COVID-19 infection continues to impact Kentuckians with our hospitals and ICUs filling up with patients. Hospitals are straining to keep up adequate staffing, lifesaving medications are in short supply, and even ventilators are a scarce resource during the Delta variant surge. We learn more each week about the treatment for COVID-19 since that first case in Kentucky in March 2020. Patients who develop COVID-19 benefit from early use of monoclonal antibody treatments (such as Regeneron). Steroids, current antivirals and interleukin-6 inhibitors are reserved for the sickest patients requiring hospitalization. Multiple trials are underway to discover better therapeutic and preventative measures, and it is likely that there will be progress in the future.
One thing, however, is certain. We cannot treat our way out of this pandemic with just monoclonal antibodies, steroids and antivirals. New cases of COVID-19 are overwhelming the health care resources in the Commonwealth. We must utilize all our tools available to manage the COVID-19 pandemic, which includes a focus on prevention so we may avoid using the more expensive, resource limited monoclonal antibody. Monoclonal antibody treatments, like Regeneron, do not replace the need for vaccination, and they have their place – use early, not late for best effect.
Vaccination provides a long-term memory B, and T cell immunity that will allow the body to respond to future COVID-19 exposures without becoming critically ill and requiring hospitalization. Vaccination provides a protective template for the body.
The current vaccines protect against severe disease from COVID-19, including the Delta variant that is currently circulating. You are less likely to be hospitalized and end up on a ventilator in the ICU if you are vaccinated, even if you get a breakthrough infection. Most of our sickest patients in the ICU are unvaccinated (>90%). There are uncommon cases in the ICU who were vaccinated (usually < 10%), but most often they are patients who are immunocompromised or elderly who did not respond completely to the vaccine. Hence the recommendation for an additional booster.
Vaccination shortens the shedding of infectious virus in breakthrough cases compared to the unvaccinated as the immune system ramps up. Vaccination reduces the risk of secondary transmission in the household setting and, likely, the community. Immunity from natural COVID-19 infection may provide some protection against severe disease, but receiving a vaccine has also been shown to boost COVID-19 immunity. This may be especially important for those who had an asymptomatic or mild case of COVID-19.
Immunity is the key to getting past this pandemic. We still have many unvaccinated Kentuckians at high risk for developing serious consequences to COVID-19 infection. 28.3% of Kentuckians under the age of 65 years have a risk factor for severe disease if infected with COVID-19. Clinicians will use everything in their power to manage active infection, including advocating for better access to monoclonal antibodies for early treatment, as we develop new therapeutic agents in the future. Meanwhile, let us work on vaccinating our communities to protect our loved ones from becoming seriously ill and hospitalized from COVID-19 in the first place, so we won’t have to worry about access to a ventilator in the future.
Dr. Daniel Rodrigue, Lexington Infectious Disease Consultants, treats patients at Baptist Health Lexington, Saint Joseph Hospital and Saint Joseph East in Lexington.