Dual antibody treatment could mean more normalcy for 'remarkably resilient' Fargo North student
Josiah Gillen, who has a transplanted kidney and has battled cancer, has a suppressed immune system, making him more susceptible to infections including COVID-19. A dual antibody treatment and two booster doses of vaccine offer hope patients like Josiah can live a more normal life.
FARGO — Josiah Gillen is 15 years old. He’s a freshman at Fargo North High and has an avid interest in drama.
Outwardly, Josiah appears like any 15-year-old, and he wants more than anything to live as normal a life as possible.
“He’s a teenager,” his mother, Rachel, said. “He wants to hang out with friends and be active.”
But the stage Josiah walks upon in life is that of a person with a compromised immune system, making him vulnerable to COVID-19.
At age 4, an autoimmune disease that is so rare it doesn’t have a name caused his kidneys to fail, requiring travel several times a week to Sioux Falls, South Dakota, for pediatric kidney dialysis treatments.
He received a donated kidney from his father at age 7. “The transplant was well-received,” Rachel Gillen said. But a year later Josiah developed a complication called post-transplant lymphoproliferative disorder, a form of cancer that sometimes results from medications to prevent transplant rejection.
“He was in the unlucky 5% of patients this happens to,” she said. Josiah receives chemotherapy treatments at Sanford’s Roger Maris Cancer Center. “He’s been on quite a journey.”
Because of his severely compromised immune system, Josiah qualified for an antibody treatment that is being prescribed to help prevent COVID-19 in high-risk patients. He’s one of a number of Sanford patients in Fargo who have been given Evusheld, which combines two long-acting antibodies.
He also recently received his fourth COVID-19 vaccine dose, his second booster, to try to enable his suppressed immune system to fight against the rapidly spreading coronavirus.
Josiah and his family are hoping the protections will allow him to lead a more normal life as the pandemic continues.
Last year, Josiah and his two sisters attended school via the Fargo Public School District’s Virtual Academy.
“It’s been a challenge,” Rachel Gillen said. “This year, he felt really relieved to be back in school.”
Now that masks are no longer required in school, however, Josiah once again must limit his exposure to the risks posed by the classroom, so he has mostly taken his classes at home.
“It really wasn’t safe for him to be back in school 100%,” Rachel Gillen said. Keeping up on his classes has been difficult. “But the teachers have been really great and really supportive.”
Dr. Avish Nagpal said antibody treatments like Evusheld, which aim to prevent infection, are part of the first line of defense against COVID-19 for those who have immunodeficiency. “We typically rely on pre-exposure prophylaxis,” he said.
“This does not replace the vaccine,” Nagpal said. “It supplements it.”
Although a crucial protection, vaccines are vulnerable to breakthrough infections, especially for those with weakened immune systems. “We always see breakthrough infections with vaccines,” he said. “Most of them are mild.”
Studies have shown that Evusheld is 77% effective in protecting against COVID-19 — highly effective, although not perfect, Nagpal said.
Once Josiah’s recently administered second booster takes full effect, he hopes to spend more time back in school.
“I think he will be going back,” Rachel Gillen said. Josiah’s main extracurricular school activity is theater, and the vast majority of students in that program wear masks voluntarily.
Josiah, who declined to be interviewed, doesn’t like to draw attention to himself, his mother said. “He is remarkably resilient. He’s had to spend much of his life being on restrictions that other kids don’t have.”
Long before the pandemic, for instance, because of his failing kidneys, he had to strictly limit his water intake, while other kids could drink water freely. Because of illness, he had to miss almost half of first and second grade.
With the antibodies and booster doses, normalcy seems “a little closer,” Rachel Gillen said. “Hopefully, it will be baby steps toward getting back to maybe normal.”
At a time when many have given up on wearing masks in crowded indoor settings or refuse to get vaccinated, the family is grateful for those who take precautions against spreading the coronavirus and other germs, helping to make life safer for those who are immunodeficient.
“We’re really thankful for people who are getting vaccinated and still taking precautions,” Rachel Gillen said. “There are a lot of people in a situation who really rely on other people doing the right thing.”