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Amid a surge in cases of COVID-19 that keeps Puerto Rican hospitals in check — in the face of the steady increase in people admitted to clinics — there is an alternative that could prevent many of the immunocompromised infected from developing a severe disease in Puerto Rico. through the preventive treatment of monoclonal antibodies.
Graduate nurse Sonia Morales, who works in the Emergency Room of the Medical Services Administration (ASEM) of the Medical Center, in Riu Pedres, testifies about the effectiveness of the drug that was administered to her a month ago when he became infected with the virus that put his life at risk.
“I live alone … maybe I was dying and no one found out,” said the nurse, one of dozens of employees who have been ill since July in various areas of the Medical Services Administration of Medical Center, in Piedras River, due to an outbreak that triggered in the recent death of one of its companions, the practical nurse Luis Oquendo.
As detailed in Primera Hora, he had been suffering for two days with symptoms such as fever, chronic cough and pain in the lung area, when the general supervisor of emergency room nursing, Llum Santiago, spoke to him about the possibility. to undergo intravenous treatment of monoclonal antibodies using the drug Regeneron.
At the Medical Center, treatment is promoted by Dr. Regino Colom Alsina, who explained in Primera Hora that monoclonal antibodies “are proteins produced naturally by the immune system in response to an infection.” However, there are times when these natural antibodies alone are not enough to fight a disease so a clinical alternative is laboratory-produced monoclonal treatments that help mimic or enhance the body’s natural immune response against of an invader, such as infections or even cancer.
“Monoclonal antibodies have an advantage over other types of treatment for infection because they are created to specifically attack an essential part of the infectious process … in the case of a severe SARS-CoV-2 coronavirus infection they have a protein at the tip of the surface that helps the virus adhere to and enter human cells.These monoclonal antibodies what they do is that they bind to that protein that is in the beak or whatever. they say ‘spike’ and help block the virus so it doesn’t invade human cells, ”the doctor explained.
He added that this type of treatment was developed in 1975 and the first was approved in 1986 to prevent rejection of kidney transplants. “Before COVID-19, monoclonal antibodies were developed to treat viral infections, such as Ebola and rabies. There are currently more than 30 approved by the FDA (Federal Drug Administration),” he said. that in the case of COVID monoclonal antibodies were announced in November 2020 under emergency use authorization by the FDA.
In the case of Nurse Morales this process was her salvation, considering that she is asthmatic and has in her right lung what is known as chronic obstructive pulmonary disease. The chances of the nursing professional developing a serious COVID-19 disease and being hospitalized were high. In fact, any complication predicted admission to an intensive care unit.
Monoclonal treatment is given by an intravenous infusion. The process usually takes an hour and is applied in emergency rooms or by experts in infusion centers or on an outpatient basis at home. Subsequently, the person is left under observation for an additional hour and then can go home to complete the quarantine process.
“I didn’t feel anything, it was like a normal serum. I remember when they put it on my lungs hurt and that was the first symptom of relief I felt. The pain was gone. Thank God it didn’t give me any reaction and little by little I got better because, really, my health was compromised, “the nurse said.
“Right now I feel new … but having COVID is a strong process. Thanks to this treatment I was able to recover, otherwise the story would have been different,” said one who returned to work a month after the diagnosis. “I feel ready to get back to what my passion is: working in the Medical Center emergency room,” she expressed excitedly.
Dr. Colom Alsina is convinced that just as a complication for COVID was avoided in Nurse Morales, it could happen to many patients in Puerto Rico.
“The treatment is effective. In fact, the picture would be of immense hospitalizations if people chose to be vaccinated and, in case of infection, receive treatment. It is proven that monoclonal treatment stimulates the immune system and assists it. to fight this amount of viruses that are free in the blood, “he said.
Who qualifies?
Until the time of this report, carried out last week, 114 evaluations had been carried out at the Medical Center on patients who tested positive for viruses, some of them employees of the institution. After examining the profile of each patient the treatment was not approved by 22 people, while four refused to undergo the process. There were also two treatment suspensions as one of the patients presented with mild difficulty breathing and another became “anxious”.
“There is always a minority who do not accept the suggested treatments and we have seen that in this minority there are patients who ended up very complicated in terms of intubation and intensive care,” said Colom Alsina.
The youngest patient who has received treatment at the Medical Center is 19 years old, while the oldest is 80 years old. “Everything went very well with them … in fact, we only have two patients who after the treatment had a hospitalization and both recovered successfully. Neither was intubated,” he stressed. which will also treat about 32 patients between the ages of 56 and 65 and 28 between the ages of 46 and 55.
On the other hand, he explained that among the criteria for offering the treatment is that the person is 12 years old or older, is within 10 days of the onset of symptoms of the disease (mild to moderate) and weighs more than 88 free.
“There are some high-risk criteria that are also taken into account, such as people over 65, obesity, pregnancy, chronic kidney disease, diabetes, cardiovascular disease, chronic lung disease, sickle cell anemia, disease of neurodevelopment and those who are dependent on medical equipment such as tracheotomy, gastrostomy, ventilators (not related to COVID), among others, ”the doctor explained.
Asymptomatic patients, people with a history of allergies to monoclonal antibodies, and COVID-positive patients with severe symptoms are completely excluded from treatment. “If you have a saturation less than 94%, unstable vital signs or dependent on oxygen (related to COVID) you cannot receive treatment,” he pointed out.
He stressed how “important” it is for the public to know that vaccinated people can receive monoclonal antibodies. “In addition, it is important for them to understand that this treatment does not replace vaccination. Vaccination remains the main recommendation. Another thing is that unvaccinated patients receiving monoclonal antibody treatment should wait 90 days to be vaccinated. if, ”he explained.
Does it work against new variants?
One of the concerns among patients is whether the treatment works with people infected with new variants of viruses circulating on the island and which have caused a new rise in cases, hospitalizations and deaths.
“It is important to clarify that variants arise due to mutations in the virus genome … the higher the community transmission the greater the risk that these mutations will develop. That is why vaccination is important. As for whether they are effective or not I should say that monoclonal antibodies are still effective against new variants of SARS-CoV-2.However, some mutations can cause changes in beak protein, or spike, that could interfere with the effectiveness of the currently available monoclonal antibodies, “he said.
He explained, for example, that the arrival of variants such as the Alpha and Delta changed the treatment scenario.
It was by December 10, 2020 that Bamlanivimab monoclonal antibodies were first used in Medical Center. But the presence of new variants led to a redesign of the treatment and, currently, the combination of Casarivimab with Imdevimab, the latter known by its trade name as Regeneron, is used.
“Treatments have changed with the advance of the pandemic and that is what happened. We currently use Regeneron and it is working,” said Colom Alsina when explaining that this type of drug has been applied in 16 patients since arriving on the island in July.
Health recommends using the treatment
Faced with the increase in hospitalizations caused by the SARS-Cov-2 virus, mostly in unvaccinated people, the Secretary of the Department of Health, Carlos Mellado López, stressed the importance of using monoclonal antibody treatment to combat COVID-9. So far, over 200 patients have received treatment successfully, preventing hospitalization and death.
“We need to make use of available treatments that allow us to decrease the number of people hospitalized. Monoclonal is a valuable and effective alternative available to our people. The treatment contains defenses to weaken the virus by preventing the disease from progressing, reducing the likelihood hospitalization and worsening the health of people infected with the virus, “said Mellado.
At present 12 facilities on the island have the treatment and it is free of cost for the patients. Monoclonal treatments are available at Hospital Bon Samarità in Aguadilla; Mennonite Hospital of Aibonito, HIMA San Pau de Bayamón; Mennonite Hospital of Caguas; University of Puerto Rico Hospital in Carolina; Advanced Infusion Center in Cataño; Optima Health a Daurat. Also in the municipality of St. John’s at Ashford Presbyterian Hospital, Best Option, Cardiovascular Hospital and the Administration of Medical Services (ASEM).
Mellado delimited that it is the doctors who can give the medical order to benefit from this alternative. However, epidemiologists can also recommend the citizen with the doctor during the interview that is conducted after seeing a positive case reflected in the agency’s bioportal.