Only COVID-19 patients scored as high risk will get popular monoclonal antibody treatment at new Utah center

With Utah’s hospital systems at capacity, state health workers are stepping in to provide monoclonal antibody treatments for coronavirus patients.

A new, state-run infusion center has opened at Intermountain Healthcare’s Murray campus and it can offer the popular COVID-19 treatment to 50 eligible people each day, the Utah Department of Health announced Thursday.

“The hospital systems, at least along the Wasatch Front, were hitting up against their ability to infuse, and they were identifying more people who would benefit than they could actually offer it to,” said Dr. Michelle Hofmann, UDOH deputy director and chief medical advisor.

Capacity had been limited more by hospital staffing shortages than by supply of the actual antibodies — though supplies of the treatment began to deplete as providers in several southern states offered nearly unlimited treatments in response to rising case rates.

The treatments, which have proven successful at reducing coronavirus symptoms if administered shortly after infection, have been widely touted by conservative media and politicians, and have been especially popular in areas with low vaccination rates.

But with each state now limited to weekly allocations, Utah is restricting eligibility to high-risk patients — the ones who are most likely to be spared a hospital visit if they receive the treatments, Hofmann said.

“As a scarce medication, it becomes important to limit it to who it’s best for,” Hofmann said. “If we can target the highest-risk people, we can reduce hospitalizations of every eight of those people by one. With the hospitalization surge, we’ve got to really target who we get it to.”

With rising cases and the same staffing shortages that have left hospitals unable to administer the treatment, Utah’s intensive care units have been above capacity since mid-August, and the percent of ICU beds occupied by COVID-19 patients is now at its highest point of the pandemic.

“There are probably more people out there who could benefit from this than we have resources. The feds are allocating out the treatments to states, which limits the number of treatments we can administer per day,” said Brian Hatch, director of the Davis County Health Department.

Health officials are hoping Utahns see monoclonal antibodies strictly as a “hospital preservation strategy,” rather than an alternative to getting vaccinated.

“Obviously, that’s a huge risk and unintended consequence,” he said, “and all the more reason to be very prescriptive in its use.”

To receive monoclonal antibody treatment, patients will be scored according to their risk of serious illness from COVID-19, with points given for age, sex, being part of a high-risk racial or ethnic group, and certain medical conditions. Because vaccinated patients are already at lower risk of needing hospital care, unvaccinated patients require a lower score to be eligible for the treatment.

For instance, any unvaccinated man older than 30 with a body mass index over 30 would be eligible. A vaccinated woman, meanwhile, might need to be over 80, obese, diabetic and have another health condition like chronic liver disease. Meanwhile, some severely immunocompromised patients may be eligible whether they have been vaccinated or not.

Even if patients are deemed sufficiently high risk, they can only receive the treatment if they developed symptoms less than seven days earlier. If they’ve been infected longer than that — or if they are already sick enough to need supplemental oxygen or other hospital care — it’s too late for the treatments to be fully effective, Hofmann said.

That means prompt testing is essential for anyone who is at high risk.

“Speed is really critical in this,” she said. “If people delay getting tested and then they have to go see the doctor and get a referral, they’re going to be outside that seven-day window.”

That means high-risk Utahns need to be getting “comfortable testing early, and not dismissing mild symptoms as an allergy,” she said.

UDOH already has had a team of employees and Utah National Guard members providing monoclonal antibody treatments at nursing homes with outbreaks, Hofmann said. That same team will be staffing the new Murray center.

Meanwhile, health care systems will continue to provide the treatment as their own staffing allows. Intermountain, for example, has integrated its COVID-19 test results with patients’ existing medical records to try to identify high-risk patients who test positive and notify them as soon as possible that they might be eligible for the treatment.

Health care systems have been administering around 500 treatments per day, so the new treatment center doesn’t add enormously to Utah’s existing capacity, but UDOH hopes to recruit new staff to provide the treatments to more people, Hofmann said.

“The antibody infusion has proven to be effective, but it can only be administered after a high-risk person has tested positive for the virus,” Gov. Spencer Cox said in a statement. “The vaccines remain the best way to prevent someone from being hospitalized because of COVID-19. Around 90 percent of people who are hospitalized with COVID-19 have not been vaccinated. "

Utah Senate President Stuart Adams, who previously has promoted more use of the treatment, agreed. “Monoclonal antibodies aren’t the path out of this,” Adams said. “They won’t prevent someone from getting COVID. They’re a part of the solution.”

— Reporter Bryan Schott contributed to this story.