You may have been hearing about “blood plasma therapy,” and there’s some exciting preliminary
evidence that it may be an option to treat COVID-19.
The only problem: we’re not 100% sure it will work.
- You hear positive stories, but you always have to balance your hope as a physician with
the objectivity you try to execute as a scientist.
That’s why Dr. Joyner and his team have jump-started a national initiative called
the Expanded Access Program to determine where plasma therapy fits into the current pandemic…
and it may just help us prepare for outbreaks in the future, too.
First, let’s start with the basics.
Your blood is about 45% red blood cells, white blood cells, and platelets.
The rest is plasma, a yellow-clear liquid containing water, clotting factors, CO2, hormones,
mineral ions, glucose, and dissolved proteins.
Some of those proteins are antibodies.
Those who have recovered from COVID-19 have antibodies to SARS-COV-2 swirling through
their blood’s plasma.
So, the idea is this: inject some of that antibody-rich plasma into someone who hasn’t
yet recovered, and you might help them acquire “passive immunity”–that is, protection
against the virus that they didn’t have to build themselves.
Not only have plasma infusions been used to treat medical emergencies like burns and trauma,
as well as bleeding disorders faced by cancer patients, but we’ve turned to convalescent
plasma therapy in past disease outbreaks of SARS and MERS, Ebola, and even during the
influenza pandemic in 1918, with mixed results.
If we can prove plasma therapy works for COVID-19, it could be a viable option to control the
virus’s spread.
For one thing, plasma donation is relatively simple.
Although it takes a bit longer and involves an additional step where the plasma is separated
in a centrifuge, the process is largely the same as a regular blood donation.
A single donation will yield between two and four units which will go on to be screened
for communicable diseases and transferred to a patient in need.
And under the Expanded Access Program, this process will be accelerated, offered more
widely, and rigorously documented.
- I anticipate that within a week we'll be giving you know, 400 or 500 units, maybe even
1,000 units a day.
And now it's a question of just monitoring the situation, collecting the data and going
from there.
But even if it proves effective, plasma therapy isn’t without its challenges.
Blood compatibility is critical, meaning the universal donor type, AB for plasma, is in
even higher demand than the procedure itself.
Some research from the Ebola outbreak suggests that patients and donors should be geographically
close together to ensure immunity against the right strain of the virus, which could
further limit the supply pool.
And as with any treatment, there are some risks, including lung injury, circulatory overload,
and infectious disease.
- I think one of the things we hope to do in this is to understand how the properties
of the plasma relate to any changes in the disease trajectory?
Do we reduce the risk of being admitted to the intensive care unit, and for people
in the intensive care unit, can we shorten their stay?
Predictions suggest that this therapy might be most effective when it’s given as a preventative,
or “prophylactic” measure for those most at risk, or shortly after exposure to the
virus.
But if it turns out that convalescent plasma is safe and effective at any stage of COVID-19,
will all our corona-woes be over?
- This is not a panacea.
It's a stop gap measure.
It may help in a selected group of patients under a selected group of circumstances.
And it's really a chain of developments from this sort of first wave to the second wave
being a concentrated product, to the third wave being perhaps something from biotech,
maybe, maybe not, and ultimately a vaccine.
Until then, even if COVID-19 convalescent plasma disappoints in clinical trials,
Dr. Joyner is hopeful that setting up a system to study it will help build the breakwaters
we need to be more prepared whenever the next wave of infectious disease hits.
- Anytime you have an opportunity like this, a disaster, you need to learn from the process.
And so the question we need to ask ourselves is, what sort of a baseline infrastructure
do we need for 100 year outbreaks for novel infectious diseases?
I think if you had reasonable strategies for social distancing, disease tracking and efforts
at a contact tracing, and a comprehensive outbreak control strategy when there are hotspots,
this product could be used to help further control those hotspots.
If you’ve recovered from a confirmed case of COVID-19, you might qualify as a donor.
To find out, visit the National Covid-19 Convalescent Plasma Project’s website linked below.
And if you want to learn more about COVID-19, check out our playlist here.
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