Highest-Risk COVID Patients Least Likely to Get Monoclonal Antibodies

Adults 65 and older make up about 75 percent of the roughly 900,000 U.S. deaths caused by the coronavirus since the start of the pandemic, federal data show. In addition to age, which is a risk factor for severe COVID-19, about 80 percent of adults 65 and older have at least one chronic health condition that can worsen a coronavirus infection.​

Obstacles along path to treatment

The study's authors point to “multiple potential explanations” for why many higher-risk patients have missed out on monoclonal antibodies, including the idea that this population may have a more difficult time navigating the treatment process.  

“It's a very long path,” Barnett told AARP, and it’s one that starts with recognition of symptoms (the treatment needs to be started within 10 days of symptom onset), followed by access to testing to confirm the diagnosis. Not all coronavirus infections result in symptoms right away, though — some studies show that up to 40 percent of cases come with none — and testing has fallen short of demand throughout many phases of the pandemic.

Even if things go “relatively smoothly and two or three days after symptoms, someone gets a test and it's positive,” the patient still “needs to be aware enough to call their physician to just check in about whether there's anything else that can be done or what should they do,” said Barnett, who is also a primary care doctor in Boston. “And the physician needs to be aware that monoclonal antibodies are probably a good choice.” 

The treatment needs to be readily available, too — supplies of monoclonal antibodies have been limited since their debut — and the health care provider needs to “understand the referral process,” he added. If a patient does get a referral, they have to be able to get to an infusion center, where the treatment is administered by IV. “There's lots of steps along the way where people who can't drive or feel too sick to do much at all or who don't have family to help them navigate all of this or who may not feel that comfortable calling up their doctor or may not believe that it's necessary to bother testing” can fall through the cracks, Barnett said.

To complicate matters, there are fewer monoclonal antibodies available now than there were during previous periods in the pandemic. The U.S. Food and Drug Administration (FDA) on Jan. 24 said that two of the three monoclonal antibody treatments are ineffective against the now-dominant omicron variant and shouldn’t be used while the strain is in such high circulation. The JAMA study examined data only through August 2021, before the emergence of omicron, but “there's no reason to think things have gotten better,” Barnett said.

Have COVID? Know your options

Fixing the problem by getting monoclonal antibodies to the people who need them the most isn’t going to be easy, Barnett said, “but there are a few things that can probably help.”

The first, he said, is patient education. More patients should know about their options if they get COVID-19, including a breakthrough case. “You don’t have to be intimately familiar with whether you’re eligible or not. But you can ask your physician … ‘How can I get better?’ ” For many adults there are a few different options.  

Along with intravenous monoclonal antibodies, two new pills that can be taken at home, from Pfizer (Paxlovid) and Merck (molnupiravir), have been authorized to treat COVID-19 and help prevent hospitalization of high-risk adults. Similar to the monoclonal antibody therapy that works against omicron, these two treatments are also in short supply, but federal officials have announced plans to make them more readily available in the coming months. The FDA-approved antiviral remdesivir (Veklury) can be used as well to help keep a mild to moderate case of COVID-19 from spiraling into something more serious; providers also administer this drug to patients hospitalized with COVID-19.

Educating doctors on the supplies available and the population that’s eligible for them is another important point, Barnett said. So is investing in the home care workforce to “get out to people's homes to deliver these infusions, or somehow streamline the referral and transportation process to infusion centers to make sure that people can actually get there,” he said. “Because I think just this process of getting the drug into people is a definite bottleneck for people who are very sick or who started off very sick in the first place before they got COVID.”