For the last 18 months, I worked extensively in treating COVID-19 patients. While I did this I encountered a lot of questions from the affected patients and their families. Some of the common questions were:

  • How did I acquire COVID-19 infection?
  • Why is this infection so severe in me, while my friends are recovering well?
  • What could be done to prevent this infection from worsening?
  • Is there anything to treat this infection?

Not long ago, we didn’t have answers to most of these questions. The research scientists and healthcare professionals have learned a lot in the last two years about the SARS-CoV-2 virus and the Coronavirus Disease-2019 (COVID-19), the risk factors, clinical features, and treatment options and the evidence continues to evolve as I write this.

The development of vaccines against COVID-19 was a major breakthrough. The mRNA vaccines such as Pfizer-BioNTech (BNT162b2) and Moderna (mRNA-1273) have been very effective in preventing infections, hospitalizations, and deaths due to COVID-19 infection. Steroids have been the mainstay of treatment for hospitalized COVID-19 patients due to COVID-19 pneumonia and who require oxygen support. But there were not many treatment options for non-hospitalized patients until recently. And now we have monoclonal antibodies that have shown to be effective in preventing clinical deterioration of the COVID-19 in mild to moderate disease.

But what are these monoclonal antibodies?

Monoclonal antibodies are the protein products that have been used widely even before this pandemic began for various other conditions such as rheumatoid arthritis, inflammatory bowel disease, cancers, etc. These are specifically designed to bind a specific target in the body. Similarly, in COVID-19 infections, these are designed to bind to the spike protein of the SARS-CoV-2 virus and assist the immune system in preventing this infection from getting worse & aid in recovery. There is a fair amount of evidence that these drugs can reduce the risks of disease progression, hospitalizations, and deaths due to COVID-19.

What are the common types of monoclonal antibodies?

Three varieties of monoclonal antibodies are currently in use. However, their availability may vary depending on the location. The ‘antibody cocktails’ that received emergency use authorization are as follows:

  • Bamlanivimab plus etesevimab (from Eli Lilly)
  • Casirivimab plus imdevimab (Regen-CoV, from Regeneron)
  • Sotrovimab (Xevudy, from GlaxoSmithKline)

What are the common indications of using monoclonal antibodies? When do we use these?

Non-hospitalized patients who have mild to moderately severe COVID-19 disease and have any of the following factors or medical conditions (high risk of disease progression) meet the criteria to get monoclonal antibodies:

  • Age 65 years and above.
  • Obesity/ Overweight (with BMI of 25 and above)
  • Diabetes
  • Hypertension
  • Cardiovascular disease
  • Chronic lung conditions
  • Chronic kidney disease
  • Pregnancy
  • Sickle Cell Disease
  • Patients who have immunocompromised conditions or take immunosuppressive medications.
  • Neurodevelopmental disorders and other complex genetic or congenital conditions.
  • Patients who have a tracheostomy, gastrostomy, etc.

It is important to remember that these antibodies need to be given as soon as possible after the diagnosis is made and within 10 days of symptom onset.

I have been diagnosed with a COVID-19 infection. How do I know if I have mild/moderate/severe disease?

Patients with symptoms and signs such as fever, sore throat cough, loss of taste or smell, vomiting, headaches, body aches, and other symptoms without having any difficulty in breathing are typically classified as ‘mild’ COVID-19 infection. Patients with breathing difficulty or any evidence of lung involvement but with a normal oxygen level are classified as ‘moderate’ COVID-19 infection. And patients with low oxygen levels and or extensive lung involvement have ‘severe’ COVID-19 infection and often require hospitalization.

How do I know if I qualify for this treatment?

If you meet any of the above criteria or if you believe that you are at high risk of severe COVID-19 infection, contact your primary care physician for guidance.