As the number of patients hospitalized in San Antonio with serious complications from COVID-19 reached an all-time high Wednesday, an effort to treat those with worsening symptoms is underway at an overflow hospital set up in the early days of the pandemic.
Doctors and nurses at the Regional Infusion Center, established at the Freeman Coliseum in November by the South Texas Regional Advisory Council (STRAC), are administering doses of monoclonal antibodies to patients who are positive for the novel coronavirus and at risk of becoming very sick.
Monoclonal antibodies, authorized for emergency use by the Food and Drug Administration in November, are laboratory-made proteins that mimic the immune system’s ability to fight off harmful antigens such as viruses.
As COVID-19 hospitalizations rise, the goal is to prevent an even greater number of emergency room visits and hospital admissions – and perhaps save lives in the wake of a post-holiday surge of cases – by using the monoclonal antibody therapy before patients’ symptoms worsen.
“Our hospitals are struggling and working very hard to be able to handle all the patients,” said Bexar County Judge Nelson Wolff on Tuesday. “While we have 1,380 in the hospital today, you can expect that to continue to go up.”
The treatment program began Nov. 30 with only a few patients a day and has grown to serve about 60 patients daily. So far, the infusion center has treated 620 people, said Dr. C.J. Winckler, medical director of the Regional Infusion Center.
Clinical trials have shown antibody treatment is effective in preventing hospitalizations for high-risk COVID-positive patients who are less than 10 days since the start of symptoms and suffering only mild to moderate symptoms, according to the FDA. The therapy is not approved for patients who are already hospitalized with COVID-19.
Patients are referred for antibody infusion by a doctor, clinic, urgent care center, or emergency room. An appointment is required before arriving at the center, which is located in an area set apart from where COVID-19 tests are conducted.
Overseen by doctors, nurses, and administrative staff from University Health, BCFS, and the San Antonio Fire Department, it takes about an hour for the intravenous infusion and another hour for post-treatment observation. STRAC is using the 80 beds set up in March to handle overflow if local hospitals reached capacity.
“The majority of the people that go to [the center], they drive up in their vehicle, and they walk in to get treatment,” Winckler said. Most say they feel better immediately following the infusion, he said, but that’s likely due to the fluids a patient receives along with the antibodies.
Though early research has shown antibody treatment is considered both safe and effective in minimizing symptoms of the virus in those who are already infected, more study is needed to prove it reduces hospitalizations, Winckler said. The state is tracking patients treated with antibodies so the data can be studied later.
“I’m hopeful. We need more medicine but we’re in a pandemic,” he said. “Like everything, from hydroxychloroquine to Remdesevir to convalescent plasma, … everyone involved with this understands that if we have to shift focus, we will shift focus.”
An antibody is a protein produced by the immune system to attack something foreign in the body, known as antigens, which can be found on allergens, bacteria, and viruses, or a transplanted organ. A monoclonal antibody treatment mimics that natural immune response.
“These man-made protein antibodies go in and fight the virus if you haven’t generated enough of your own antibodies to fight it off,” said Elliott Mandell, senior vice president and chief pharmacy officer at University Health.
“That’s what prevents it from [getting] to the point where you’re hospitalized. So before it gets to that point, you get your own antibodies and some sort of external antibodies into your system to prevent the disease from growing.”
Winckler said STRAC has worked with the Bexar County Medical Society to get the word out to physicians that the treatment is available, but he feels the center could be treating even more patients.
“The real answer to keeping people out of the hospital is to get your vaccine when it’s available,” Winckler said. “But until that time, we’re doing our best to follow the data that we have, which is very limited, and treat people that are sick with COVID with the monoclonal antibodies.”
The Department of State Health Services is distributing the laboratory-made antibody medication to local hospital systems. But because hospitals are prevented from administering the treatment within facilities where other patients – those with cancer and autoimmune diseases – are regularly being treated, putting them at risk of coronavirus exposure, those allotments are being pooled and processed at University Health. San Antonio Fire Department officers transport batches twice a day to the infusion center.
“I think when these drugs first came out, and the question came up about where and how to treat these patients, no one really wanted to bring all these known COVID-positive and symptomatic patients into any place in the health system,” Mandell said. “So it made sense to look at this from a regional perspective and develop one location where these patients could be handled regionally.”
The infusion center provides an isolated site for COVID-19 antibody treatment, and ultimately helps prevent people from ever needing a hospital stay, Mandell said.
“Hospitals now are reaching that critical mass. This is a key tool in our arsenal that I think is being underutilized.”