How monoclonal antibodies can help San Franciscans fight COVID

Intravenous treatments available at Stanford, UCSF

As COVID-19 cases surge yet again, treatment options are evolving just as rapidly as the virus they aim to neutralize.

Monoclonal antibody treatments are one option that Bay Area health experts say has made a difference to keep hospitalizations low for high-risk individuals with mild COVID symptoms. But how effective the widely accepted therapy will be against the new omicron variant remains unclear.

“If a high-risk individual gets COVID, studies have shown that treatment with monoclonal antibodies reduces chances of getting severe disease and hospitalization,” said Upinder Singh, professor and division chief of Infectious Diseases and Geographic Medicine at Stanford University.“There is a path forward, but we are in a fluid situation and the healthcare system will have to adapt to omicron.”

Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off harmful pathogens, including the coronavirus, by blocking the virus from attaching to and entering human cells.

The three treatment options available in the U.S. are given intravenously and are typically available at hospitals, including at Stanford and UCSF in the Bay Area, plus other medical clinics like Total Infusion in the East Bay. The process typically takes about two to three hours, including an observation period afterward that’s used to monitor for any reactions, similar to vaccine protocols.

The antibody treatments were some of the earliest COVID-19 therapeutics to gain emergency authorization from the Food and Drug Administration in 2020. More recently, an August 2021 Mayo Clinic study found that monoclonal antibody treatments can reduce hospitalization and death by as much as 70% among high-risk patients.

But omicron has thrown a curveball yet again and scientists are now working to determine which antibodies are the most effective against the latest variant.

Omicron is now the dominant version of the coronavirus in the country, federal health officials announced Monday. In the Bay Area, 71% of samples at Stanford’s Virology lab contained omicron as of Tuesday, according to the lab’s director Dr. Ben Pinsky.

“With the emergence of omicron, we need to determine which are the most appropriate antibodies to use and each locality will have to look at their own omicron rates and determine when to change to an antibody that treats omicron,” said Singh, who oversees a monoclonal antibody treatment center at Stanford.

An illustration of antibody immunoglobulins attacking a COVID-19 influenza virus cell. (Corona Borealis Studio/Shutterstock)

An illustration of antibody immunoglobulins attacking a COVID-19 influenza virus cell. (Corona Borealis Studio/Shutterstock)

Antibody treatments that are still showing early signs of effectiveness around reducing the severity of omicron-related illness will be distributed by the federal government based on a variety of factors, including population size, case counts and vaccination rates.

UCSF on Dec. 20 announced that some of the monoclonal antibodies it uses for treatment would be on hold “due to predicted lack of efficacy against the Omicron variant.”

That means it could get harder to find the treatment option in places like San Francisco, where 80% of the overall population is vaccinated against COVID-19, and doses will likely be reserved for extremely high-risk individuals.

Like much of the pandemic thus far, the situation remains fluid. In the meantime, some of The City’s top infectious disease experts say that San Francisco and many other places are not tapping into the treatment option on a broad enough scale.

Although some places, including Stanford and UCSF, have made the treatment available for free, many people across The City still don’t know about it or may struggle to find a clinic.

“It’s completely underutilized,” said Peter Chin-Hong, an infectious disease expert at UCSF. “California is like most states where you have to be referred and in the hospital system; there aren’t many slots per day. But the main thing is, many people don’t know or think about it.”

According to Singh, vaccinations and boosters remain the best line of defense against the virus as cases inevitably increase and scientists work to understand omicron and how existing treatment options stand up to the variant.

“We are in good shape because of our vaccination rates here,” said Singh, “but we need to get boosting up.”

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