When people first started lining up to receive monoclonal antibody treatments at the convention center in Dalton, Georgia, last month in the hopes of fighting COVID-19, the city said prescriptions were not necessary for patients.
Given the somewhat intense nature of the treatment — involving four injections to the abdomen — some wondered how it could be done without a written order from each patient's doctor.
The answer? The Dalton effort is taking place under a standing order from Dr. Jason Nicely, emergency medicine physician at Hamilton Medical Center.
Officials planning the Dalton drive took inspiration from Florida Gov. Ron DeSantis, who launched a rapid response initiative for the treatments in August under an order from the state's surgeon general to waive the need for prescriptions.
Nicely issued a similar standing order for the city of Dalton that allows qualifying individuals seeking treatment to receive it without ever needing to contact their primary care doctor, officials said.
Under the standing order, any coronavirus-positive person considered to be at "high risk for progression to severe COVID-19, including hospitalization or death" can drive to the treatment site, present their positive test result and answer a few health questions to establish that the treatment is appropriate for them before getting it.
The pre-treatment interview includes questions such as when symptoms started and whether a person has been vaccinated and, if so, when the vaccine was received.
The following are examples of medical conditions that may put a person at risk of severe illness and therefore qualify them for monoclonal antibody treatments under Dalton's standing order: obesity, any autoimmune disorder, high blood pressure, heart disease, diabetes, a suppressed immune system, cancer, pregnancy, kidney disease, chronic lung disease and neurodevelopment disorders.
Those who are unvaccinated or older than 35 automatically qualify as high risk, as do those who are dependent on medical devices and those whose household family members have tested positive for COVID-19.
Patients who do not meet the criteria in Dalton are turned away without treatment. Those who do meet the criteria receive the four injections. The monoclonal antibodies mimic the immune system's ability to fight off harmful pathogens such as viruses and block the virus's attachment and entry into human cells, which has been shown to prevent serious illness and reduce hospitalizations by up to 70%.
Tammy Allen, a spokeswoman for Regeneron Pharmaceuticals in New York, said the monoclonal antibody treatments must be ordered by a health care professional, and all uses must be reported to the Department of Health and Human Services. She said Dalton's model is typical for how local clinics are distributing Regeneron's treatment.
"We've seen several models for treating patients, and they typically fall into two categories — an administration site where patients would have been evaluated by a health care professional who orders REGEN-COV and refers them to a site that's delivering treatment, or an administration site plus where patients can be evaluated by a health care professional and receive treatment in the same setting," Allen said. "It sounds like they are doing the second option, which is something we're seeing more and more."
Georgia Department of Public Health Communications Director Nancy Nydam said other hospitals and medical centers in the state have created similar standing orders that allow patients to receive treatment quickly and without the need for a doctor visit.
At all of the sites where those orders are in place, Nydam said, a health care professional should be present to ask screening questions. Someone should also follow up with patients after treatment as well, she said, to monitor any potential side effects.
"The important thing to remember is that whoever decides the treatment, because it's prescription-based, they are on the hook for that treatment," she said. "They're going to want to make sure they've done their own testing and assessment, as opposed to just accepting anything as truth. Then they'll want to check on them later."
Dalton City Council member Annalee Harlan, a former paramedic and local hospice company owner who has taken the lead at Dalton's treatment clinic, said health care professionals staffing the clinic give those who receive treatment a follow-up call exactly one week after they get their injections.
Patients are asked to report any side effects or worsening symptoms during the call. As of Friday, she said, no one had reported any negative effects.
"I've been saying that we think it is the sharpest tool in our tool belt right now for fighting COVID, and I really believe that to be true," Harlan said. "We have heard nothing but good things from people so far, and we are very optimistic about what these treatments could mean for the community and our local hospitals."
Hospitals in Dalton and the surrounding area have been burdened with overflowing intensive care units and emergency rooms over the past several weeks.
Hamilton Medical Center, which serves the Dalton community, and AdventHealth Gordon, a hospital in nearby Gordon County, both recently formed partnerships with municipalities to allow city and county employees to volunteer for paid shifts during which they would help with tasks such as stocking supply shelves and ensuring visitors are masking before entering medical buildings.
In a joint letter sent to the public earlier this week, public health officials from across North Georgia urged the community to get vaccinated. Vaccination, they said, was the best way for Georgians to ease the burden on local health care systems and their employees, as treatments such as Regeneron's do not prevent the spread of the virus, only its symptoms.
"We need your help like never before," they said in the letter. "The pandemic — its current surge driven by the highly transmissible delta variant — continues to spread throughout Northwest Georgia and is quickly becoming a pandemic of the unvaccinated. Most new cases, hospitalizations and people in our critical care units on ventilators and advanced oxygen support are unvaccinated. COVID-19 vaccination is our best tool for reducing the overwhelming strain on our health care system, health care providers and EMS personnel."
The letter was signed by North Georgia Health District Director Dr. Zachary Taylor, Northwest Georgia Health District Director Dr. Gary Voccio, Hamilton Health Care System President and CEO Jeff Myers, AdventHealth Southeast Region CEO Mike Murrill, Floyd Health System CEO Kurt Stuenkel, Harbin Clinic CEO Kenna Stock, Piedmont Cartersville Medical Center CEO Chris Mosley and Redmond Regional Medical Center CEO John Quinlivan.
Vaccines are still free statewide for everyone, and identification is not required when getting vaccinated.
For more information on how to get vaccinated in North Georgia, visit nghd.org or nwgapublichealth.org. Contacts for other COVID-19 vaccine providers in the area are available at vaccines.gov.
For more information about monoclonal antibody treatments or to find a clinic offering them, visit the Department of Health and Human Services website at bit.ly/ma-locations.
Contact Kelcey Caulder at email@example.com or 423-757-6327. Follow her on Twitter @kelceycaulder.