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What are monoclonal antibodies, and how can you get the treatment?

BY JENNIFER CABRERA

We had a chance to sit down with Dr. Kenneth Scheppke, Chief Medical Officer for the Florida Division of Emergency Management, to talk about the new monoclonal antibody site in High Springs. Dr. Scheppke is also the State EMS Medical Director for the Department of Health. 

Governor DeSantis has been touring the state, opening 18 sites so far to administer monoclonal antibodies, which Dr. Scheppke said “have really been under-utilized during this pandemic.” 

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What are monoclonal antibodies?

Monoclonal antibodies have been available for about 9 months, but many people, including doctors, don’t know much about them or where to get them. “I really applaud the governor for… not only highlighting it, raising the public awareness, but also raising the awareness among physicians… on how to access this, but really increasing the ability to get a lot of people through.” 

Although the governor has been criticized for putting so much emphasis on treatment instead of vaccination (in spite of holding numerous press conferences earlier in the year to open vaccination sites around the state), Dr. Scheppke said both prevention and treatment are important, and vaccinated people are also eligible for the monoclonal antibody treatments. “You have to be ready, as a medical system, to treat people, whether because the vaccine didn’t work well because they’re immunocompromised for one reason or another, or because they chose not to get the vaccine. So I don’t understand the criticism. You need both; you always need both, in every single disease.”

He said that the State is using Regeneron because it has some unique authorizations and properties that makes it “the most valuable” of the three brands. 

Monoclonal antibodies have been used for decades, but we have three that are specific to COVID-19 and directly target the spike protein of the virus. (Unlike the vaccines, the monoclonal antibodies do not prompt the body to make spike proteins.) “They are designed to prevent the virus from getting into your cells and thereby blocking it from copying itself and allowing your immune system to get it out of your system, basically neutralizing the virus.”

Eli Lilly was the first to be granted an Emergency Use Authorization (EUA), and it did well for a while but is not working as well against the current variants. Glaxo’s version will probably be effective but is not approved for post-exposure prophylaxis (preventing infection in someone who has been exposed to COVID-19 but is not yet sick). Glaxo is also not approved for subcutaneous injection, which is a faster administration method than intravenous infusion. 

Regeneron’s EUA is for both infected and exposed individuals, and the entire stock has been purchased by the federal government, so it is free to both the State and the individual. Studies of over 15,000 patients show that Regeneron has been proven to prevent death and hospitalization and to prevent infection in exposed individuals. It can also be administered subcutaneously. Dr. Scheppke says he thinks this will make a big impact, particularly if other states follow Florida’s lead, which is already beginning to happen. 

Who is eligible?

All adults and children, 12 and over, are eligible for the treatment if they are sick and have one of a long list of risk factors (advanced age, pregnancy, high blood pressure, heart disease, lung disease, kidney disease, ongoing treatment for cancer, etc.). Eligibility factors for prophylactic treatment include being vaccinated but having a condition that might make the vaccine not work well (advanced age, medications that suppress the immune system) or unvaccinated with one of the conditions listed above and being exposed to someone who has been diagnosed with COVID-19.

Because of the prophylactic properties, monoclonal antibodies can be used in places like nursing homes and other congregate living settings if any residents test positive; the treatment can be used to protect the other residents. 

The Surgeon General of Florida has entered a standing order for the treatment, so patients do not need to visit a physician to get an order before registering for an appointment.

How do I find a treatment center? 

To find a center, Florida residents can go to the PatientPortalFL or to the FDOH COVID-19 site. Since an account is needed to even check the locations, you may want to go ahead and set up an account for easy access if you need the treatment in the future. The National Infusion Center Association tool also provides the locations of monoclonal antibody treatments. 

In Alachua County, the monoclonal antibodies are available at Fellowship Church, 16916 Northwest U.S. Highway 441, between Alachua and High Springs. The administration site is located in the gym at the back of the church. The site is open 9 a.m.-5 p.m., Monday-Friday. 

That site is not showing yet on the appointment website, but patients can walk in, understanding that there may be a wait.

What happens when I get there?

The treatment is administered with four subcutaneous (under the skin) injections, one in each arm and one on each side of the torso. Patients are monitored for about an hour before going home. Ambulances are available on site for those who require more advanced care or who have a reaction to the treatment. 

When should I get it?

Dr. Scheppke said it’s important to get the treatment as soon as possible after testing positive; if you have underlying risk factors and test positive, you should immediately start looking for a nearby location for the treatment. 

The antibodies wear off after about 30-60 days, and if you were unvaccinated when you received the treatment, Dr. Scheppke recommends waiting about 90 days before getting vaccinated to make sure the antibodies “have washed out of your system.”

What about the woman lying on the floor at a treatment center?

A picture from a treatment center in Jacksonville of a woman lying on the floor has gone viral, raising alarm about the treatment. Dr. Scheppke said he spoke to the woman, who has some medical conditions that prevented her from getting the vaccine but also put her at risk of a bad outcome from COVID-19. The woman became sick with COVID-19, and her mother saw news stories about monoclonal antibodies and suggested that she go to the Jacksonville site. By the time she went to the site, she’d had symptoms for at least a week and was very ill and unable to stand in line, so she lay down. After getting the treatment, she told Dr. Scheppke that there was no doubt in her mind that if she hadn’t gotten Regeneron, she would have been hospitalized and placed on a ventilator. Yesterday she was feeling better and walking around, with her energy returning.

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