It may feel like ancient history now, but it was only five years ago that the COVID-19 pandemic posed a serious danger to public health around the world.
In those early days, before COVID vaccines were widely available, the only effective treatment for the virus was a monoclonal antibody — a lab-produced protein, infused into the bloodstream, that targets spike proteins in the virus, preventing COVID from attaching to and entering human cells.
And though the days of using monoclonal antibodies to treat COVID are in the past, researchers in the University of Colorado School of Medicine continue to investigate their effectiveness and usage, in large part because they may be used again should another public health crisis such as COVID arise.
“We don't usually think of intravenous medications as an outpatient treatment for illnesses — that's not something we've commonly done before, but it's not an unreasonable thing to consider,” says Lindsey Fish, MD, associate professor of general internal medicine. “There may be times or particular illnesses or populations where this might be an important way for us to treat patients in the outpatient setting.”
Closer look at the patient experience
Adit Ginde, MD, professor of emergency medicine, led a monoclonal antibody research group that was part of the Colorado Clinical and Translational Sciences Institute. Ginde and his team, including Fish and Samantha C. Roberts MS, MPH, a research scientist at the Colorado School of Public Health, are authors of a recent article in the journal PLOS One that looks at the experiences of COVID-19 patients — some of whom received monoclonal antibody treatment — in 2021, paying special attention to their insurance status and social demographics.
“We wanted to get a systematic view of what potentially impacts people's ability to access a novel treatment to help us be able to more effectively get treatment to the people who need it the most, and address whatever their concerns might be,” says Fish, medical director of the Peña Urgent Care Clinic at Denver Health.
The insurance difference
One finding from the study, Fish says, is that people who had Medicaid and people who were uninsured were much less likely to get monoclonal antibody treatment — a finding that might make financial sense except for the fact that Medicaid fully covered the cost of the treatment, and there was a special fund set up by the federal government to fully cover the cost for people who were uninsured.
“We frequently think about financial barriers for people who don't have commercial insurance being a big factor in how people can access care, but there should not have been a financial barrier for these people to receive this care, so there were clearly other barriers,” Fish says. “I suspect that it was lack of knowledge that the treatment was covered, both from patients and from clinicians. A key takeaway point from the research is that when you do something novel that's counter to the typical system way of doing things, it's going to be difficult to get everybody educated on how it works and how things are covered.”
What’s the worry?
When it came to patients’ worries about a COVID-19 diagnosis, Fish says, some of the concerns seemed logical — people with comorbidities like diabetes, obesity, or hypertension were more worried about catching the virus — while others were less congruent with the realities of the disease at that time.
“For example, female patients had higher levels of worry, but in reality, men had worse outcomes if they got COVID,” she says. “We also saw that patients who had received multiple COVID-19 vaccinations were more worried about COVID-19, which in some ways makes sense — ‘I'm more worried, so I’m more willing to get vaccinated’ — but that should also alleviate some of your worry, because if you're vaccinated, you’re less likely to have severe COVID. There continued to be a juxtaposition between what the experience was that we were seeing of patients with COVID and how people's worry related to that.”
The study also found that Hispanic patients had a higher level of worry about COVID-19 overall, and that people with more than two years of college under their belt were less worried about receiving monoclonal antibody treatment.
“I think this points to the fact that education plays a big role,” Fish says. “Theoretically, college-educated people would have read some information on monoclonal antibodies before getting the treatment, so they felt comfortable that this was a safe treatment for them to receive.”
Patients and providers
The survey also asked patients who had received monoclonal antibody treatment for COVID about their experiences with health care providers, shedding light on the importance of patient-provider relationships.
“If you're a patient, you want to trust that your provider is doing the right thing for you,” she says. “What was different about the COVID-19 environment was that you couldn't always get in to see your regular provider. We found that the people who didn't trust their provider very much were middle-aged people between the ages of 45 to 64 and those who primarily got care at a walk-in clinic and didn't have a primary care provider.”
It makes sense, she says, that without an established relationship, people had less trust in their providers. The study also found that people with multiple medical conditions — who likely saw their provider or providers more regularly — had a higher level of trust and also were more likely to get vaccinated.
Add to all that a finding that women reported more difficulty receiving monoclonal antibody treatment than men, while Medicaid patients — the same ones who were less likely to access the treatment — reported little difficulty, and you have a multilayered puzzle that reveals the strengths and shortcomings of the early response to the COVID crisis.
“The biggest takeaway for me is a recognition of when there's something novel out there, you've got to look at your system as a whole,” Fish says. “It’s easy to assume where the disparities are going to lie, but when you have a novel illness and a novel treatment, it might not be the same as it is with other things that we are accustomed to dealing with all the time. It reiterates the importance of asking the questions, doing the research, then rapidly making adjustments to try and improve care for everybody as quickly as possible.”
