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There Might Finally Be a COVID Solution for Immunocompromised People Like Me - Slate

Medical Examiner

A new use of a familiar—and coveted—drug might be our ticket out.

A drawing of an IV going into a forearm.

Illustration by Natalie Matthews-Ramo

Read a partner piece in Slate about what life is like for immunocompromised people who haven’t gotten good immune responses from their vaccines.

Allen from Dallas hasn’t been able to see his grandchildren for 18 months. Stacy, a professor, worries that trips to the supermarket will become ever more dangerous for her now that mask mandates are loosening but the delta variant is still here. Karen doesn’t know whether she can still work as a basketball coach in a maskless high school. Aimee wants her kids to have a normal school year but feels terrified they’ll bring home the virus to her.

These are the pandemic experiences of immunocompromised people—those with organ transplants or certain cancers, those on chemotherapy or immunosuppressant drugs, those with genetic immunodeficiencies, those with other issues that suppress their immune systems. All of these conditions can hamper the ability to fight off COVID effectively—and they can also limit the body’s ability to respond to the coronavirus vaccines. As a result, many immunocompromised people end up in an unenviable situation: They’re less protected by the vaccines and more likely to die if they do get sick.

I’m an emergency room doctor who is also among the 3 percent of Americans with immunocompromise. Because I take a drug that impairs my immune response to vaccines, I didn’t generate protective antibodies after my COVID vaccination and may well not generate any even with another booster. While my friends reveled in newfound freedom after their vaccinations, I fought to keep my spirits up during what looked to be a potentially interminable pandemic, an experience I talked about in an article for JAMA and on the Slate podcast What Next earlier this summer. No travel or restaurants. No gatherings with more than a few friends, even outside. No opportunity for a respite from my N95 respirator for even a couple minutes during 16-hour shifts at work. And perhaps most overwhelming of all, no ability to make any plans for the future—or to imagine a world where sudden and devastating illness from COVID didn’t hang over me.

Then in August, my life transformed in half an hour. Through an IV line, I got my first dose of a mixture of two monoclonal antibodies, a drug that has gotten most attention as a way of treating COVID (used, perhaps most famously, by former President Donald Trump), but when taken prophylactically, can help protect immunocompromised people against infection after they’ve had an exposure. At the end of July, the Food and Drug Administration expanded the emergency use authorization for the Regeneron cocktail to include this kind of use and has since approved a similar expansion for the cocktail made by Eli Lilly.

Monoclonal antibodies for routine prevention in immunocompromised people—not just prevention after exposure to someone infected—are likely coming down the pipeline too.

These drugs work because the antibodies are proteins that attach to the coronavirus to stop it from infecting cells in the body. (Monoclonal simply means that the antibodies are identical to each other.) Most people make their own antibodies in response to the vaccines. For me, the monoclonal antibodies I got stand in for the ones my own immune system failed to produce. Immunocompromised people who have been in close contact with someone with the coronavirus are eligible for the drug. And for those like me who work or live in environments such as hospitals, prisons, or nursing homes, where there’s ongoing exposure to infected individuals, we can receive monthly doses, either by IV or injection under the skin, to help keep us healthy.

I know that the Regeneron antibodies I got aren’t perfect, and they weren’t researched specifically in immunocompromised people—but they’re pretty good. In study participants who had an infected household member, no evidence of past coronavirus infection, and a negative nasal swab right before they got the cocktail, the drug decreased the risk of symptomatic infection by 81 percent. There were no more side effects than with the placebo.

Monoclonal antibodies for routine prevention in immunocompromised people—not just prevention after exposure to someone infected—are likely coming down the pipeline too. Last week, AstraZeneca applied for an emergency use authorization for a combination of antibodies that the company announced was highly effective in preventing COVID in an unvaccinated and high-risk population—and that researchers hope may offer protection for up to a year after dosing.

I was the first person to get antibodies for prevention of COVID at the hospital where I’m a patient. I was first because I’m privileged: I’m fluent in medical language, well-connected, have the ability to self-advocate, and am lucky to have excellent doctors at a major academic medical center. Just like the vaccines, the antibodies are currently free to patients, paid for by the government—so while supply shortages have begun to play a role, the barriers for immunocompromised people to access the drugs have largely been due to logistics and lack of awareness among both doctors and patients.

Though there’s no data on exactly how many people have gotten the monoclonal antibodies to reduce infection after coronavirus exposure but prior to disease, I’m sure it’s not many, both from my own experience as a physician and from conversations with friends across the country who are doctors. Although use of the drugs for treatment has shot up during the delta surge, immunocompromised people require separate locations from COVID patients to receive the cocktail, with the need for extra staffing and new protocols, and most hospitals and clinics have not put these systems in place. The logistics of distribution and administration are complicated. The timing has to be right: The antibodies ideally must be given as soon as possible after exposure. The facilities that could dispense them are already stretched thin. The ability of the drugs to protect immunocompromised people has been publicized little, a remarkable failing in government messaging.

But we’ve overcome huge research and public health barriers as a nation to ensure access to other proven, effective prevention and treatment measures for the coronavirus, from remdesivir to vaccines. We need to do what it takes to provide monoclonal antibodies for prevention too, which shouldn’t be available only to highly privileged people like me.

A day after getting the antibodies, I flew across the country to see my extended family for the first time since the beginning of the pandemic. I played cards with my grandma, cooked huge meals with my cousin, played hide and seek with the older kids, and pushed the 2-year-old’s stroller around at supersonic speed while he screamed in delight. When I saw my aunt, it was the first time I’d given someone a hug in a year and a half.

On my flight home, I thought about the hundreds of thousands of people who are bound to me by the commonality that the coronavirus shapes every aspect of our days. I had just experienced the joy of living free from that specter, of remembering what it’s like to feel that life is infused with possibility. They deserve that too.