Straight-talking Alaska pharmacist on COVID and seniors
October 1, 2021 | View PDF
Coleman Cutchins is a clinical pharmacist with Department of Health and Social Services. He has a Doctor of Pharmacy degree and is board certified in pharmacotherapy, the treatment of disease with drugs. He has a long history in research, and working with infectious diseases. I interviewed him September 6. These are some highlights.
What have you been focused on recently?
I've been on this [COVID] team since really right after the Wu Han flight landed. At least 80% of my time or so has been on COVID. In the last two, three weeks with cases being the way they are and hospitals being overwhelmed, it's been more like 150%.
We hear a lot about the use of monoclonal antibodies for the treatment of COVID. Can seniors benefit from that?
With monoclonal antibodies, we're giving you synthetically produced antibodies that have a target on one side of it to the virus, and a target on the other side for your immune system. It's essentially not quite as good, but it's almost like if you could go back in time and vaccinate somebody. But they're not nearly as effective as vaccine. They also have a very narrow window when they're most effective. As early as possible from symptom onset and testing positive is when they're most effective. You start to get a diminishing return to the point when somebody is in the emergency room about to get hospitalized. Then it's too late. They're not effective.
So, with seniors and monoclonal antibodies, I would say not everyone is a good fit for these drugs. They're difficult to deliver. They're either given via intravenous infusion or subcutaneous injection. And you have to have a one-hour observation time afterward, because there is a very rare risk of anaphylaxis, similar to what we think of with vaccines.
[However,] a lot of seniors will qualify -- unvaccinated for sure. Vaccinated, I always think of it more like the people...with immunocompromising conditions. They are probably going to benefit a lot more from monoclonals, but really, you have to make that decision with each patient.
If we're standing on the edge of a cliff, a good guardrail is our vaccine. It prevents us from falling over the cliff. Monoclonals are sort of like a safety net about 10 feet down. It's a lot safer to not fall over that cliff in the first place, but that safety net 10 feet down is better than falling all the way down. Vaccine is really the best tool we have. And 25% of those over 65 in this state are unvaccinated. That is that is not a small number of people.
Who would we see to be evaluated for the monoclonal antibodies treatment?
As soon as you test positive talk to your primary care provider. If you don't have a primary care provider, or if your primary care provider isn't educated on monoclonal antibodies, then our state vaccine hotline has been converted to a vaccine and monoclonal hotline. That's 907-646-3322.
Monoclonal antibodies are the only therapy for people not admitted in the hospital, proven to be safe and effective. And it's the only one recommended by medical guidelines. There's a lot of misinformation out there about other drugs, and nutritional supplements and vitamins -- none of those have any evidence to support their use. It's scary to me because here we have a drug, and this is what people should be seeking out if they need treatment.
Do you have any last comments that are really important for the readers?
I think the thing right now that's really disheartening for me is how much misinformation there is about any other drugs or vitamins or nutritional supplements. You know, we're at a really different time in the pandemic now. I think we have more hope than ever right now.
If you think about where we were a year ago, we didn't have vaccine, we didn't know about monoclonal antibodies, we didn't have a very good protocol for treating hospitalized patients. It was scary a year ago. Now you fast forward to where we are. Now we have vaccine, which is our best tool. We have monoclonal antibodies, which are sort of that safety net, and we have a much better idea on how to treat hospitalized patients. Moving forward, as long as we can get our vaccine rates up and keep our hospitals from being overwhelmed, we have a much better idea how to treat and manage people with this virus.
Please look at the reliable sources like the Food and Drug Administration, Centers for Disease Control and Prevention, National Institutes on Health, Infectious Diseases Society of America, and not fall victim to social media and these other websites that are touting treatments and cures that are not evidence-based and not grounded in any type of research.