Why a treatment used for over a century on diseases like measles, mumps and influenza could work to treat the new coronavirus strain. USA TODAY
In New York and Houston, pints of straw-colored convalescent plasma have dripped into the veinsof fiveU.S. coronavirus patients.Hundreds more there and across the nation are set to follow.
Whether the plasma, derived from the blood of people who recovered from COVID-19, will help them fight off the devastating disease caused by the new coronavirus that haskilled more than 5,100Americans is unknown. In less than three weeks, the effort to find out has gone from an ideato a worldwide program entirely self-organized by medical researchers.
Like so muchabout the desperate efforts to fight the COVID-19 pandemic, its seat-of-the-pants medicine. Doctors dont know whether it will work buthopeto find out in weeks, not the years it typically takes for studies to yield answers.
Our treatments began on Saturday, said AniaWajnberg, an internist at Mount Sinai Medical Center in New York City who directs its Serum Antibody program.
There are 8 strains of the coronavirus circling the globe: Here's what clues theygive scientists.
It was only four days before that, March 24, that the U.S. Food and Drug Administration began allowing researchers to request emergency authorization to test whether the plasma will help.
Plasma is the almost clear liquid that remains after red and white blood cells and platelets are removed from blood. It contains antibodies that can fight disease.
The Chinese paper came out days ago, but days are feeling like years to me right now, Wajnberg said, referring to a paper published March 27 in the Journal of the American Medical Associationthat described a test of convalescent plasma on five critically ill patients in Shenzhen, China.
For Wajnberg and thousands of other doctors worldwide, nothing feels fast enough.
One of the first COVID-19 antibody tests in the USA is being used on recovered patients in New York City to determine whether they produced a high amount of antibodies. If so, they could donate their antibody-rich plasma to help others mount an immune response.(Photo: Icahn School of Medicine at Mount Sinai)
Methodist Hospital in Houston began recruiting plasma donors Friday and gave the first plasmatransfusions to a COVID-19 patient the following day.
Its a gamble of time, energy and money, said William Schaffner, a professor of preventive medicine and infectious disease at Vanderbilt University School of Medicine in Nashville, Tennessee.
Convalescent plasma therapy has a mixed history of success. It's time-consuming, expensive and difficult to deploy on a large scale. Even so,hes all in favor of it.
Any port in a storm and weve got one heck of a storm out there, he said.
The project, dubbed the National COVID-19 Convalescent Plasma Project, posted a protocol for clinical trials on its website.
"The world is downloading it," said Arturo Casadevall, one of the project's organizers and chairman of molecular microbiology and immunology at Johns Hopkins Bloomberg School of Public Health.
The plasma iscollected from patients who recovered from COVID-19. Each donates apintof blood. The red and white blood cells are separated and put back intothe donors bloodstream while the blood plasma, rich with virus-fighting antibodies, is kept aside.
Those coronavirus 'cures' you're hearing about?They're fake.
The donor and the patient must be fromcompatibleblood types, and the plasma is tested for multiple diseases, including COVID-19, HIV and hepatitis, to ensure it cant transfer them.
Though convalescent plasma (from the blood of people convalescing, or recovered, from a disease) has been used successfully in outbreaks of other diseases, such as polio, measles and mumps, its by no means a slam-dunk.
Its been used for other viruses, some with efficacy and some without, Wajnberg said.
The plasma showed promising results in the small Chinese studyposted as a preprint March 27. Another preprint, released March 16, about plasma treatment in10 severely ill patients in Wuhan, China, found similar results.
Blood plasma is processed at the New York Blood Center. Blood plasma contains antibodies that can fight diseases. An experimental treatment is being tried to use blood plasma from people who recovered from COVID-19 to treat patients who are severely ill with the disease.(Photo: New York Blood Center)
Preprints are papers posted to online open-access sites before theyhave gone through the rigorous scientific peer review process, soinformation can be shared rapidly. During the COVID-19 crisis, they have been crucial in quickly disseminating essential data.
In bothstudies, almost all the patients also receivedantiviral and other treatments, making it difficult to know in a group of only 15 patients what specifically helped.
For now, plasma therapy isone of few options for doctors when critically ill patients "don't have much time,"saidEric Salazar, principal investigator in the Department of Pathology and Genomic Medicine at the Houston Methodist Hospital and Research Institute.
Have you recovered from coronavirus?Here's how you can help doctors find a treatment.
Convalescent serum therapy could be a vital treatment route because, unfortunately, there is relatively little to offer many patients except supportive care, Salazar said.
No one anticipates the treatment will have a "Lazarus-like effect on the really ill," cautioned Michael Joyner, who worked to set up trials at the Mayo Clinic in Rochester, Minnesota, where he is a professor of anesthesiology.
"What's more likely is that the slope of the patient's decline will gradually slow and that they can be weaned off of ventilation," he said.
The idea of giving desperately ill patients blood plasma from people who recovered from the same illness is more than a century old and was first used to treat a German child suffering from diphtheria.
Using it to fight COVID-19 has gone fromone paper published in the Journal of Clinical Investigation on March 13 suggesting the idea of a large trial to a broad program in less than three weeks.
Its become an international effort, showing the ability of scientists to self-organize at a speed unimaginableeven three months ago. As of Monday, more than 100 researchers and 40 large hospitals in 20 states are involved in the effort to bring survivor plasma to clinical trials, according to project leaders.
'Who lives and who dies': In worst-case coronavirus scenario, ethics guide choices on who gets care
Other countries are joining what began as a grassroots endeavor by doctors and scientists.
"We brought in the United Kingdom over the weekend. Ireland, too," said Casadevall, who co-wrote the paper March 13.
When a person is infected with COVID-19, the body creates blood proteins called antibodies to attack the virus, said Mark Slifka, a viral immunologist at the Oregon Health and Science University in Portland.
When the body mounts an antibody response, it clears the virus, and then you maintain that antibody response, said Slifka, who studies the bodys immunological memory after vaccination or infection.
Depending on the disease, the body keeps making those antibodies for weeks to months to a lifetime. No one knows how long the antibodies against COVID-19 will stay in the bloodstream, but work on similar coronaviruses suggestsits at least a year, he said.
The plasma is taken from people who were exposed to or contracted COVID-19 about three weeks ago and recovered. That seems to be the time the body requires to mount a strong immune response to the virus.
People who tested positive for COVID-19 and fully recovered can register on the Plasma Project's website to see whether they are eligible and if there's a plasma donation program near them.
Almost all of the people who learned they are positive for antibodies to the virus and eligible to donate plasmahave offered to do so.
The race for a vaccine: Thousands of scientists are studying 41 possibilities
Thats been a bright spot in all this, everybody wants to help. Its nice to see, Wajnberg said.
Patients are given one to two units of the plasma, about one to two pints. Doctors hope to find out quickly how much is required.
At Mount Sinai, a committee is deciding the right candidates forpossible treatment. Only hospitalized patients with severe clinical disease are considered. Those who get the plasma are meticulously tracked to see its impact.
If it does help, scientists hope to build a pool of plasma for all blood types that can be given to severely ill patients.
Maybe in a few weeks, well be able to report our first 10 or 20 patients, Wajnberg said.
One donors blood is enough to give to no more than one or two recipients. We will need a lot of donors, Wajnberg said.
The Plasma Project is working on the problem, and"a national distribution plan (for the plasma) is being worked on as we speak," Joyner said.
Your coronavirus questions, answered: Are malaria meds working? How many people have recovered?
The effort is an example of how medical researchers are self-organizing in the face of the COVID-19 pandemic.The project has proceeded with "terrific" help from the FDA, Casadevall said, but has no government lead.
"What hasn't materialized is a federal coordinator," Casadevall said.
The effort is guided by an executive committee from theIcahn School of Medicine at Mount Sinai, the Mayo Clinic School of Medicine, Washington University School of Medicine in St. Louis, Michigan State University and Johns Hopkins University. The groupconvenes meetings by conference call once or twice a week.
The project's unofficial motto reflects the doctors'drive to do everything they can to fight the virus:"Don't permit what you cannot do to interfere with what you can do."
Weise of USA TODAY reported from San Francisco;Johnson of the Journal Sentinel, part of the USA TODAY Network, reported from Milwaukee.
Read or Share this story: https://www.usatoday.com/story/news/health/2020/04/01/coronavirus-plasma-therapy-5-us-patients-covid-19-donors/5090946002/
Read the original post:
The first US coronavirus patients are being treated with convalescent plasma therapy. Will it work? Not even the doctors know - USA TODAY