Cullman Regional

After nearly a year of caring for COVID-19 patients, medical professionals have learned more about treating the disease. One lesson has been the importance of early intervention for high risk patients, said the chief medical officer at Cullman Regional Medical Center.

“We have developed a better understanding of the two phases of this disease: the first phase is when the virus is replicating and doing damage and lasts about 10-14 days; the second phase is the inflammatory phase when the body is literally attacking itself with a massive inflammatory response and begins about day 10,” said Dr. William Smith. “This understanding allows more timely and effective applications of the available treatments and explains why many treatments are not effective late in the illness.”

One such treatment is the use of monoclonal antibodies, which are laboratory-made proteins that act as substitute antibodies. It’s a treatment used previously for cancer, rheumatoid arthritis and some viruses. Donald Trump received the FDA-approved monoclonal antibody treatment Regeneron when he was diagnosed with COVID-19.

CRMC has used the treatment on more than 350 patients and only 12 have required hospitalization.

Monoclonal antibody treatment is authorized for use by the Food and Drug Administration to be used within the first 10 days of the onset of symptoms for patients in high risk categories.

Smith said, “Generally these are patients over the age of 65 with associated medical conditions such as diabetes, kidney disease, immunosuppressive disease, receiving immunosuppressive treatment, or obesity. Also patients over the age of 55 with cardiovascular disease or hypertension or chronic obstructive pulmonary disease or other respiratory disease.”

Early treatment is an important factor in monoclonal antibodies. “It is not an option for patients hospitalized due to COVID-19, or patients on a ventilator due to COVID-19, or patients who require oxygen therapy due to COVID-19, or patients on chronic oxygen therapy who are requiring increased amounts of oxygen as a result of COVID-19,” said Smith.

“Remdesivir also is more effective when given early,” he added. “Steroids on the other hand are more beneficial later in the course of the disease to treat the inflammatory phase.”

Because it’s difficult to predict how the virus will affect individuals, Smith cautions people to seek medical attention early. “Some of the most effective treatments for patients at the highest risk are only applicable early in the disease,” he said.

Developing these treatment options are important, he said, because even with vaccines, the virus is likely to be with us for a long time.

“No doubt vaccines will help, but unlike diseases like smallpox or polio, coronavirus vaccines will likely require regular booster shots making it difficult to ever have enough people vaccinated at one time to eliminate the virus completely, not to mention the mutations that might escape protection from some vaccines,” said Smith. “Treatments coupled with the vaccines have the greatest potential for preventing hospitalizations and saving many lives.”

The past year has also reinforced the importance of preventing the spread of germs. With people washing hands, avoiding close contact and wearing masks, the number of flu cases has been “drastically reduced,” said Smith.

“Given the greatly increased infectiousness of coronavirus, it is hard to imagine where we would be without at least most people wearing masks and following basic public health measures,” he said.

And even after people receive get vaccinated, they will still need to wear masks, Smith added. According to the CDC, its not yet known if getting the vaccine will prevent people from spreading the virus.

“While experts learn more about the protection that COVID-19 vaccines provide under real-life conditions, it will be important for everyone to continue using all the tools available to help stop this pandemic,” the CDC advises.