Scott Swanson
When Ridgeway Health opened a walk-in medical clinic late last September, founder Dr. Sam Milstein and his staff soon found themselves facing a challenge: a rush of COVID patients looking for treatment.
They went from “six patients a day for the first three weeks” to “30 to 50 a day,” coming from “the entire Pacific Northwest.
“We had one-and-a-half providers. We had to surge up with staff to 22. In the first six months we saw 2,200 patients.”
A little over half of those were people with COVID symptoms, they said.
Part of the reason for that is Milstein and colleague Dr. Tim Hindmarsh decided to try a treatment for COVID that wasn’t widespread across Oregon: monoclonal antibodies.
The treatment involves infusion of monoclonal antibodies, “proteins developed in a lab in order to fight off infections that our bodies aren’t familiar with, like COVID-19,” according to the Oregon Health Authority. The antibodies mimic the human immune system’s response to the SARS-CoV-2 infection that causes COVID-19.
“You’re essentially getting a passive immunization – I hate to use the word ‘immunization’ because now it’s just become something it’s not – of antibodies,” Hindmarsh said. “So the end stage of what your body’s supposed to do when it sees a threat, you get those right off the bat. It attacks the COVID virus and signals to other cells to destroy the virus.”
He noted that monoclonal antibodies are used to treat diabetes, migraines, HIV, herpes and other maladies.
“It’s actually a very elegant way of producing drugs, using biologic entities rather than chemistry.”
Milstein said his clinic was able to procure treatments for outpatient use shortly after they became available in Oregon.
Ridgeway, he said, was one of two outpatient clinics to have applied for allocations of Regeneron, which was the then-experimental treatment administered to President Trump in October of 2020.
The FDA gave the treatment emergency authorization in late November.
Monoclonal antibody treatment is intended for patients who show early symptoms of COVID, he said.
“Don’t wait until you have severe symptoms because, more than likely, it’s too late.”
“It works best in the first five days,” Hindmarsh said.
“The earlier the better,” Milstein added.
Patients were eligible for the treatment up to 10 days from onset of symptoms, he said. For those who got it, “it basically cut the duration of the illness in half,” he said. ”
Hindmarsh said that using Regeneron, the treatment Ridgeway employed most widely, “people were usually pretty much done by 48 to 72 hours.”
Then they got newer varieties.
“Sotrovimab was like a light switch,” Hindmarsh said. “It’s really bizarre. That may be because the variety itself was less severe. But it worked good.”
Within two weeks of applying, they had treatments, Milstein said.
“Initially, we requested a small amount, because there was a limited supply,” he said. “It was gone in a hot second, so we increased allocation requests and continued to receive substantial inventory.
“I think, at the time, there were only eight, 10 or 12 places in the entire state that were on the allocation list. At one point we had the state’s largest stockpiled repository of Regeneron.”
“Because we kept asking,” Hindmarsh said.
While they certainly were not the first to offer Regeneron and other monoclonal antibody treatments, word got around and they started seeing patients, not just from east Linn County but as far away as Arizona, California, Nevada, Washington, Milstein said.
They attributed some of those cases to what he described as “the erosion of trust between providers.”
One woman, they recall, had contracted COVID and drove with her husband from Lake Oswego because her primary care provider told the woman, who was in her second trimester of pregnancy with her first baby and had not been vaccinated, that she had a 15% chance of dying or losing her baby, of having her baby die from COVID, “and berated her because they weren’t immunized,” Milstein said.
The couple drove to Ridgeway, the final arrivals of the day, he said, “in tears.”
“I was so astounded, shocked, offended and hurt by the violation of trust. I pulled Tim in because I wanted to be sure I wasn’t hallucinating. COVID can have some very serious complications, but the vast majority of people do not need treatment.
“It was really quite unconscionable.”
“Amazing,” Hindmarsh said.
“I said, ‘There’s not a shred of data that suggests that you have a cold, you and your baby. You’ll be fine.'”
The doctors noted they did have patients who ended up in hospital emergency rooms, including one, they recall, who initially refused monoclonal antibodies treatments and came back “looking horrible,” as Hindmarsh put it, whom they sent to the hospital.
They also can cite cases of people who suffer from “long-term COVID,” as it’s come to be known, or “Long-Haul COVID.”
One, a trauma surgeon in another part of the country who is a friend of Hindmarsh’s, got COVID early on in the pandemic.
“She didn’t get that sick, but then she got long COVID and was disabled for the better part of half a year. She couldn’t walk to the bathroom. It’s just bizarre.
“In those younger cohorts, the younger healthy people that got it, got really sick, there’s clearly some, you know, genetic diathesis (tendency to suffer from a particular medical condition) that those people have,” Hindmarsh added. “There’s some weirdness, some auto antibody that they produced, or something.”
Milsten said they were interested in treating people with long-haul COVID and looked into various “complementary alternative medicines, treatment modalities” for use with patients who didn’t qualify for monoclonal therapy.
“NAD and Glutathione had some good data about their use and COVID. So we got some and started using it and it’s actually been pretty well received, especially with long-haul COVID.”
Essentially, Hindmarsh added, those treatments are “vitamin infusions.”
They said it worked.
“Especially for Long-Haul,” Milstein said. “It took people’s fever away and I don’t know how you do that without Tylenol, Ibuprofen or steroids.”
He said case and outcome numbers issued by the state are not reliable because hospital emergency room case and admission rates should be collated with the state’s test and death report results.
“Did Albany have the same case rate as the rest of Linn County, but a higher ER visit and admission rate than Lebanon and Sweet Home? Because if we treated 700 patients, that’s a significant dent in the caseload,” Hindmarsh said.
He said that test numbers were skewed by types of tests used and the fact that “asymptomatic” people were tested, “which makes absolutely zero sense.”
Plus, he said, patients could have “a non-specific immune response in your nose” and “sniff up a little bit of COVID but you never get infected by it, you’re not a case. But if you have dead virus in your nose, you’re going to be positive.”
The pandemic has highlighted divisions and “cowardice” – Hindmarsh’s word – within the medical field.
“Group-think and pseudoscience has been amazingly pervasive in western medicine for as long as you choose to remember,” he said, citing various previous examples, such as the opioid crisis. “This just kind of brought it out.
“We didn’t do anything that was particularly unique,” Hindmarsh said. “We weren’t Pierre Kory coming up with Ivermectin protocol and starting the (Front Line Critical Care Alliance). We weren’t out there.
“These were government-approved treatments that went through all of the same kind of rigor as the vaccines, had the same designation as the vaccines. And I’m like, ‘How come there wasn’t every single independent clinic in Oregon doing this?’
“I think it’s because of the group think of ‘there’s nothing you can do,’ plus a tremendous amount of fear, plus the political labeling that goes on with real COVID treatment.
“You know, you just have to be a doctor. I mean, are you risking getting sick, seeing COVID patients? Of course, yeah. But I never feared it.”
Hindmarsh added, chuckling, that he did get a case of COVID, but it was while he was riding to the Sturgis motorcycle rally in South Dakota.
Doctors’ job is to advocate for patients, Milstein said, “and act on their behalf on their beliefs and ethics, not ours. That’s a difficult bias to overcome, but it’s required of our profession.”
“When it comes down to it, go back to your fundamentals, your anatomy, your physiology, and the tenets of medical ethics – justice, non-malfeasance, beneficence, and autonomy.
“In the patient exam room, what goes on in that and the conversations that are hard are as sacred and holy as what happens in your bedroom, and sacrosanct.”