THE DESANTIS SNAKE OIL:

Scientific American talked with several experts about mAbs and how they fit into the fight against COVID.

What are monoclonal antibodies, and how do they work?

MAbs have long been used to treat diseases such as cancer and autoimmune disorders--the U.S. Food and Drug Administration has approved nearly 100 such treatments since 1994. To create them, researchers inject a protein--part of SARS-CoV-2, for instance--into a mouse and then collect some of its immune cells that create antibodies against the protein. These cells are then fused with human cancer cells and allowed to multiply so that the specific antibodies can be made at scale and infused into patients. Many mAbs for COVID seem to work best as a "cocktail" of antibodies that each target different parts of the virus.

The approved COVID mAbs appear to be most effective when given right after a person begins showing symptoms. "That's the time window in which the virus itself is playing a bigger role, before it triggers the inflammatory complications," says Brandon Webb, an infectious disease physician at Intermountain Healthcare in Utah. If a patient's immune system overreacts to the infection and requires artificial ventilation because of inflammatory damage to the lungs, the antibodies appear much less effective--and may even be harmful. [...]

Are mAb treatments a substitute for vaccination?

Both Webb and Doblecki-Lewis stress that mAb treatment is no substitute for vaccination. "Unfortunately, the vaccine has become so political that some people would prefer monoclonal antibodies because of the way they're being promoted," Doblecki-Lewis says. But the vaccines have fewer side effects, are cheaper and more widely available, and are much easier to administer. "The vaccine is just so clearly a better step one," she says.

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