By JEFF CLEMETSON
Like a lot of filmmakers, La Jolla resident Adam Raby’s film projects in 2020 were put on hold. But on Dec. 31, a nonprofit entity named Empowering a Billion Women (EBW, ebw2020.com) connected with Raby for an opportunity to film in “ground zero” in the fight against the COVID-19 pandemic — El Centro, California.
EBW is an organization made up of a global network of women leaders who advocate for women’s health and prosperity. Raby was activated as part of the EBW network to aid in a public information campaign in El Centro, informing residents about the availability of monoclonal antibody treatments (MABs).
“When President Trump got diagnosed with COVID-19, they took him to Walter Reed in a helicopter and as soon as he landed they gave him this treatment,” Raby said. “It was only available to certain people at that point, it wasn’t available to anybody, really. Now the government wants to use this as a vehicle to lower the hospital rates in because hospitals are overwhelmed. In El Centro, they got parking lots full of tents with people in them and they’re just trying to find a way to help this community.”
The MAB program that EBW, Raby and his partner Jose Valdez filmed was started by Assistant Secretary for Preparedness and Response (ASPR), Dr. Robert Kadlec and is carried out by HHS and the El Centro Regional Medical Center, a UCSD hospital. The team’s role was to inform the public about the program, help alleviate fears and fight misinformation about the new treatment.
Improving communication of COVID treatments
Women make 80% of health care decisions in the United States, according to Department of Labor statistics, so gaining the trust of women was critical in galvanizing support for the MAB program.
“There is a lot of messaging out there that has made this virus and this pandemic even more tragic,” Raby said. “Using EBW to engage the women in this community and say ‘We have something that will help you, don’t be afraid to go get a test, don’t be afraid to go to the hospital, there are resources there that will help you,’ was an important part of this.”
Raby recalled one woman his team interviewed named Laura, a general manager at electrical cooperative, who shared that one of her employees called in to work because she was not feeling well. Laura encouraged her to get tested.
“She also told her, because now she was aware of this, that she should ask her doctor if she meets the requirements for monoclonal antibody treatment. Two hours later she was getting the monoclonal antibody. So that’s the power of sharing the story.”
Another success story was the El Centro fire chief, Cedric Cesena, who had severe symptoms from COVID.
“Within 48 hours after the monoclonal treatment, I was at 80% back to normal,” Cesena said. “My wife’s life was also saved by the infusion. She’s got bronchitis and developed a pneumonia, and without the infusion she probably would’ve died.”
But educating the public about MABs wasn’t the only issue facing the EBW team.
“Our roll in El Centro started with how we galvanize people around knowing about the antibodies,” said EBW founder and CEO Ingrid Vandeveldt. “It has morphed into something far greater than that. How do we simplify for the American public COVID’s five-step progression?”
Vanderveldt said that progression starts with prevention through masks, washing hands and social distancing for people not infected with the virus. Vaccinating the population is another step. The third step is for people who test positive, and if the virus is caught early enough, to treat them with antibodies which will likely keep them out of the ICU.
“But after that, things start to rapidly go downhill,” she said. “Stage four is you’re in the hospital; stage five is the ICU; and after that is death.
“[Health officials] haven’t communicated this five step process well enough — and probably the most important message is to communicate this five step process,” she added.
Infusion center successes
The MAB program in El Centro utilizes infusion centers where patients at high risk of severe reaction to COVID are treated within 72 hours of symptoms or after receiving a positive test. The MAB drugs, like the COVID vaccines that are now available, are already purchased by the government and are given to qualified patients at no cost.
The program has so far been successful. Of the first 133 patients treated with the infusion, only six later required treatment in an ICU, said El Centro Regional Medical Center CEO Dr. Adolphe Edward.
“That means we avoided hospitalizations for a lot of people – six wound up coming back and were admitted, so there’s a slight chance that you’ll get admitted,” Dr. Edward said.
“But what we’re talking about is we’re avoiding hospitalization early; we’re catching the COVID positives early; we’re treating the COVID positives with the monoclonal body early; and we’re getting better results at the end of the day,” he added.
Dr. Edward estimates that one ICU bed is freed up for every 10 patients treated with a MAB infusion. Pre-COVID, the El Centro Regional Medical Center had only 12 ICU beds, but has now expanded to over 60 in the hospital and even in outside tents.
The frontlines of a pandemic
As Raby, Valdez and Vanderveldt interviewed local community leaders, healthcare professionals and citizens who shared their stories about the successes of the infusion centers, their backdrop was often the COVID-positive tents where the filmmakers witnessed the around-the-clock battle healthcare workers were engaged in trying to save lives.
“It felt like we were in a war zone,” Raby said. “People weren’t shooting at us but there was the effect of the bodies that were lined up outside the hospital ward because they had nowhere to put the deceased. We had that view. And it was powerful. It was disheartening. It was tragic.”
Dr. Edwards described the situation in El Centro as “a fearful fact. That is the reality here.”
“We’ve been on the New York [Times] list of bad places with very high concentrations of COVID positives. We’ve been ranked number 1 for 10 weeks, although we’re down to three or four right now, but that’s one of those lists you don’t want to be on,” he said.
After the team finished filming in El Centro, they realized they had documented more than just a government program.
“The emotions of what I experienced over the last six days hit me and tears just started pouring down my face,” Raby said. “Because what we were witnessing wasn’t just something about COVID-19, it was about a community. It was about people. It was about a history of the land.
“This was once a desert and because of water it has turned into the fruit and vegetable basket of our country in the winter months,” he continued. “Along with that comes people who’ve been affected by this pandemic more than most places in the county. I think their positive rate was at 37%.”
The high rate of infection comes from a variety of factors in El Centro, where a sizable portion of the population are migrant workers exposed to environmental pollutants like pesticides and many families live in multi-generational households with little to no ability to quarantine at home.
“These people have been affected for a long period of time and their health is at risk. COVID-19 picks on people who have those kind of health issues and it doesn’t allow them up,” Raby said. “And now, hopefully, the people that were there — HHS, certainly EBW, as well as the Department of Defense that is doing this Operation Warp Speed — they will see this community needs the help. And if we can help this community, we can take this program and help the entire country.”
A strategy emerges
As the COVID vaccine becomes more available, the EBW team, as well as the doctors at El Centro Medical Center, envision a new tactic to fight the surge by pairing vaccination stations with infusion centers.
“When EBW first visited here, I encouraged that we marry up the infusion and vaccination together because it helps us at the end of the day,” Dr. Edward said. “We’re been talking about getting more vaccinations down here, it hasn’t happened yet, we’re still waiting for distribution. But avoiding hospitalization, avoiding an ICU bed means a better outcome for the patient, which is a healthier society.”
The EBW team and Dr. Edward see the one-two punch of infusion and vaccination center as a chance to educate the public about the availability, safety and efficacy of each treatment no matter where a person is in the five-step process. If a person comes into the tent to get a vaccine, he/she can be educated on the MAB treatment and then go and encourage family and friends to get the treatment if they get a positive test. If someone comes in for a treatment, he/she will find out about the availability of vaccines.
Dr. Edward thinks that for every 10,000 vaccines administered at an infusion center, they will find 500 at-risk people with COVID to get treated with antibodies and save El Centro Medical Center 50 hospital beds in the process.
Vanderveldt also points out that right now it seems unlikely that the surge will be stopped by vaccines alone.
“Rolling out vaccine distribution without antibody distribution at the same time is a problem because there are not enough vaccines out there,” she said. “Plus, there is still too much doubt about vaccine safety and so the public adoption rate may not be enough to reach herd immunity.”
This is not a plan that will take months to see results. According to Dr. Edward, if the community gets vaccines and their distribution is paired with infusion centers, the situation in El Centro could start to turn around in three days.
In the meantime, spreading the word about the MAB infusion treatment is underway. EBW has launched a communications campaign using the Rady’s film images on billboards, flyers to hang on doors in English and Spanish, social media and short-form, podcast-type interviews to educate community members about the MAB program.
EBW and Raby hope the next phase is to tell this story in a documentary form, possibly a series.
That documentary or series, the team imagines, would not only show the devastation of the pandemic in one of America’s hardest hit cities, but also the hope that comes out of people helping people.
“If we come together and put aside some of those differences, put aside those ideas and thoughts, put that aside and help each other, maybe this is an opportunity to move forward and make some changes in our community where we all help each other — even outside of healthcare,” Raby said.
“For the first time in history, we’re all focusing on the same issue,” Valdez added. “We’re all focusing on COVID-19 and that’s the camaraderie of what can bring us together as a society, so hopefully this can be an opportunity.”