From the Wright Center: The amazing power of monoclonal antibody infusion therapy

Weakened and barely able to walk, Kimberly McGoff arrived at The Wright Center for Community Health’s Mid Valley Practice with a distressing diagnosis of COVID-19 and another big reason to worry.

McGoff copes with lupus and related conditions that severely limit her immune system’s ability to fight disease, putting her at increased risk of developing complications from the virus that has claimed the lives of tens of thousands of Pennsylvanians.

It was a scorching day in August. Yet McGoff felt a penetrating chill as she crossed the parking lot and burrowed deeper into her winter coat, hoping to stop her body from shaking. Her husband and a few concerned Wright Center employees helped her shuffle into the Jermyn clinic, where she had an appointment to receive a treatment that, for McGoff and other high-risk patients, can seem like a miracle.

Called COVID-19 infusion therapy, it has been shown to lessen the severity of symptoms for certain patients, potentially quickening their recoveries, preventing hospitalizations and saving lives. The Wright Center began offering the therapy in mid-January 2021 and has so far infused more than 200 patients – many of whom report experiencing sudden, dramatic improvement.

“I immediately felt better,” recalls McGoff, a resident of Spring Brook. “I couldn’t walk into the room by myself, but I was able to get up, take my Wright Center blanket and walk out. Infusion therapy is an amazing thing. I don’t know what’s in it, but it’s amazing.”

COVID-19 infusion therapy contains virus-fighting proteins known as monoclonal antibodies. These antibodies are made in a laboratory to target a particular invader, in this case, the novel coronavirus. However, monoclonal antibodies perform the same defense function as a healthy person’s naturally occurring antibodies: identifying invaders, then latching onto and destroying them.

The therapy is a one-time treatment. Delivered via an intravenous infusion, it can easily be administered in outpatient settings such as a doctor’s office. A patient typically will spend much

of the appointment reclining on an exam table or in a comfortable chair, not unlike a visit to a blood-donation center. The entire appointment generally takes about two hours.

Among those eligible to receive the therapy are seniors, ages 65 and older, with mild to moderate COVID symptoms. Younger patients, ages 12 to 64, also are candidates if they have an underlying health condition such as a chronic lung disease (including moderate to severe asthma, cystic fibrosis and COPD), cardiovascular disease or hypertension, chronic kidney disease, diabetes, sickle cell disease and obesity.

The Wright Center has streamlined its referral process so that if a patient tests positive for COVID-19 at any of its primary care practice locations in Northeast Pennsylvania, the individual can be immediately scheduled for infusion therapy.

In one instance, a Wright Center team even provided COVID-19 infusion therapy at an off-site location – treating nine residents of a Scranton-area senior living community in a single day. All of those residents have dementia, and some experience agitation, which posed extra challenges to the care team, recalls Sheila Ford, R.N., associate vice president of clinical quality and patient safety.

“Not one of those patients wound up in the hospital,” she says, calling the situation “a historic event for The Wright Center and our collaboration in the community.”

Jignesh Sheth, M.D., chief medical officer for The Wright Center, orchestrated the rapid rollout of the therapy when it first became available to the health center. Only weeks later, Dr. Sheth dispatched a team to the senior living community to tamp down its cluster of COVID cases. Based on his observations, he now refers to monoclonal antibodies as “the unsung heroes when it comes to the fight against COVID-19.”

‘I was so scared’

The U.S. Food and Drug Administration granted emergency use authorization amid the pandemic to a handful of COVID-19 monoclonal antibody therapies. As with any medicines, they come with potential side effects, which in this case include allergic reactions and infection at the intravenous site.

Bryan Refice, The Wright Center’s Employee Health Nurse and Credentialing Coordinator, advises coworkers about the therapy if they test COVID-positive. “Since we began offering the therapy earlier this year, we haven’t had any emergencies,” he says. “In some cases, people have even said to us, ‘I believe you saved my life.’”

Infusion therapy must be administered within 10 days after a patient’s symptoms first emerge and/or after a positive COVID-19 diagnosis. “We prefer to get you infused within the first 48 hours after testing positive,” says Refice, “just so your symptoms don’t worsen.”

For McGoff, 50, who is a Wright Center employee, her symptoms started mildly on a Monday morning, with watery eyes, and soon steamrolled. By that evening, she had a pounding headache. Then fatigue. Overnight, she awoke with chills and took her temperature: 102.9 degrees.

“Automatically, I just got up, took my pillow and went to another room,” she says. “In the morning I sent my husband a text message saying, ‘I’m pretty sure I have COVID.’ I was so scared.”

Although fully vaccinated, McGoff knew she was in a vulnerable spot. Due to lupus and a disorder known as Sjogren’s syndrome, her immune system can sometimes go haywire. The common cold can knock her out of commission. Plus, she is a regular user of an inhaler to control lung issues. For her, something as nasty as COVID-19 can be lethal.

Linda Thomas-Hemak, M.D., president and CEO of The Wright Center, recognized the implications that COVID-19 infusion therapy can have for certain high-risk patients and identified it in January as a must-have for the organization. Within days, employees contacted the U.S. Department of Health and Human Services, received a shipment and performed an infusion.

“We do things quickly here at The Wright Center if it’s to help our patients,” says Ford.

She and other registered nurses, including Beverly Birch and Kari Machelli, conduct the infusions. Treatments typically are given on weekdays at the Mid Valley Practice, 5 S. Washington Ave., Jermyn, although patients faced with transportation or other hurdles can be helped as needed at the Scranton Practice, 501 S. Washington Ave.

A momentary lapse

McGoff and her husband had been extremely cautious, wary of contracting the virus since it first reached Northeast Pennsylvania in early 2020. They adopted household protocols to protect her.

At the end of each workday, upon arriving home, McGoff went directly to the basement where her husband would leave a fresh change of clothes. She would slip into a robe, then shower and put on the clean outfit, immediately tossing that day’s work clothes into the washer. They suspended their social activities, declining visits even with family members.

“We didn’t see anybody,” says McGoff, a North Pocono High School graduate. “We didn’t do any holidays. It was the two of us, and we just kind of stuck together – apart from going to work. And we were really careful at work, too.”

McGoff is employed as The Wright Center’s Manager of Dental Operations. In the earliest days of the pandemic, she considered requesting a leave of absence. After talking with her supervisors, however, she was completely comfortable with the organization’s multiple safeguards to protect employees and patients. She stayed on the job as COVID cases surged in 2020, even transferring to the front lines of the medical clinic for a while, helping to check in its patients while the dental clinic was temporarily shuttered. “Not once did I feel that I wasn’t safe,

which was great,” she says. “I was able to continue working and I was able to help amid the pandemic.”

But after nearly 18 months without a slipup, and admittedly emboldened because she was fully vaccinated, McGoff briefly let down her guard – and her mask. She was at a community event in downtown Scranton on a Friday. She left after 15 minutes, concerned about overcrowding. Three days later, she was ill.

‘Elephant on my chest’

Receiving the results of her COVID test on that August morning was a blow to McGoff, erasing her sense of security.

The virus punished both her body and spirit. “I never felt that sick before,” she says, recalling how her lungs struggled for oxygen. “It felt like there was an elephant on my chest. I could not breathe. And what I could get in, I could not get back out.”

Arriving for her infusion therapy appointment, McGoff could sense her condition getting worse. She briefly felt as if she might pass out. Then, the infusion process began. “The process is easy and quick,” she says. “It’s a little pin prick as they hook you up. That’s it.”

She spent the duration of her appointment with headphones on, playing a game on her phone. “By the time the infusion was over, I felt so good,” she remembers. “On a scale of zero to 100, I was 20 when I went into the clinic. And when I left, I felt like 50.”

For some recipients, infusion therapy seemingly kick-starts a fast and full recovery. That was the case for 27-year-old Lauren Nardelli, manager of The Wright Center’s Scranton Practice, who contracted COVID-19 this summer.

“About a half hour into the infusion I felt relief,” says Nardelli, who copes with asthma. “As the therapy went on, I was like a totally different person. I was more alert. I could breathe. At that point, I knew that I was going to be OK.”

‘I’m going to beat this’

For McGoff, however, recovery was less certain. Out of caution, she visited a hospital emergency room soon after her infusion therapy to get checked for pneumonia. Her lungs were infection-free, she was told. An emergency room physician also validated McGoff’s choice to get infusion therapy, telling her “I can’t believe how good you are doing considering your health issues,” she recalls.

Even so, McGoff’s worries didn’t subside for several days. She quarantined at home, finding the isolation difficult, especially at night. She developed a routine of setting her alarm clock to go off every one to two hours, rousing her so that she could check her vital signs and assess her condition. She didn’t want to decline overnight, with no one near her, no one to hear her, no one to help. She did not want to be put on a ventilator. She did not want to die alone.

“That was one of the most scary things during isolation: I had no one there to check me,” she says. “Who’s going to save you?”

McGoff credits a loyal network of people for helping her get past COVID’s assault on her mental health during quarantine. Her husband would watch TV with her, pulling up a chair to her window and watching through the glass. Family members, neighbors, friends and colleagues all supplied frequent check-ins, calling, texting or sometimes talking through the window.

Likewise, The Wright Center’s employee-health team offered continual support. “We have a great team,” McGoff says. “They called me every day, asking: ‘How are you? What’s your temperature? Did you eat anything? Do you need anything?’

“That contact is huge when you’re sick,” McGoff adds.

Most insurances cover the cost of receiving COVID-19 infusion therapy. For patients who don’t have the ability to pay, The Wright Center offers a sliding fee scale. A patient who receives the therapy should wait 90 days after treatment before getting a COVID-19 vaccine, according to health experts.

It took nearly five days after McGoff’s infusion before she finally was confident enough to tell herself, “OK, I’m going to beat this.”

She has since recovered and returned to work at The Wright Center. But as a result of her COVID scare, she and her husband decided to fully embrace their pandemic-era precautions. They cancelled two scheduled vacations and scrapped plans for social get-togethers.

“We’re going back to our old protocol,” says McGoff. “We’re not going out. We’re just going to take it easy and stay safe.”

For more information about COVID-19 infusion therapy or to schedule an appointment, visit TheWrightCenter.org/covid-19/ or call 570-230-0019.