EVANSVILLE — Tara Wunderlich could feel herself sinking into COVID-19 hell. Her head felt like it could split open any minute, which wouldn't have been as bad if she could have just stopped coughing.
When Deaconess Health System called Wunderlich after she tested positive to quiz her about her symptoms and offer its monoclonal antibody treatments, she jumped at the chance. The treatment, administered via intravenous infusion, is intended to stop the progression of mild-to-moderate COVID-19 illness in patients at high risk that their illness might worsen enough to require hospitalization.
Wunderlich, an Evansville resident, did not want to be hospitalized.
She got the infusion at an annex outside Deaconess Gateway Hospital earlier this month. But she still felt lousy for a couple of days. Maybe this wasn't going to be her miracle treatment, after all. And then it was.
Tara Wunderlich relaxes with her dog, Zeus, while watching movies with her husband, Ed, Wednesday afternoon.
"You feel like you’re dying there for a while, and then you’re like, ‘OK, OK, I’m feeling like I’m coming back to the land of the living,'" Wunderlich said with a hearty laugh. “I was like, 'I’m going to make it. I’m going to be OK.’”
More: Despite drop in COVID cases, we're nowhere near the end, say doctors
Wunderlich can laugh now. She stayed out of the hospital, got well and finished quarantining a week ago. Ed Wunderlich, her husband, got the treatment too. For now at least, the couple is back up and running.
Deaconess and Ascension St. Vincent Evansville have been offering monoclonal antibody treatments since November, seeing slightly more than 2,000 COVID-19 patients so far between them. Most of those — 1,752 as of Monday, according to Deaconess — have received the infusions at an annex Deaconess built in three days in front of the Emergency Department entrance at Gateway.
Do antibody infusions hold up against COVID-19 variants?
It doesn't take a medical degree to grasp the basics of the antibody therapy.
"When you come in contact with any virus, your body makes antibodies. But that takes some time," said Dr. Gina Huhnke, director of medical affairs for the Deaconess emergency department. "This is an antibody that’s been made in the lab, and they go ahead and give it to you in the IV. That way, it gives your body a jumpstart.
"Your body doesn’t have to take the time to make the antibodies because voila, there it is."
Huhnke cited internal Deaconess data projecting that for every 15 persons infused, one hospitalization of a high-risk patient is prevented. That would mean Deaconess' 1,752 infusions have prevented 117 hospitalizations.
More: Arrival of UK variant of COVID-19 in Evansville is bad news, medical leader says
More: Deaconess believes UK variant of COVID-19 has more than tripled locally in two weeks
"Of all those patients that we’ve infused, not a single person has died from coronavirus," Huhnke said. "That’s very, very, very impactful."
Lives have been saved, Huhnke declared.
Deaconess projects that at least 15% of the 117 patients that would have been hospitalized would have ultimately died. That's 18 people.
"That’s just based on comparison to a group of patients who did not receive the monoclonal antibody and with all of these comorbidities, their hospitalization rate, their mechanical ventilation rate, and their mortality rate," Huhnke said.
But there are questions about how well the monoclonal antibodies treatments hold up against mutation-riddled COVID-19 variants that present worrisome new characteristics.
STAT+, a subscription service that covers biotech, pharma, policy and life science, reported Friday that a team of virologists had found that Eli Lilly and Company’s antibody treatment, bamlanivimab, appears to work well against the so-called "UK variant," but is less effective against the South African variant.
Deaconess has already reported the presence of the UK variant in this area. One case of the more threatening South African variant has been seen in Rock Island, Illinois, a six-hour drive up U.S. 41 North and I-74.
"The loss of power against that particular (the South African) variant was also observed for Lilly’s second monoclonal antibody, which this month was authorized for use in combination with the first," STAT+ reported. "Same goes for one of the two antibodies in Regeneron’s cocktail, though its partner molecule currently holds up well against both those variants."
STAT+ reported that Andrew Adams, scientific leader for Lilly’s anti-Covid-19 platform, said that sequencing data had shown, "the good news is, today, bamlanivimab still is effective against the majority of the virus in the U.S."
"That’s going to change over time, because different strains will circulate,” Adams said. "The thing we’ve learned is, this will be a cyclical war of attrition with the virus. The virus will change, we’ll come forward with new antibodies."
COVID-19 antibody infusions are for high-risk patients
The infusions, as they are at the moment, are not for everyone who acquires COVID-19. You have to be high-risk.
The FDA gave emergency use authorization to bamlanivimab, commonly referred to as "bam," along with Regeneron’s combination imdevimab and casirivimab. On Feb. 9, the FDA issued another EUA for bamlanivimab and etesevimab administered together. The EUAs came with several sets of qualifying risk factors.
PDF: Read the bamlanivimab EUA fact sheet for health care providers
One set includes six risk factors, any one of which qualifies an adult weighing at least 88 pounds. They include being older than 65, having a body mass index of greater than 35% and suffering from diabetes. Tara Wunderlich said she is diabetic.
More: It's mostly white people getting COVID-19 vaccine in Vanderburgh County, new data shows
Another set requires a COVID-19 patient to be older than 55 and have a history of suffering from at least one of the following — cardiovascular disease, hypertension or COPD/chronic respiratory disease. There's a long list of qualifying risk factors for adolescents between 12 and 17.
Patients already hospitalized with more severe cases of the coronavirus aren’t eligible for monoclonal antibody treatment. They must be in their first seven days of symptoms.
COVID-19 antibody infusions are happening all over the nation
Ascension St. Vincent Evansville uses the Eli Lilly product. Lilly announced Feb. 1 that it had partnered with health systems to launch dedicated infusion center locations, including St. Vincent's center at 100 St. Mary’s Epworth Crossing in Newburgh.
"We are happy to say that the need for it has decreased with our numbers of positive (COVID-19 cases) going down over the last few weeks," said Dr. Heidi Dunniway, chief medical officer of Ascension St. Vincent South Region.
"But we certainly anticipate that we may have a period where positives increase again. We may again have another surge, and we're prepared for that and to ramp up our ability to provide that service."
More: Fighting COVID-19 with 'bam' and vaccine is the plan, Vanderburgh health board says
More: Progress against COVID-19 will come in 2021, Evansville medical leaders say
Nationwide, monoclonal antibody treatments are big business.
The U.S. Department of Health and Human Services (HHS) bought 300,000 Regeneron treatment courses initially but has since added at least another 1.25 million. HHS has agreements with Lilly to buy up to 3 million treatment courses. HHS' latest data shows that more than 798,000 total monoclonal antibody treatments have shipped.
Things seem to have slowed down a bit for Deaconess as well as for St. Vincent. Huhnke acknowledged that Deaconess has "more products available than we have demand for."
Cost isn't an issue for most patients. Deaconess said there is no cost to the patient with insurance or without insurance.
An HHS web page dedicated to the treatment said much the same.
"The federal government is currently distributing monoclonal antibodies treatments at no cost for patients," HHS stated. Anyone on Medicare "should not have to pay any costs for getting the treatment," the HHS page stated.
'It was going to go downhill pretty quick'
Don Titzer's wife was hospitalized with COVID-19, so she wasn't eligible. But the 72-year-old Titzer got tested as a result of her sickness, found out he was positive and soon found himself sitting in Deaconess' Gateway clinic taking a couple of bags in the arm.
Titzer, an Evansville resident, was one of the lucky ones. He had just begun to feel poorly when Deaconess came calling.
"I was dragging. I wasn’t feeling great. I was running a temperature. I was aching," he said. "But after the infusion, that next day I was feeling – I was ready to go. I still had the temperature, but it wasn’t bothering me."
More: Gov. Holcomb signs bill providing COVID-19 liability protections to businesses, nursing homes
Within a few days, Titzer's temperature was back to normal. He has no doubt things would have gotten worse if not for the monoclonal antibody infusions.
"It was going to go downhill pretty quick," he said.
Tara Wunderlich used her cell phone camera to take pictures inside the Deaconess infusion clinic.
Monoclonal antibody treatment is a useful weapon in the war against COVID-19, Wunderlich declared. She appreciated the care she got at the clinic.
"I just figured it’s something that needed to be captured in this time and period right now, with what’s going on in the world," she said. "The (health care workers) I was with were amazing. Bless their hearts for everybody that they put their lives on the line for."