Frequently Asked Questions

What are monoclonal antibodies and how do they fight COVID-19?

Monoclonal antibodies are laboratory-made proteins that mimic your immune system's ability to fight off harmful antigens like viruses. Monoclonal antibodies against SARS-CoV-2, the virus that causes COVID-19, block the virus from attaching to human cells by binding to the virus's spike proteins, making it more difficult for the virus to enter the human cell, reproduce, and cause harm. They also directly neutralize the virus, which allows the immune system to eliminate the virus. 

The sooner we treat, the better the outcome. The goal is to prevent COVID-19 symptoms from worsening and to keep people from becoming hospitalized. The hope is that symptoms will improve faster and patients will feel better after the infusion. The other hope is that with treatment, an infected person's symptoms are reduced, which would help reduce further spread of the virus.

What does the FDA say about these monoclonal antibodies and what are the side effects? 

 

Both bamlanivimab/etesevimab and casirivimab/imdevimab (REGN-COV) are currently available to use for the treatment of COVID-19 following its FDA's emergency use authorization (EUA). The FDA allows its use on non-hospitalized patients with mild to moderate COVID19 who are at high risk of clinical progression. They include the following patients:

  • Older age (age 65+)

  • Obesity (BMI >30)

  • Overweight (BMI 25-30)

  • Diabetes

  • Cardiovascular disease (including congenital heart disease) or hypertension

  • Chronic lung disease (e.g. COPD, asthma, interstitial lung disease, cystic fibrosis, pulmonary hypertension)

  • Immunocompromising conditions or immunosuppressive treatment

  • Chronic kidney disease

  • Pregnancy

  • Sickle cell disease

  • Neurodevelopmental disorders (e.g. cerebral palsy) or medically complex conditions (e.g. genetic or metabolic syndromes and severe congenital anomalies)

  • Medically-related technological dependence (e.g. tracheostomy, gastrostomy, or non-COVID19 positive pressure ventilation)

  • Other medical/social risk factors

The NIH recommends its use for COVID-19 in its treatment guidelines as authorized under the EUA (see here). 

The infusions are well tolerated. The main side effect we look for are infusion-related reactions and allergic reactions. During the infusion at the house call, I directly monitor you both during and after the infusion for any adverse reactions. If any adverse reactions occur, I take care of them right away. If any emergencies occur, we deal with those appropriately. Please let me know any medications you are taking, any history of infusion-related reactions, and any history of allergic reactions. 

Click on the link below for the Fact Sheets for the Monoclonal Antibodies for more information

 

Bamlanivimab/Etesevimab 

(Prescriber / Patient English / Patient Spanish)

Casirivimab/Imdevimab 

(Prescriber / Patient English / Patient Spanish)

Its use will depend on availability and the SARS-CoV-2 resistance pattern to variants. 

I tested positive for COVID-19, felt better, but now feel worse. I don't feel well at all and am really struggling to breathe. Can you come help me?

 

COVID-19 can evolve over time and many people, particularly those who are unvaccinated, may require hospitalization. If your illness is lasting more than 10 days, or you worsen at around the 7-10 day mark, it is very important that you are evaluated at a medical facility such as your primary care physician's office, an urgent care, or emergency room at a hospital, because people can develop COVID-19 pneumonia. House calls would not be right for you. 

If you have a life-threatening emergency (like a heart attack, stroke, or seizure) or you are struggling to breathe and in severe respiratory distress because of COVID-19, you need to go to the emergency room at a hospital, and calling 911 is the better idea.

I have health insurance. Do you accept health insurance?

 

I have temporary approval to take Medicare for the duration of a federally-declared public health emergency. 

Otherwise, no, I see patients outside of their health insurance and cannot process claims for house calls. I am considered out-of-network for private health insurance. I can give you an itemized receipt for you to submit to your insurance company, if you choose. They may or may not reimburse you back directly. Please verify your own health insurance benefits, as I cannot guarantee their payment. 

For patients traveling, I accept travel insurance, but I ask the travel insurance company to secure payment for the visit prior to the house call visit. 

What about labs and imaging? 

 

I do not have lab supplies such as PCR or antigen testing to check you for COVID-19. I recommend that if you have been exposed, or if you have symptoms, that you proceed to a testing facility. If you test positive for SARS-CoV-2, the virus that causes COVID-19, your symptoms are less than 1 week, and you have mild to moderate symptoms, I can treat you on a house call basis after you receive your test results. 

 

I am unable to draw blood at the house and do not provide mobile imaging like x-rays to look for pneumonia. Because I have shifted my focus to monoclonal antibody treatment for COVID-19, I do not carry any other point-of-care tests. I recommend you proceed to a medical facility like your primary care physician's office, an urgent care, or the emergency room at a hospital for testing.

I have a family member who is medically very complex. They are on a ventilator, have severe dementia, and are incapacitated. They are doing fine, but we need a doctor to come to the home periodically and be our new primary care doctor. Can you do that?

I know how hard and overwhelming it is to have a family member who has a lot of medical needs. It's hard, it really is. It's even harder when you don't know where to go for help.

 

When I first started this house call practice, I knew there were a lot of people we could serve. Over the years, however, I have learned that I am not set up to adequately take care of medically complex and vulnerable patients as well as I know they should be. These patients need (and deserve) a well-trained, multidisciplinary team of caring experts who can do the job right; and because of that, I have to respectfully decline the opportunity. 

I currently have pivoted my focus to providing treatment for COVID-19 by using monoclonal antibodies on a house call basis. I feel that I can put my experience as a principal investigator in COVID-19 clinical trials to good use in the community.

Luckily, we live in Houston in the shadows of the legendary Texas Medical Center and there are a lot of geriatrics, hospice & palliative care, internal medicine, and family physicians who are capable of handling the challenge. If you are lost, send me a note and hopefully I can point you in the right direction.