Health System Partners with Paramedics to Administer Monoclonal Antibodies at Home

A Michigan health system partnered with paramedics to administer monoclonal antibodies in the homes of patients with COVID-19, offering an innovative solution for administering the treatment while reducing the burden on emergency departments and cutting the risk of transmission.

The program, launched by St. Joseph Mercy Health System in February, was detailed in a recent research letter published in JAMA Network Open.

“The pandemic has been difficult for many reasons, but one of the challenges has been healthcare worker staffing—staffing and logistics and space,” lead author Anurag Malani, MD, CPE, FIDSA, FSHEA, medical director for the Infection Prevention and Antimicrobial Stewardship Programs at St. Joseph Mercy Health System, told Contagion.

Malani said the health system’s effort to partner with community integrated paramedics (CIP) to administer the monoclonal antibodies in homes was a successful real-world solution rather than a research project.

“Since this has been published in the last couple of days, I’ve had emails from people on the east coast, people on the west coast asking me more specifics because they’re thinking about how they may be able to replicate a similar type of process,” Malani said.

He said similar programs could use home care services or nurses, depending on the needs and available resources of the community.

From February to early May, 144 patients in the Michigan program received monoclonal antibody infusions in their homes. The mean age was 60.1, the majority (57.6%) were women, and 86.8% were White.

A team of three nurses reviewed cases at multiple hospitals in the health system to assess eligibility for monoclonal antibody treatment and worked with CIP to schedule home infusions with clinical support from a medical director.

In 13.9% of cases, patients were part of households where multiple members received monoclonal antibody infusions.

Eight of the patients (5.6%) were hospitalized for worsening COVID-19 symptoms and all were discharged after an average length of stay of 3.3 days. One patient was hospitalized with a hypersensitivity reaction and two visited the emergency department for hypersensitivity reactions but were not admitted.

Offering in-home infusions eliminates the need for patients and their loved ones to travel to a hospital emergency department or infusion center for monoclonal antibody treatment. At the time the program began, hospitals were facing a high burden of COVID-19 cases along with a surge in patients seeking care for other health needs after putting off care early in the pandemic.

The process of administering monoclonal antibodies takes a couple of hours, which can tie up beds needed for other patients in emergency departments. Administering the treatment in infusion centers also presents challenges of keeping COVID-19 patients separate from cancer patients and others.

The program demonstrated the ability of the healthcare industry to respond rapidly and adapt to meet needs.

“The pandemic has made us better,” Malani said. “Our ability to respond, our ability to adapt to new science and new evidence is much better. And I think we’re not in silos. It’s not my health system versus the other health system, or it’s our issue or it’s the paramedics’ issue. I really do think that public and population health, the hospitals and health systems have really tried to work together to respond to COVID, which I think is a silver lining.”

Monoclonal antibodies have emerged as an important tool in the fight against COVID-19. Currently 3 monoclonal antibody products have been approved for use in COVID-19.

In September, the Food and Drug Administration revised a previous emergency use authorization to allow a combination of bamlanivimab and etesevimab to be used for post-exposure prevention of COVID-19