Monoclonal antibody therapy being used in Maui county
As COVID-19 cases rose around the state and Molokai being isolated and dependent on off-island hospitals for critical care, Molokai Community Health Center officials “proactively sought out” antibody therapy for COVID-19 patients on the island.
The health center began offering monoclonal antibody therapy — which helps COVID-19 patients from developing severe illness that would require hospitalization — at its facility in late August.
It has since successfully administered the one-time medication via injection to four patients who had symptomatic COVID-19, officials said this week.
“We saw the alarming rise and hospitalizations and the decreasing availability of in-patient beds for patients all over the world, and we know that being somewhat isolated out here on Molokai, we are 100 percent dependent on hospitals on taking our patient transfers when they become sick enough to be admitted to the hospital with COVID,” said Dr. Scott Link, chief marketing officer at the health center. “We asked ourselves, ‘what can we do to make it so that we’re not adding to that problem?’ and so that we can try as hard as we can to keep our patients from being in the position of showing up in the emergency department, needing to be admitted and being told that no bed is available.”
Link said on Thursday morning that “all four patients tolerated treatment really well.”
The health center had reached out to a Department of Health and Human Services representative before connecting directly with the manufacturer Regeneron Pharmaceuticals Inc.
Several other health facilities in Maui County have also been administering monoclonal antibody treatment to individuals with mild to moderate COVID-19 symptoms.
“Targeted use of monoclonal antibodies could keep Hawaii COVID19 patients from developing severe illness that requires hospitalization,” said Hawaii Department of Health director Dr. Elizabeth Char in a news release. “However, COVID-19 vaccination remains the most effective way to create long-lasting immunity
and prevent severe illness and death. Increasing access to monoclonal antibody therapy will reduce strain on our hospitals.”
A federal team of 30 clinicians are expected to arrive in the state on Sunday to assist with existing monoclonal antibody therapy services, which was authorized by the U.S. Food and Drug Administration earlier this year to treat recently diagnosed coronavirus patients.
As part of the federal program, Maui Memorial Medical Center will receive a team of about five nurses to assist and, hopefully, expand its monoclonal antibody clinic, said spokeswoman Tracy Dallarda.
Maui Health System, which operates Maui Memorial Medical Center, Maui Memorial Medical Center Outpatient Clinic, Kula Hospital and Clinic, and Lanai Community Hospital, has been administering monoclonal antibody treatment for early COVID-19 since July 30.
So far, more than 130 patients received the treatment at Maui Memorial and a few at Kula Hospital, Dallarda said.
Currently, treatment is by physician referral and the administration of the antibody therapy is done primarily in the Maui Memorial Medical Center emergency department, Dallarda said.
The therapy, also known as “MAB is a proven highly effective treatment for qualified individuals with early onset COVID-19,” she added. “Studies have shown MAB reduces hospitalization by 70 percent, less severe disease symptoms. It is important individuals are treated within ten days of symptoms onset.”
In a column “Health Wise” in The Maui News, Dr. Nicole Apoliona, physician and medical director at Kula Hospital, said that more than 700,000 people across the country received this treatment in August during the delta variant surge.
Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off harmful antigens such as viruses.
“They work by binding to the virus and preventing it from replicating and infecting more cells. Monoclonal antibodies have been used for decades to treat a variety of illnesses, from rheumatoid arthritis to cancer,” Apoliona wrote.
According to the Health Department, the criteria to qualify for MAB treatment are broad and many people are likely candidates who would benefit.
Monoclonal antibodies can be given to individuals 12 years and older, vaccinated or unvaccinated, with mild to moderate COVID-19 who are not hospitalized and who don’t need supplemental oxygen. Once a patient is hospitalized the treatment is no longer an option.
The Food and Drug Administration requires that a patient receiving this form of treatment be monitored for an hour post-injection.
The Federal Emergency Management Agency is providing six teams to be stationed at hospitals or federally qualified health centers across the state, including Maui Memorial Medical Center.
The other sites include Waianae Coast Comprehensive Health Care Center, Kaiser’s Moanalua Medical Center, Hilo Medical Center, Queen’s Medical Center West Oahu and Straub Medical Center.
FEMA teams will administer monoclonal antibodies by subcutaneous injection only, as opposed to IV infusion therapy, which provides a short burst of immunity, compared to the longer-lasting immunity created by vaccination, according to a news release.
Subcutaneous injections are effective in administering medications, such as insulin.
“We are taking yet another strategic step to preserve hospital capacity during a time of unprecedented demand,” said Hilton Raethel, president and CEO of Healthcare Association of Hawaii, in a news release. “Increasing the number of COVID positive residents who receive this therapy will result in a reduction of symptoms, and reduce demand on our hospitals.”
Kaiser Permanente Maui Lani Medical Office in Kahului started antibody treatment on Aug. 30 by Regeneron via IV, said Laura M. Lott, director of communications. Maui Lani has been doing about seven treatments per day.
Back on Molokai, Link said there are many high-risk patients who do or will qualify for the treatment, but some may not be aware that this therapy is available or are not seeking it out for multiple reasons.
The Molokai Community Health Center is the only location on Molokai providing the treatment, officials said.
There is no cost to the patient and treatment is offered after screening regardless of patient status or health insurance, said the health center’s CEO Helen Kekalia Wescoatt.
“We have limited resources and staff capacity and access,” Wescoatt said. “We wanted to be able to respond to a crisis that might happen locally and help mitigate further hospitalizations for our people here on Molokai.”
The FDA’s recent approval of administering monoclonal antibodies via a subcutaneous injection “has really allowed health centers like ours, and lots of health centers like ours, to take access to this therapy,” Link said.
But still, the number one tool to keep from being hospitalized is to get vaccinated, he said.