Transcription:
Infusion Therapy for Covid-19

Prakash Chandran: This Outer Banks Health COVID-19 podcast was recorded on May 14th, 2021.

While vaccines are slowly being distributed to the public, there's still people contracting COVID-19. Luckily, there's a way to jumpstart and protect a compromised immune system to help COVID patients feel better faster. We're here today with Dr. Bonnie Burnham, a hospitalist for the Outer Banks Hospital.

This is Outer Banks Health. My name is Prakash Chandran. Dr. Burnham, thank you so much for your time today. It's great to have you on. I'd love to start by hearing a little bit about yourself. Tell us where you're from, what is your educational background and what's your family life like?

Dr. Bonnie Burnham: I moved here about a year and a half ago from Virginia, where I had been practicing for several years. I went to undergrad actually at UNC Greensboro, medical school at Virginia Tech, and then residency back in North Carolina. I am married happily for the last 20 years and I have four children ages seven, five, four, and two. So they keep me very busy.

Prakash Chandran: You know, before we start talking about the topic of today, which is COVID-19 therapy infusions, I’d love for you to explain the job of a hospitalist.

Dr. Bonnie Burnham: So I am on the medical-surgical floor of the hospital. My job is kind of two-fold. I evaluate patients in the emergency room when the emergency room physician feels like the patient needs to be admitted to the hospital. I will go down, see and evaluate the patient, admit them if appropriate, subsequently take care of them on the medical-surgical floor until they're stable for discharge to home.

Prakash Chandran: Yeah. You know, I've heard a lot of great things about the hospital's medical-surgical department, and I'm sure that they're glad to have you up there. So, let's now talk about the monoclonal antibody infusion. Can you tell us exactly what that is and what it does?

Dr. Bonnie Burnham: So the monoclonal antibodies are proteins that are actually made in a lab. They mimic the immune system's ability to fight off viruses like COVID-19. They are not a live virus and they're not made from live viruses, so you cannot catch COVID-19 from getting these antibodies. The goal of the antibody infusion is to reduce the severity of illness and how long that you're ill. So basically, it makes you feel better quicker.

So currently, all of the monoclonal antibody infusions that are being used for COVID-19 are all emergency use authorized medications. So what that means is that these have been specifically authorized by the Secretary of Health and Human Services to be used during an emergency, like the pandemic we're currently having.

This also means that the FDA has not officially approved these medications at this point. They have gone through clinical trials with the FDA to determine the safety and efficacy of the medicine, but they have not gone through the full FDA approval process. So the infusions that we're currently providing at the Outer Banks is called bamlanivimab and etesevimab. And I'm going to call it bamlan for short, if that's okay, because that's a mouthful. And again, these are investigational, so anytime a patient's interested in this, I will always call them in and consent them before they receive the medications and again just explain to them that this is a medication that's not been FDA approved.

So we use it really in patients with mild to moderate COVID symptoms. Patient has to reach certain markers to be eligible for it. And I'll go over that a little bit later. The combination of medications is now something that we're using because of the new variants that have been coming out and it's found to be more effective, we hope, against the new variants that are coming up.

Prakash Chandran: Dr. Burnham, I think just for the audience, I'd love some clarification around the existing vaccines that are out there that are, you know, meant to protect us from COVID-19 and the infusion. What are high-level differences between the two? And when would you use infusion versus a vaccine to protect you?

Dr. Bonnie Burnham: So vaccines are meant to protect you from getting COVID-19 and the infusions are to help you feel better after you get COVID-19. The infusions are not going to protect you from COVID-19. They're not going to help you not get the infection. But if you do get the infection, hopefully, it will make you feel better more quickly and get your energy back and your appetite and gets you back on track much more quickly. The only other caveat I'd like to add is that, if you have not received your COVID-19 vaccine and you get the infusion, you do need to wait 90 days between the infusion and your vaccine.

Prakash Chandran: That makes sense. So let's move on to some of the outcomes that you've seen as a result of doing this antibody infusion.

Dr. Bonnie Burnham: Sure. So we've actually been doing the infusions since December of 2020. To date, I know they've done hundreds of infusions down in the AMU. We've seen a lot of really good outcomes. The staff here is amazing at following up with the patients. They call every 24 to 48 hours to check on them. And about 90% of the patients report feeling a relief of symptoms and improving symptoms within the next 24 to 48 hours.

Prakash Chandran: Wow. That's a pretty quick recovery time. Are there any risks that people should be aware of?

Dr. Bonnie Burnham: Yes. And with any medication, there's always risks. And because this is an emergency use authorized medication, the list of risks that I have to read patients is very long and a little scary. But we have to read them this so that they understand that, you know, there are risks and this has not been FDA approved.

We have not seen a lot of reactions here, which is good. But the possible side effects are allergic reactions, worsening symptoms after treatment, like infusion site reactions, patients can have an anaphylactic reaction to this medication, nausea, vomiting, headache. Again, we don't see a lot of that, but there are a lot of potential risks as with any medication.

Prakash Chandran: Yes, absolutely. So let's dive a little bit deeper into the qualifications for the infusion. You know, I think you mentioned that they had to test positive for COVID, mild to moderate symptoms, but how specifically are patients selected?

Dr. Bonnie Burnham: So they also look at when their symptoms started. The goal of this infusion is to get it started as soon as symptoms start. That's when we find that it has the most benefit. Beyond that, we look at kind of high-risk indicators as to who is approved for the medication. For example, for adults having a body mass index greater or equal to 35, if they have chronic kidney disease, if they have diabetes, if they're on immunosuppressive therapy. If they're age 65 or older, they qualify. If they're age 55 or older, and they have cardiovascular disease, hypertension, COPD, they would qualify as well.

And kids, adolescents, can actually get this infusion as well. We're offering it to ages 12 to 17, but they have to have some kind of co-morbidity or a BMI greater than 85%, asthma, reactive airway disease, something along those lines.

Prakash Chandran: What does the cost look like? I know you said that it hasn't gone through some of the official approvals yet. So does insurance pay for the procedure?

Dr. Bonnie Burnham: So because it's an emergency use authorized medication, there actually is no cost for the medicine. Insurance may be billed for a facility charge or an infusion charge, something like that. But at this point, insurance companies are currently covering the cost at 100%. We do not want costs to be a barrier to any patients. So there are certainly things we can do to help. And if that's a concern, they should absolutely let us know.

Prakash Chandran: Yes, absolutely. So, you know, just as we close here, it's amazing to hear about this infusion type therapy and that there is science out there to help people, even if they get COVID, to feel better faster. Any final notes that you want to share about this innovation of infusion therapy?

Dr. Bonnie Burnham: A lot of people hesitate because it is an emergency use authorized medication. And I understand that hesitancy, but the risks of not getting it, of course, are potentially, you know, feeling worse and not getting better as quickly as you can. I just really encourage patients to consider getting it because it can be just one more tool we can use to get you back on your feet quicker and get you back to feeling like yourself.

Prakash Chandran: Well, Dr. Burnham, thank you so much again for your time. We truly appreciate it. That's Dr. Bonnie Burnham, a hospitalist for Outer Banks Hospital.

All the infusions take place at the Outer Banks Testing and Therapy Center, which is located at 4917 South Croatan Highway in Nags Head, North Carolina. COVID-19 testing is also performed at the center from 7:30 AM to 2:45 PM, Monday through Friday. Therapy infusions are performed in the afternoon, Monday through Friday.

For questions or to make an appointment, call (252) 449-6175. Further information can also be found at theobh.com. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This is the Outer Banks Health podcast. My name is Prakash Chandran. Stay well.