Health
Holy Grail treatment for COVID-19 remains out of reach. But options exist – CBC.ca
A COVID-19 treatment showing early signs of promise is at risk of being overshadowed by the vaccine rollout.
Monoclonal antibody treatments have been used by doctors in the United States on people like President Donald Trump, who fought COVID-19 in October, and on others in an effort to try to keep people with the coronavirus out of hospital. Health Canada has authorized one such drug from Eli Lilly, pending the results of trials to verify its benefits to patients.
Our immune system naturally makes antibodies to fight off the coronavirus. But it can take several weeks to gain full protection and some patients go downhill too quickly to wait. The aim of giving a one-time monoclonal antibody treatment is to seize a window of opportunity early in the course of COVID-19.
Dr. Srinivas Murthy, an infectious disease physician and a clinical associate professor in pediatrics at the University of British Columbia in Vancouver, said a treatment that’s simple and works to prevent COVID-19 from becoming severe is “the Holy Grail right now.”
“The challenge with any of those treatments is that you have to give it to a lot of people to prevent hospitalizations or severe disease because a lot of people have mild-COVID,” Murthy said. “Whatever you give has to be safe and convenient otherwise people won’t take it.”
The two monoclonal antibody treatments at the forefront of COVID-19 studies are Eli Lilly’s product, bamlanivimab, and a cocktail from Regeneron Pharmaceuticals that Trump received.
Dr. Saahir Khan, a clinical professor in infectious diseases at the University of Southern California in Los Angeles, is a co-principal investigator of a clinical trial evaluating bamlanivimab.
“The goal of this trial is to find treatment that prevents these patients with what we call mild-to-moderate disease progressing to severe disease that would require hospitalization,” Khan said in an interview.
Elderly people and those with underlying medical conditions such as heart disease or diabetes are at a greater risk of developing severe COVID. About 79 million cases have been reported worldwide. And the need for such drugs is especially pressing as the number of cases continues to climb.
“Unfortunately, as bad as it is now, it’s almost a foregone conclusion that it’s going to get worse for the next month,” Khan said.
Vaccines offer hope, but health officials caution they won’t be widely available to the general public in Canada for a few months.
In the meantime, effective treatments could help reduce the severity of disease and hospitalization rates, lower death rates and flatten the curve so health systems aren’t overwhelmed.
The oldest way to apply antibody treatments is to use the plasma from blood of people who’ve naturally recovered from COVID-19 and give those antibodies to a patient in need. That’s known as convalescent serum or polyclonal antibodies.
WATCH | Promise and doubts on convalescent serum for COVID-19:
An Indian study is casting doubt on the effectiveness of giving patients sick with COVID-19 the blood plasma of others who have battled it, to transfer antibodies. But Canadian researchers say it could still work, if the antibody levels are tested. 3:27
But convalescent serum includes a range of antibodies to various infections, such as influenza, as well as the virus that causes COVID-19, called SARS-CoV-2.
Monoclonal antibodies are synthetic, purer than convalescent serum and recognize a specific target, such as the proteins that SARS-CoV-2 uses to make copies of itself.
Before COVID-19 upended lives worldwide, other monoclonal antibody treatments were used to treat rheumatoid arthritis and Crohn’s disease, including those with injections given at home using an auto-injector-type device.
For a treatment showing early promise, there hasn’t been much pick up of monoclonal antibodies in COVID-19.
UBC’s Murthy, who also co-chairs the World Health Organization’s clinical research committee on COVID-19, said monoclonal antibodies haven’t really been embraced in Canada yet because of access and feasibility questions.
To conduct the trial in southern California for instance, Khan’s hospital set up a special tent outside, similar to COVID assessment centres at some Canadian hospitals. The site is staffed by health-care workers wearing full personal protective equipment to minimize the risk of people coming to participate in the trial spreading COVID-19 to any patients or staff.
What’s more, current monoclonal antibody treatments for COVID-19 need to be given by infusion, similar to some chemotherapy agents. Khan said it takes an hour for patients to receive the monoclonal antibodies and then staff need to closely monitor them for another hour to check for any allergic reactions.
By mid-December in the U.S., less than 20 per cent of the doses of monoclonal antibodies that the federal government allocated had been used. Red tape, staff shortages, testing delays and skepticism are keeping patients and doctors from using the drugs. Evidence on their effectiveness is also thin so far.
Competition from vaccines
Meanwhile, hospitals and health-care systems in Canada and the U.S. are devoting more attention and resources to the vaccine rollout.
Dr. Donald Vinh, an infectious disease specialist and medical microbiologist at the McGill University Health Centre in Montreal, said monoclonal antibodies could help people with COVID-19 who need to keep their blood levels of oxygen up, while staying out of hospital.
Vinh, who advises the federal government’s COVID-19 Therapeutics Task Force, said to his knowledge, monoclonal antibodies aren’t being used in Canada to treat COVID. In contrast, Pfizer-BioNtech’s vaccine is going into arms across the country.
“These vaccines are extremely effective in stimulating people to produce polyantibodies that protect you against COVID,” Vinh said.
Matthew Miller, an associate professor at the Institute for Infectious Disease Research at McMaster University in Hamilton, about 70 kilometres southwest of Toronto, said logistical and economic issues are hindering the use of monoclonal antibodies to treat COVID-19.
Before the treatments can be given, people need to be diagnosed with COVID-19 quickly, Miller said. And he estimated monoclonal antibodies are about 1,000 times more expensive than a vaccine.
The U.S. has paid $1,250 US per dose for 950,000 doses of Lilly’s bamlanivimab. Eli Lilly Canada signed an agreement with the federal government to supply 26,000 initial doses of bamlanivimab, also at $1,250 per dose, between December 2020 and February 2021, pending the results of trials to verify its clinical benefits.
To maximize the potential of monoclonal antibodies and to take advantage of when they work best, Miller suggested using them to prevent infection, rather than treat it.
“The sort of obvious settings where these would be really useful is nursing homes, because obviously those people are at a really high risk of dying and that population is usually a population that’s quite hard to vaccinate,” Miller said.
Other people who could potentially receive the preventive option include employees at meat-packing plants with outbreaks, or households with confirmed COVID-19 cases.
Three new clinics are set to open in Vancouver and Surrey for British Columbians suffering from long-term effects of COVID-19.
The clinics will open at St. Paul’s Hospital, Vancouver General Hospital, and the Jim Pattison Outpatient Care and Surgery Centre in Surrey.
In addition to providing care for those suffering from lingering effects of the virus, the Provincial Health Services Authority said Friday that it will be developing knowledge and best practices for dealing with long-haul patients.
COVID-19 long-haulers are patients who have contracted the virus but continue to live with chronic symptoms months after tests reveal they’re virus-free.
“We know some people who recover from COVID-19 experience long-term health effects,” Health Minister Adrian Dix said in a release. “Through the dedication of a large team of experts and health leaders across the province, we are working to ensure that specialized care is available to British Columbians, when they need it.”
The clinics will be staffed with specialists and health professionals with an extensive knowledge of the virus long-haulers, the province said.
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The St. Paul’s clinic has already seen more than 160 post-COVID-19 patients, the province said.
“We want patients to feel like they are not alone,” physician lead and internist Dr. Jesse Grenier said in a release.
“We are here. We’re listening. With patient partners, researchers, specialists, and primary care physicians across many health authorities, we are working together to learn from and support one another to ensure that patients get the care they need.”
Three long-hauler clinics are also set to open in Alberta — two in Calgary and one in Edmonton.
Prior to the opening of these new clinics, the long-hauler patients were receiving care from a team of experts from Fraser Health, Providence Health Care, VCH, BC Centre for Disease Control, PHSA and several others.
An early study of COVID-19 long-haulers in B.C. showed more than half of participants had abnormal breathing tests three months after they first started feeling sick with COVID-19. Further examination with CT scans showed one in five had lung scarring, which is permanent damage that will lead to compromised lung function.
“COVID-19 presents a special opportunity for research — we are leveraging the unprecedented focus on a single threat to bring together investigators and patients, who would otherwise be isolated, to create and mobilize new insights to benefit our community and beyond,” Dr. Chris Carlsten, Vancouver Coastal Health Scientific Director of Legacy for Airway Health and professor of medicine and head of the division of respiratory medicine at UBC, said in a release.
© 2021 Global News, a division of Corus Entertainment Inc.
Health
Coronavirus: Beware workplace, family spread, new Ottawa Public Health case study warns – Global News
The latest case study documenting coronavirus transmission in Ottawa shows the risks of lowering one’s guard in the workplace and when interacting with other households.
Ottawa Public Health tweeted a real-world contact tracing example Friday morning, as the heath unit has done previously, to show how COVID-19 spread through organized sports, weddings and outdoor social events, this time depicting virus transmission from one confirmed case in a few seemingly innocuous settings.
Before showing symptoms, this individual went to work where inconsistent mask use and physical distancing, coupled with some team members sharing a meal together, resulted in six employees testing positive for the virus and 18 more co-workers forced to self-isolate due to their high risk of exposure.
Two additional cases were linked to this workplace outbreak after one of the employees who tested positive brought the case into their home; other household members of the positive cases also had to self-isolate.
The original person who tested positive then developed minor symptoms but still attended a family gathering, where four households came together.
Six additional people tested positive as a result of this gathering and three other high-risk contacts were created.
Finally, the original person had a friend over to their home. That contact then tested positive for the virus as well and exposed the other five members of their household.
Within two weeks’ time, the original case had become 15 with 40 high-risk contacts.
“We’re naturally more relaxed around people we’re close to, but this cluster is a reminder that COVID doesn’t care how well we know someone. Whether around coworkers we’ve known for years, friends or family members, we must remain vigilant,” OPH said in the tweet.
The local health unit also added one addendum to the case study: don’t gather with four households.
© 2021 Global News, a division of Corus Entertainment Inc.
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VICTORIA — British Columbia is updating its immunization strategy for COVID-19 today as Premier John Horgan is scheduled to be joined by health officials to lay out the latest on the government’s plan.
Nearly 31,000 doses of vaccine that the province expected to arrive by Jan. 29 could be curtailed due to production delays in the supply from Pfizer-BioNTech.
Two doses of the vaccine are needed to ensure immunity from the virus that causes COVID-19 and Health Minister Adrian Dix said earlier this week that B.C. was set to begin administering second doses.
He said the province remains committed to ensuring all those who have had the first shot get a second dose within 35 days.
On Thursday, the province said it had administered 104,901 doses of COVID-19 vaccine, of which 1,680 were second doses.
Horgan is being joined in making today’s announcement by Dix, provincial health officer Dr. Bonnie Henry and Dr. Penny Ballem, who is leading the COVID-19 immunization rollout.
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