High Risk

[Jolly]

I was listening to a doc being interviewed on the radio the other day. I thought he was very even-handed in his approach to COVID. Some of the things he talked about:

1. He was pro-vaxx, but he thought the vaccines had been oversold a bit. Too many people thought the vaccines provided total protection, when we knew from trials that the goal of vaccine effectiveness was to prevent serious disease and death.
2. He didn't like the government dictating what drugs doctors could use in the formulary. He felt if a doc wanted to use something off-label, it was between him and his patients.
3. He felt that treatment with monoclonal antibodies has been a little under-emphasized and can be as effective as vaccination at preventing death and hospitalization.
4. He also held the opinion that government should be pursuing treatment options with more vigor. His opinion us that COVID will continue to evade the vaccine through mutation.

[Aqua Letifer]

Agree with all stated.

[George K]

@jolly said in High Risk:

He felt that treatment with monoclonal antibodies has been a little under-emphasized and can be as effective as vaccination at preventing death and hospitalization.

Y0u mentioned this earlier.

The problem is a logistical one. Monoclonal antibodies are not administered as a simple an injection in the deltoid.

(Almost) any idiot can shoot a vaccine into an arm (and not follow protocol for aspirate before you inject, by the way), whereas the infrastructure and staffing needs for widespread monoclonal antibodies are huge. How many trained IV starters do you need in a hospital? At Northwestern, by noon, back in March, they were doing about a thousand injections. No hospital can ramp up that kind of response.

[Axtremus]

@george-k said in High Risk:

@jolly said in High Risk:

He felt that treatment with monoclonal antibodies has been a little under-emphasized and can be as effective as vaccination at preventing death and hospitalization.

Y0u mentioned this earlier.

The problem is a logistical one. Monoclonal antibodies are not administered as a simple an injection in the deltoid.

(Almost) any idiot can shoot a vaccine into an arm (and not follow protocol for aspirate before you inject, by the way), whereas the infrastructure and staffing needs for widespread monoclonal antibodies are huge. How many trained IV starters do you need in a hospital? At Northwestern, by noon, back in March, they were doing about a thousand injections. No hospital can ramp up that kind of response.

Agree with @George-K’s reply above, which cuts against @Jolly’s characterization that the doc was “even-handed” in his approach to COVID-19.

I also disagree with his claim that the vaccines have been “oversold”. The reports we read, even those in popular press, quite often state that “this vaccine is x% effective against infection,” “that vaccine is y% effective against death and hospitalization.” Those statements quite clearly do not claim “total protection” (x and y are less than 100). These days, more often than not, “total protection” claims show up as straw-man arguments rather than accurate retelling of history.

[taiwan_girl]

I wonder about #2. I think that the US drugs testing group is the best in the world - a bit conservative but overall, very careful and do an excellent job.

Most people (and many doctors) do not have the experience with the 1000's of drugs out there, so to give them free chance to use drugs in an unknown fashion could be quite dangerous.

[Jolly]

Florida has been very successful with monoclonal antibody infusion centers. How good do you have to be to slide a Jelco into a median cubital vein?

[Jolly]

And here's something else the doc said, something that I hadn't heard...If you look at the literature, people should understand that they are at a higher risk of catching COVID in the first few days after vaccination, and should take proper precautions.

[Jolly]

@axtremus said in High Risk:

@george-k said in High Risk:

@jolly said in High Risk:

He felt that treatment with monoclonal antibodies has been a little under-emphasized and can be as effective as vaccination at preventing death and hospitalization.

Y0u mentioned this earlier.

The problem is a logistical one. Monoclonal antibodies are not administered as a simple an injection in the deltoid.

(Almost) any idiot can shoot a vaccine into an arm (and not follow protocol for aspirate before you inject, by the way), whereas the infrastructure and staffing needs for widespread monoclonal antibodies are huge. How many trained IV starters do you need in a hospital? At Northwestern, by noon, back in March, they were doing about a thousand injections. No hospital can ramp up that kind of response.

Agree with @George-K’s reply above, which cuts against @Jolly’s characterization that the doc was “even-handed” in his approach to COVID-19.

I also disagree with his claim that the vaccines have been “oversold”. The reports we read, even those in popular press, quite often state that “this vaccine is x% effective against infection,” “that vaccine is y% effective against death and hospitalization.” Those statements quite clearly do not claim “total protection” (x and y are less than 100). These days, more often than not, “total protection” claims show up as straw-man arguments rather than accurate retelling of history.

If you had a brain, you'd be dangerous.

[Axtremus]

@jolly said in High Risk:

Florida has been very successful with monoclonal antibody infusion centers. How good do you have to be to slide a Jelco into a median cubital vein?

Pharmacy employees in the likes of CVS and Walgreens can administer vaccine shots. Can they slide a Jelco into a median cubical vein to administer monoclonal antibody?

[Jolly]

How many RN's live in your state? Phlebotomists? Med-techs? And assorted other medical professionals?

[Jolly]

That is, the ones that aren't being fired for not getting vaxxed?

[George K]

@axtremus said in High Risk:

Pharmacy employees in the likes of CVS and Walgreens can administer vaccine shots. Can they slide a Jelco into a median cubical vein to administer monoclonal antibody?

You're talking about a vastly greater skillset.

Vastly.

Starting an IV is nothing like giving an injection.

Nothing.

The only thing they have in common is that sharp things are being used.

I have no idea how long it takes to administer a dose of monoclonal antibody, but rather than taking seconds (as an injection), an infusion is probably more than 10 minutes. Places like pharmacies simply do not have the infrastructure to do this type of thing.

It's a great idea, but functionally beyond impractical.

[Mik]

I know one person who had the monoclonal antibodies and I've had experience with infusion centers. I think it is fine for those at high risk, but it is not a panacea due to both supply and process.

[LuFins Dad]

I’m glad that the Regeneron treatment is available and effective, I just wonder why people that are against the vaccine are against having this crap pumped into you.

[Jolly]

@mik said in High Risk:

I know one person who had the monoclonal antibodies and I've had experience with infusion centers. I think it is fine for those at high risk, but it is not a panacea due to both supply and process.

Then ramp up production and remake the process.

No, it's never going to be as easy as giving a shot. OTOH, training is very minimal for people who are familiar with starting IV's or performing phlebotomies. And there are a lot of people out there with that skill level.