Can survivors’ blood help others too weak to fight?
Stanford and UCSF are taking donations in an effort to aid critically ill patients
Elle Wohlmuth’s blood is rich in immune cells that waged war, and won, against COVID-19.
They protected her. Could they help someone else?
Volunteers in a desperate new treatment strategy, Wohlmuth and other COVID survivors are donating their virus-fighting antibodies at Bay Area blood banks in an effort to save those who are less lucky.
Last week, their cells were shipped to critically ill patients in California and Midwestern hospitals.
“I have the ability to give back in a unique and unprecedented way,” said 27-yearold Wohlmuth, a San Francisco resident whose brief illness last month caused only a mild fever, minor body aches and a trivial cough. “It felt like a no-brainer.”
As deaths climb with no proven treatment or vaccine in sight, such donations are a medical Hail Mary.
There is little evidence that a plasma transfusion from a COVID survivor can help a sick patient fight the disease. But the potential is so enticing that U. S. Food and Drug Administration regulators have waived the traditional testing requirements and authorized emergency shipments to the critically ill. As of Monday, doctors have requested plasma for 316 patients; of these, 64 have completed their transfusions.
To boost donations, Stanford, UC San Francisco and 853 other sites around the nation are now registering patients to contribute so- called “convalescent plasma.” The effort, called Expanded Access Program for Convalescent Plasma for the Treatment of Patients with COVID-19 protocol, is organized by Minnesota’s Mayo Clinic. They also hope to give it to sick Bay Area patients, if needed.
Stanford Blood Center started on April 7, welcoming Wohlmuth as its first donor.
“We’re ramping up collections this week and hope it will grow,” said Dr. Suchi Pandey, chief medical officer at Stanford Blood Center, which is partnering with hospitals in the Bay Area and beyond to build a wider network of donors. “If you are someone who had COVID and has recovered, then please consider a donation. One donor can potentially help up to three patients.”
UC San Francisco is erecting a tent and soliciting volunteers to open this week or next.
“Americans have always risen to a challenge,” said in
fectious disease expert Dr. Peter Chin-Hong, who with Dr. Annie Luetkemeyer is leading UCSF’s program. “I have no doubt that they’ll also do it this time.”
In San Jose, obstetriciangynecologist Dr. Phuong Nguyen is registering to donate. The 52-year old chief medical officer of Santa Clara Valley Medical Center sickened after attending an annual national conference for postgraduate medical training in late February. Now she’s healthy.
“It should go where someone needs it,” she said. “Once you experience COVID, you can relate to patients’ symptoms, and the sense of fear, uncertainty and concern. … It makes me want to try to do even more things to help people.”
While new to COVID-19, plasma donation is an approach that dates to the late 1800s and for decades was a mainstay of treatment for infectious diseases such as rabies, snake bites, and hepatitis A and B.
It was developed as a treatment during the 1918 flu pandemic and has also been used during the SARS, MERS and 2009 H1N1 outbreaks.
“There is biological plausibility that it works,” said Chin-Hong. “And we have very little in the way of current proven antiviral or other therapies for an illness that has a high mortality in certain populations.”
One very small Chinese study, published in the March 27 Journal of the American Medical Association, reported encouraging — yet early — results of treatment.
This is the concept: People who have recovered from COVID-19 have an abundant supply of so-called “neutralizing antibodies” that their body built to fight off the virus. These antibodies only live in the straw- colored plasma of the blood.
When those people donate their blood, the antibodies are filtered out and removed, and then injected intravenously into someone whose body isn’t able to produce its own immune response or fight off the disease.
It’s also thought that these antibodies could be given preemptively to health care workers, to help boost their immune system as they fight on the front lines of the pandemic.
Everyone who is sick makes these neutralizing antibodies, said UCSF’s ChinHong. But for many patients, “it is late. It’s not around when you need it.”
“So you find someone else who’s been there, done that,” he said. “You transfer their army to neutralize the virus in someone else.
“We don’t know if it works in COVID-19,” he added. “But it’s a cool idea.”
To study its effectiveness, a smaller group of physicians and scientists from 57 institutions in 46 states, led by Johns Hopkins University, have self-organized to conduct a formal research study, called the National COVID-19 Convalescent Plasma Project. If proven beneficial, that could lead to FDA approval for wider use.
In these clinical trials, only certain patients are eligible to participate. Half get the plasma; the other half gets an inactive placebo. Doctors closely watch for side effects and measure clinical signs and death rates.
Such research may reveal that COVID-19, like Ebola, hepatitis C, HIV and some other viral diseases, does not respond to plasma infusions.
But if the plasma looks promising, the trials can help inform future strategies, suggesting who is likely to benefit and the best time to offer treatment. Virus-fighting plasma likely will work best if used early during the illness, said Chin-Hong, “when a patient is sick but not too sick.” In the later stages of illness, it’s the body’s hyperactive inflammatory response, rather than the virus, that’s the primary concern.
“If you predict who would get sick,” he said, “you could give the product to stop the virus in its tracks.”
And not every survivor has abundant antibodies, he added. People with very mild illness may not have enough to donate.
Stanford and UCSF will conduct such focused research in the future — but for now, they’re participating in an alternative approach, called “expanded access.”
Less intent on data collection, it’s a massive last-ditch effort to save lives at hundreds of participating hospitals.
Local donations will go into a centralized distribution system for patients everywhere.
In many ways, plasma donation is a lot like conventional blood draw. It takes a little longer, perhaps 45 minutes or so. The preparation is identical.
It differs in that it uses a procedure called apheresis, which collects only plasma. Other parts of the blood, such as hemoglobin, are returned to the donor.
And the donation criteria are much stricter. Donors must have tested positive for the virus when they were ill, recovered, have had no symptoms for 14 days, and now test negative.
Because there has been such a great shortage of tests, many potential donors won’t qualify. Those who qualify can donate repeatedly.
“I was lucky. I feel really privileged that I was able to be tested,” said Wohlmuth. A senior program manager for global inclusion and diversity initiatives at Apple, she was infected while traveling in Europe for work. “I’m not elderly. I’m not sick. I don’t fall into any of the high-risk categories.
“There are people who need our help now,” she added. “We can all do a little bit of something.”