor has to refer you to treatment; you can’t schedule yourself.
Once your doctor decides you might benefit from the treatment, they will use CDPHE’s online Monoclonal Antibody Connector Tool to try to find you an appointment. Horn said the treatment can be given either as an infusion, which takes about 30 minutes or as a subcutaneous injection, which is faster. Both then require an hour-long period of monitoring to make sure patients don’t have an allergic reaction.
Can anybody who has COVID-19 get them?
To manage the supply and logistical constraints, people who are more vulnerable to severe cases of COVID-19 are prioritized.
This means people who are age 65 and older, who are overweight or who suffer from conditions like diabetes or heart disease get priority. (CDPHE has a more detailed breakdown on its website.)
This is also where people who are unvaccinated come in. Because the unvaccinated are more likely to develop a severe case of COVID-19, a National Institutes of Health panel has recommended that they be prioritized for monoclonal antibody treatment. CDPHE says it is following this guidance.
“Unvaccinated persons with multiple comorbidities are at highest risk of hospitalizations and should be prioritized,” the agency spokesperson wrote in an email.
Is it fair that people who are unvaccinated be given first dibs?
University of Colorado bioethicist Dr. Matthew Wynia said there are sound reasons for the prioritization.
For one, most people who are vaccinated are already producing antibodies, so the added value of the monoclonal antibody treatment is far less than it would be for an unvaccinated person. And, second, there’s a core tenet of medical ethics at stake.
“We try not to judge people when they come in,” Wynia said, speaking generally, not specifically of Prager. “You don’t judge the person for their prior behavior and mistakes. … I think there’s a lot of reluctance to treat people differently based on whether they’ve chosen to get the vaccine or not.”
Horn said the pandemic has been brutal on health care workers — not just because of the workload and the amount of tragedy they’ve seen, but because of the belligerence some patients have brought to the exam room. Horn said patients have demanded they be given hydroxychloroquine. Patients around the country have sued doctors for not prescribing ivermectin.
But she said she and other doctors still do their best to treat everyone equally and with compassion, vaccinated or unvaccinated.
“I try to keep in mind that I wish they would have done something different,” she said. “And yet this is the reality that we’re in. I’m going to take care of the patient who is in front of me.”