Up Close | UCSF Fresno Provides Therapy to Prevent Infection in Adolescents and Adults Whose Bodies are Unable to Fight COVID-19

Soon after Evusheld, an antibody therapy was approved in December 2021 for the prevention of COVID-19 infection in people with weakened immune systems, Phyllis Farrow called the UCSF Fresno Mobile HeaL COVID-19 Equity Project (CEP) for an appointment.

“I think I was your second patient,” she said.

Farrow, 66, of Fresno, came to CEP in January after a blood test showed a medication she takes for multiple sclerosis had depleted her immune system and she had no antibodies to COVID-19, even though she was fully vaccinated. “It was like I never even got a vaccine,” Farrow said.

People with compromised immune systems are unable to mount a strong immune response to the coronavirus and are at higher risk for serious illness and hospitalization. About 30,000 residents in Fresno County could be candidates for Astra Zeneca’s Evusheld (tixagevimab co-packaged with cilgavimag), according to the Fresno County Department of Public Health. People who can benefit from the antibody therapy include cancer patients, people who are taking medications for the control of autoimmune diseases such as lupus, people who have HIV and patients with asthma who require large doses of steroids to control the lung disease, among many others.

Evusheld received emergency use authorization in December by the U.S. Food and Drug Administration as a prevention of COVID-19 for adolescents (aged 12 and older who weigh at least 88 pounds) and adults with moderate to severe compromised immune systems and for those who have had an allergic response to COVID-19 vaccine.

Evusheld is a long-acting antibody combination for pre-exposure prevention of COVID-19. Unlike other monoclonal antibody therapies, Evusheld is not a treatment for active COVID-19. It is not given to anyone who is currently infected or who has been exposed to a person infected with COVID-19.

Monoclonal antibodies are not substitutes for vaccines, said Kenny Banh, MD, an emergency medicine physician, CEP medical director and assistant dean for Undergraduate Medical Education at UCSF Fresno. “Vaccines are the most effective protection against COVID-19 infection for people with healthy immune systems.” Evusheld is for people who fail to get protective immunity from vaccine and for those who have an allergic response to vaccine, he said.

Rais Vohra, MD, a UCSF Fresno emergency physician and Fresno County interim health officer, encourages people with suppressed immune systems to avail themselves of Evusheld. “While vaccinations and boosters continue to offer great protection against COVID infection, we recognize that some patients may not become fully immunized with a vaccine due to other conditions or medications. The long-acting antibody, Evusheld, is another breakthrough in the fight against this virus, and will protect our most fragile patients with another layer of immunity for up to six months. I really hope that people are able to access Evusheld, and I am so proud of our UCSF Fresno COVID Equity Project and Community Health System hospital partners for stepping up and providing this medication.”

The federal government is providing Evusheld free to those who are eligible. A doctor’s prescription is not needed and testing for antibody levels is not required beforehand. “Most of the people who have immune conditions will be low on antibodies, so testing is not worthwhile,” Dr Banh said.

Evusheld, which is administered as two separate intramuscular injections at the same appointment, appears to be effective against omicron and other known variants of COVID-19, Dr. Banh said. More information about Evusheld is available on the UCSF Fresno CEP website.

If you are a candidate, you should get it from wherever you can,” he said. Locations of other Evusheld providers are available on the Fresno County health department website.

Farrow expected to have to travel to the Bay area or Los Angeles to receive Evusheld, but UCSF Fresno’s CEP made it easy to get, she said. “I called. They’re so nice. So helpful. They sent me the application. I filled out the application and in less than two hours they called me back and set up an appointment for me,” she said. “I can’t say enough good things about UCSF (CEP).”

Without antibodies to protect her from COVID-19, she had severely restricted activities to mostly medical appointments and her part-time job at a nonprofit, where she works with just one other person.  “I don’t want to do much,” she said. “But I want to be able to go back to the supermarket. Back to playing pan (a card game). Back to in-person meetings … and now I can allow friends from New York to come visit, which I had to cancel them coming last month.”

Evusheld begins providing protection soon after it is administered, and Farrow had plans to play cards with seven friends on the evening following injections she received on Feb. 28 (the injections were a follow-up to those she received in January per revised dose recommendations announced by the FDA on Feb. 24, 2022).

Providing Evusheld is another free service that the UCSF Fresno COVID-19 Equity Project is pleased to have for residents of Fresno County and the San Joaquin Valley, Dr. Banh said. CEP’s mission is to bring equal access to barrier-free health care services to residents of medically underresourced communities in the San Joaquin Valley, in partnership with community-based organizations.  “I just want to make sure we can protect as many people in the Valley, and especially the high risk patients,” Dr. Banh said.