Jyll Green walked between green cots early Friday morning after a snowy drive from her home in Girdwood to a storefront in Tikahtnu Commons in Anchorage.
Green is operations manager at the state-contracted facility that’s giving hundreds of monoclonal antibody infusions every week to COVID-19-positive patients at high risk of severe complications from the illness.
The pace and demand of those treatments has soared in recent weeks as the delta variant spreads furiously across the state, pushing hospitals into crises and infecting thousands.
The treatments have gained notice recently as they’ve been pushed by local health officials for their benefits, but some providers reported hearing from people who were seeking the treatment instead of the vaccine — which isn’t recommended.
Statewide, areas with lower vaccination rates — Anchorage, Mat-Su, Fairbanks and the Kenai Peninsula — have the highest demand for the treatments, said Coleman Cutchins, state pharmacist.
Health officials are publicizing the treatment as an important component of the COVID-19 response since they’re successful at preventing severe illness in many cases, though with some limitations.
But they say it’s no replacement for inoculation against the virus.
“I just want to be really clear that like, it is in no way, shape or form close to a substitute or an alternative for a vaccine,” Cutchins said.
Monoclonal antibodies are laboratory-made proteins that work by mimicking the immune system’s ability to fight off viruses, and in this case by blocking the virus’s attachment and entry into human cells.
Some research shows it can reduce the chance of hospitalization and death by 70% and shorten the duration of symptoms by about four days. But, that’s not always the case.
The treatments are like a safety net 10 feet below a steep cliff while the vaccines are like a large fence preventing someone from falling in the first place, Cutchins said.
In a Wednesday news conference, Alaska Gov. Mike Dunleavy urged multiple measures to protect against COVID-19. He underscored the importance of vaccination as well the use of monoclonal antibodies.
Dr. Anne Zink, the state’s chief medical officer, also pushed the importance of the drug, especially getting them early as the treatment is best used within the first five days of illness.
Brittany Blake is a nurse at Urgent Care at Lake Lucille, a clinic in Wasilla that has been extremely busy in recent weeks offering the treatment. She and one clinic doctor, Dr. Louis Packer, have been working long hours in order to maximize the number of patients that can get seen: The two have done over 130 infusions in just three weeks.
“People are panicking, and we’re trying to get them in as fast as a we can,” she said.
The clinic is located in the Matanuska-Susitna Borough, which has some of the lowest vaccination rates in Alaska. The clinic is one of the only places in Wasilla that offer the sometimes life-saving treatment.
Most patients who contact that clinic and who meet the criteria are able to be treated within a few days, Blake said.
The majority of the patients they see are those who meet specific eligibility requirements — they have very recently tested positive, have had symptoms for less than 10 days and are at higher risk of severe illness from COVID-19 due to age or a chronic health issue. But the clinic has also offered the treatment to patients who live with elderly family members or as a preventive measure on a case-by-case basis, Blake said.
She said she wishes more people understood how the antibody treatment works — that it’s something that Alaskans should look into right when they first test positive, not when they’re so sick that they need to be hospitalized, because then it’s too late.
“We’ve had some people who are really frustrated because they didn’t realize the urgency of getting the treatment within that one to 10 days, and unfortunately we can’t give it to them after that because it can be harmful,” Blake said.
Dr. Leslie Gonsette, a hospitalist at Alaska’s largest hospital, Providence Alaska Medical Center, said she received a call about a 20 year-old patient who’d grown much more sick despite monoclonal antibody treatment and would likely need a non-invasive ventilator last week.
Monoclonal antibody treatments are critical now as they may keep some from being admitted to the hospital while the state’s health care system is highly strained with severely ill COVID-19 patients and staffing shortages, Cutchins said.
The treatments are mostly being administered in privately run clinics, tribal health care facilities, emergency rooms and urgent cares around the state, Cutchins said.
The government has been providing the treatment drug for free most of the time, Cutchins said. Most treatment sites bill insurance and usually are not charging uninsured patients. The cost for the treatment is roughly a few thousand dollars, he said.
At the Tikahtnu clinic, Green said they don’t charge patients regardless of insurance and she is able to refer people for the treatment even if they don’t have a provider.
On average, staff at the center infuse around 30 people a day and as many as 50 more recently, Green said. Her phone rings constantly, sometimes a phone call a minute. The night before, Green was screening patients at 11 p.m.
They treat people who are unvaccinated and vaccinated alike — focusing on a criteria of those who are at high risk for severe complications.
Green said she often hears from people that are against the vaccine, but seeking the antibody treatment instead.
“At least twice a day, I do get a call from someone who is still anti-vaccination that says, ‘Well this isn’t a vaccine right? Because I don’t want anything to do with that vaccine.”
She responds by telling people that just like the vaccine, the monoclonal antibody treatment is also under emergency use authorization from the federal Food and Drug Administration (one is fully approved by the administration). And, the vaccine is the best way to get antibodies against the virus.
“We don’t have that level of conspiracy theory and concern (around monoclonal antibodies) that a lot of people had with the vaccine,” Green said. “It’s cognitive dissonance at its finest.”
Green said she can usually point out who hasn’t gotten the vaccine and who has, based on how sick the unvaccinated patients arrive. She underscores to them that after 90 days they can still get a vaccine.
“It’s night and day between someone who’s vaccinated and unvaccinated coming in for an infusion,” she said.
Sometimes people leave and Green said she thinks, “I hope she lives.”
Green’s concerned that the supply of the antibodies is beginning to dwindle amid supply chain woes. Beyond the drug itself, even the supplies needed to do the infusion have also run short lately.
And it’s hard — Green can’t treat everyone who comes in. If someone’s oxygen level is below 94, the disease is too advanced. Essentially, it’s too late. At that point, they tell the patients to go the hospital. Once someone arrived with an oxygen level of 58.
“It’s sad,” Green said. “I always say, I can’t stop to think about everything I see in a day, or I’d be overcome and overwhelmed and I would just shut down.”
The staff at the center wear full Tyvek suits and face helmets a bit like those firefighters wear with a whirring respirator at the hip for ten hours a day. It’s loud and stressful.
But still, Green highlighted the importance of the treatment for those who need it. She said she wanted to keep it fresh in people’s minds.
As the state’s COVID-19 case rate has climbed, so has the number of monoclonal antibody treatments being administered by staff at the Chief Andrew Isaac Health Center in Fairbanks, which is part of the Tanana Chiefs Conference nonprofit that serves Interior Alaska.
Dan Nelson, pharmacy director there, said he felt like there’s an idea among some that they don’t need to get vaccinated because the treatment is available.
Nelson described a patient who received the antibody treatment and then went on to encourage friends and family that “this is a wonder drug, you don’t really need to get vaccinated because this is available,” Nelson recounted.
“That’s really been disheartening to hear those sorts of stories,” he said.
In Wasilla, Blake said her clinic’s ultimate goal in offering the treatment is to prevent people from being sick enough to need hospitalization, and to protect capacity at understaffed, overwhelmed hospitals in the Mat-Su and Anchorage.
“That’s what our end goal is: to keep people out of the hospital,” she said.