Monoclonal Antibodies (MABS) Delays: Effective COVID-19 treatment faces logistical obstacles

Treatment with monoclonal antibodies (MABS) is recommended and authorized to keep patients who test positive for COVID-19 out of the hospital, reducing the severity of mild to moderate symptoms. The treatment is done on an outpatient basis by a one-time infusion that takes several hours. In RI, however, there is a logistical backlog on quickly delivering MABS treatment to patients.

Motif was approached by a reader who tested positive on Friday, Dec 10, but was told the earliest opportunity for MABS treatment would be Wednesday, Dec 15. In response to our inquiry, RI Department of Health (RIDOH) spokeswoman Annemarie Beardsworth confirmed that “most MAB providers are scheduling three or four business days after a patient’s/provider’s request. This time-frame is due to the very high demand occurring currently, but is also exacerbated by patients and/or healthcare providers calling multiple MAB infusion sites to see where they can get an appointment soonest, scheduling multiple appointments at different MAB infusion sites, and then not canceling appointments they don’t attend. This causes a tremendous amount of unnecessary administrative burden on the MAB providers and slows down the scheduling process.” She continued, “Unfortunately, when patients do not cancel appointments they don’t plan to attend, it prevents other patients from using that appointment slot. Some MAB providers tell us they can see as many as 8-10 no-show appointments per day. RIDOH reminds all patients to cancel any MAB appointments they are not planning to attend so that other patients can get their needed treatment.”

There are logistical obstacles beyond just patient no-show appointments, Beardsworth told Motif. “Rhode Island has an adequate supply of MAB product in Rhode Island and we have been administering at a very high rate of our biweekly federal allocation. Like most other states in the country, Rhode Island is experiencing a healthcare worker shortage, so there are fewer providers than we’d like who can administer MAB. RIDOH is actively working to recruit and onboard more MAB providers. The MAB that is the easiest and fastest to administer is in short supply federally, so combined with fewer providers who can administer MAB, each administration takes longer when using the other infusion (IV) products.”

While three or four business days is still within the 10-day limit after onset of symptoms, almost a year ago when the treatment was first made available in RI, on Friday, Jan 8, 2021, RIDOH Director Nicole Alexander-Scott said, “Rhode Island now has a doctor-recommended treatment for COVID-19 that is extremely effective at preventing people from developing severe disease and from being hospitalized because of COVID-19. The key, though, is starting early: The earlier you start treatment after testing positive, the better and more effective this can be. After completing a simple infusion, intravenously, of this treatment, many people with COVID-19 start feeling better as early as the next day. The treatment does not require hospitalization, and it’s intended to help prevent people from actually having to be hospitalized.” (See “New Treatment Available: Monoclonal antibody treatments for all eligible RI patients”, by Michael Bilow, Jan 9, 2021.) At that time, she said the plan was to have infusion sites co-located with larger testing sites, so that eligible patients can get the new treatment immediately after testing positive by a rapid test. “We’re working to build out as many different infusion sites as possible, particularly at places where there is a lot of testing already occurring, so that you can just go to the next room if you’re at one of our testing sites that’s able to accommodate this and get access to the treatment. We want to get at every element,” Alexander-Scott said.

It stands to reason that patients would benefit from following longstanding RIDOH advice to get tested as soon as possible after symptom onset and to seek MABS treatment, if indicated, as soon as possible after a positive test result.

The RIDOH website – covid.ri.gov/covid-19-prevention/treatment – has information about who is eligible for MABS: “You can use MABS if you test positive for COVID-19, started having mild to moderate symptoms in the past 10 days, and are at high risk for progressing to severe disease.” It also describes who should not get MABS, how to obtain MABS if you have no primary health care provider or no health insurance, and lists – covid.ri.gov/mabs-infusion-services – MABS infusion service providers.