The treatment of Covid-19 with plasma

Mohamed Ibrahim Bassyouni
2020 / 6 / 4

Can plasma from Covid-19 survivors be taken to help save others?


On March 13, with the Covid-19 pandemic spreading and no medication available for treatment, Arturo Casadevall published what he considered to be perhaps the most important research paper in his long career. In the Journal of Clinical Investigation, two specialists in infectious diseases at Johns Hopkins University published an article in which they explained that one of the effective treatments may already be within reach: blood plasma for people who have recovered from disease and are rich in antibodies against coronavirus.
The duo pointed out that this strategy appears to have succeeded in a number of other infections, and there is an infrastructure to collect and manage plasma, and the risks are known and relatively low, and they wrote, "We recommend that institutions begin preparations to implement this as soon as possible." "Time is of the essence."
After 10 weeks, more than 16,000 patients in hundreds of American hospitals have received experimental treatment, and we hope this soon will result in more evidence of the success of this treatment.

Although a study on plasma-treated patients at Mount Sinai Hospital in New York City provided indications of this, as do other small studies elsewhere, clinical trials that are still undergoing randomized controlled trials (RCTs) will give more specific answers and more robust evidence.
Blood transfusion (or plasma) has been used from patients who have been cured as a treatment since 1918 with the Spanish flu pandemic and reports released after this epidemic indicate that this treatment has helped a lot and has been used successfully to fight SARS, measles, and Argentine haemorrhagic fever.
Plasma transfusion was not entirely successful with Ebola. In a small study of 84 patients with Ebola in Guinea in 2015, doctors saw little benefit from convalescence plasma in treating Ebola. It is not clear why-;- Plasma may not have many strong enough antibodies.

But studies by Chinese doctors on the experience of treating Covid-19 patients with recovered plasma, one of which was published in April in the journal Proceedings of the National Academy of Sciences, as well as a number of other small studies conducted in China, Italy and elsewhere, were promising.
However, randomized controlled trials with the use of the RCTs now underway in Germany, the United Kingdom, and the United States, and whose results are expected to appear in the next few months, can provide strong evidence and final responses on this topic.
Recovered plasma can also help prevent infection in people at high risk.
In an experiment at Johns Hopkins, 150 health care workers exposed to Covid-19 while not wearing appropriate protective equipment will receive plasma recipients´-or-normal plasma collected last year and then researchers will compare the number of people in each group who develop the disease.
But the real challenge is that a single plasma donation (size depends on the weight of the donor but usually ranges between 690 and 880 milliliters in the United States may suffice for only one´-or-two patients, and the donor s blood type needs to match the recipient.
But recoverers may be able to donate plasma several times each time.

There is another challenge as the antibody mixture and its concentration differ from one donor to another. Currently, the Japanese pharmaceutical company is working to produce a product called Hyperimmune Globulin where the blood of hundreds of patients who are cured is collected and the antibodies are concentrated about 10 times.
This hyper immunity globulin may have a longer life expectancy than plasma, and its high concentration may allow doctors to give more antibodies to patients without the risk of TACO and a trial of effectiveness, funded by the US National Institutes of Health, will begin this summer.

The last time Takeda produced immunoglobulin was the 2009 H1N1 influenza pandemic. The company focused antibodies from 16,000 liters of convalescent plasma, resulting in a product sufficient to treat thousands of patients. But the flu strain proved to be lighter than expected and the treatment was never used. Survivor antibodies will likely have a bigger role this time. I doubt that IgM can be prepared and manufactured before we have a valid vaccine.

As far as safety: Although blood transfusion therapy (blood plasma) is the same as any other blood transfusion process, it may involve some rare risks to the transfused patient, but researchers have already collected more data on complications for Covid-19 patients who have plasma and turned out to be Very rare.

Conclusion: The plasma treatment of the recovered, although it is still an experimental treatment, but it is highly promising and many medical teams rely on it to save the lives of a large number of patients. It is necessary to encourage the recovered to contribute to lend a helping hand in this as they could.




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