More than a month after Massachusetts hospitals began offering a high-profile new COVID-19 therapy, only a few hundred patients have received it. Many of them live in Berkshire County.
One week into the new year, just under 370 Massachusetts residents had been treated with monoclonal antibody therapy, according to the Department of Public Health. At that point, Berkshire Health Systems was responsible for administering one out of every four doses.
Even as other hospitals have begun to accelerate their programs, BHS remains a clear leader in the pack, administering more doses than larger hospital systems in Central and Eastern Massachusetts.
Monoclonal antibody therapy is an experimental treatment intended to help high-risk COVID-19 patients who have not been hospitalized yet. While the evidence is not conclusive, early studies show it might help keep patients out of the hospital if delivered early during the course of the disease. High-profile patients such as President Donald Trump have received the therapy, and the treatment has been promoted by the U.S. surgeon general.
But, the drugs have been underused nationwide since they were authorized for emergency use, and uptake has been no better in Massachusetts. By Jan. 8, the state had used fewer than 6 percent of doses allocated by the federal government, according to U.S. Department of Health and Human Services data, as beleaguered hospitals struggled to find healthy staff, willing participants and resources for inpatient clinics amid a COVID-19 surge.
At Berkshire Health Systems, hospital leaders have decided that getting the drug to high-risk patients is worth the investment. As of Friday, BHS had given some 150 infusions, according to the hospital system. Meanwhile, Tufts Medical Center in Boston told The Eagle it had administered 94 doses as of this week, while Springfield’s Baystate Medical Center said it had given out 45.
Doug Salvador, chief quality officer at Baystate, said earlier this month he believed Berkshire Health Systems had administered more doses than any other hospital system statewide.
“I’d give them credit for saying, ‘We believe this may work, we’re going to be creative, and we’re going to find as many ways as possible to engage people,’” Salvador said.
At Baystate, he said, a huge hurdle has been racing against time after a patient’s symptoms start. The Food and Drug Administration authorized the therapy for use within 10 days of a patient’s first symptoms, which leaves a short window for that patient to receive a positive test result, hear about the treatment from a doctor, sign up and come in for an infusion.
“If it does work, it’s almost certain that it works best early in the infection,” Salvador said. “But, there are still lots of parts of the state where, from the time you get a test to when you get the test result back, it just takes too long.”
The delivery of the drug also demands significant staff resources, between an hourlong infusion and another hour of direct supervision for possible side effects. A surge of COVID-19-positive inpatients and a corresponding staffing crunch have limited Baystate’s ability to staff its outpatient clinic, a sentiment echoed by hospitals across Massachusetts.
“It’s a pretty involved process,” Salvador said. On top of all of that, he added, the drugs have not yet been proved effective. If leading health agencies eventually deem monoclonal antibody therapy the “standard of care,” he said, there likely will be a much more aggressive effort at Baystate and other hospitals to get it into patients’ arms.
Baystate had been administering two infusions per day as of last week, according to Salvador, with the goal of increasing that to four or eight. Other hospital systems, including Boston Medical Center, have reported similar rates.
All those numbers mean that, when it comes to this therapy, Berkshire Health Systems has outpaced significantly larger facilities, in much denser parts of the state.
An ‘end-to-end’ delivery system
“I think it’s the nature of who we are,” said James Lederer, chief medical officer and chief quality officer at BHS. “Because we are an isolated health care system in a small county, with no other competitors but also no other avenues of support, we have to be pretty self-sufficient.”
In other words, the hospital system’s geography, often a burden, has become a boon.
Lederer calls it an “end-to-end system.” The majority of the county’s testing goes through BHS, which means hospital nurses can recommend the therapy as a potential treatment when they report back a positive result. Most of the county’s primary care physicians either work for BHS or have a close affiliation with the system, Lederer said, which makes spreading word of the treatment that much easier.
The hospital system also has tried to blanket the county with infusion sites. There are two clinics operating — one is at Berkshire Medical Center and one is in North Adams — and the hospital plans to open a third site at Fairview Hospital in Great Barrington.
But, perhaps the biggest success story out of the system’s push to distribute the drugs has been the proliferation of on-site clinics at local nursing homes.
“I think that Berkshire may be unique in the state,” Salvador said. “I’ve not heard of any of the other health systems that are identifying nursing home patients and delivering it in the way Berkshire has.”
About two in every three monoclonal antibody therapy doses from the BHS supply have gone to congregate care residents, according to Lederer.
And the hospital system launched its long-term care clinics right out of the gate: Some of the earliest infusions were given to residents at Williamstown Commons Nursing and Rehabilitation Center.
Staff shortages temporarily slow distribution
Despite the program’s success, BHS has not been immune to the issues that have plagued other hospitals. At the end of December, a severe staffing shortage forced the system to slow its outpatient infusions and put a hold on clinics at long-term care facilities.
“If I have a ward full of patients or an infusion unit, the patients who are actively on-site here and ill are going to come first,” Lederer said.
But, as the number of new staff infections dropped from a high of 15 each day to just one or two, Lederer said, the pace of infusions picked up again. That included visits to Riverbrook Residence, a residential program for women with intellectual and developmental disabilities in Stockbridge, and Springside Rehabilitation and Skilled Care Center in Pittsfield, both of which have experienced recent outbreaks.
Lederer says long-standing relationships between long-term care facilities and the hospital have made it easy to get the drug to residents. Several of the county’s largest nursing homes are operated by BHS’ sister company, while the rest have close ties to the hospital system.
“Nursing homes know that their only site of support is Berkshire Health,” Lederer said. “So, if we have outbreaks that we hear about through test results … we can reach out to them and quickly get orders entered on their patients, get their consent given, and we can go there, if need be, rather than have their patients come here.”
Those treatments might have saved lives. While health experts caution that real-world data cannot substitute for controlled experiments, the results out of the county have been overwhelmingly positive so far. Out of all the high-risk patients who have received the treatment to date, Lederer said, only one has been hospitalized.
And, at the moment, there are no supply concerns.
“Right now, the state would love for us — all of us — to double or triple the distribution,” he said.
If you think you might be a candidate for monoclonal antibody therapy, contact your primary care provider. You also can visit the Berkshire Health Systems website at berkshirehealthsystems.org/coronavirus or call 855-262-5465.
The Eagle’s Amanda Burke contributed to this story.
This story has been modified to update the number of treatments given by the providers mentioned in the story and the total number of infusions statewide.