Donor search amid plasma therapy debate
Study questions therapy’s effectiveness in reducing Covid death risks; doctors say helpful in early days
Sunny Khera has stopped answering unknown callers on his phone. He, along with a few friends, had started encouraging and arranging donors for Covid-19 patients soon after the Aam Aadmi Party government in Delhi championed plasma therapy as a lifesaver some four months ago. By mid-august, they stopped looking for new donors as the daily case count had begun to dip. But they resumed their search again late August as the numbers began to soar again.
It also meant unending distress calls. “I have not been taking calls as people cry on the phone and I can’t help. I already have tens of requests,” Khera says. So far, his team of volunteers has persuaded nearly 90 recovered patients to donate plasma.
Ghaziabad resident Gagandeep Singh, for instance, got in touch with a stranger through Khera for plasma for his father in July. His father was admitted to hospital after complaining of breathing difficulty at home following dialysis. A chronic kidney disease patient with co-morbidities such as diabetes and hypertension, he was in a Delhi hospital for three weeks after he tested positive for Covid. Doctors recommended plasma therapy on the very day he was admitted and the therapy was given in the early days itself. His father is now recovered and back home.
Delhi is leading the push for convalescent plasma therapy and started with trials during the lockdown in April. With the exponential growth in Covid cases — India has just surged past five million — and the spread rising beyond the metros, demand for plasma donors has been growing across states. Apart from Delhi, states such as Tamil Nadu and West Bengal have also set up plasma banks.
A Covid patient’s immune system generates antibodies, which are essentially proteins found in the blood plasma. In plasma therapy, convalescent plasma derived from the blood of the recovered patient is transfused into a newly infected patient. The plasma therapy induces immunity in the patient until his or her immune system starts generating sufficient antibodies of its own.
The Delhi government-run Lok Nayak Jai Prakash Narayan Hospital, which set up Delhi’s second plasma bank in July, has 500-600 Covid patients. In partnership with the Institute of Liver and Biliary Sciences, which houses India’s first plasma bank, trials are on at Lok Nayak hospital for an ongoing study on the efficacy of the therapy.
Suresh Kumar, medical director of Lok Nayak hospital, says initially it was difficult to convince people to volunteer for plasma donation. Many still hold misplaced fears that it is risky and could cause weakness.
The hospital offers counselling to recovered patients and also makes phone calls to them so that they are willing once they are capable of donating plasma two-three weeks after they are discharged.
“Out of every 10 patients whom we counsel, only two to three agree to donate,” he says. The plasma bank has had more than 80 donors so far, with one unit (400 ml) serving two patients.
It gets eight to 10 requests each from within the hospital and outside daily, Kumar adds. The hospital doesn’t cater to requests from outside Delhi. “Of the 15 to 20 demands per day, we are able to meet only three to four. And onethird of the donors who turn up are unable to donate for lack of sufficient antibodies.”
A recent study by the Indian Council of Medical Research, however, found that convalescent plasma therapy is not effective in reducing death risks among Covid patients. Responding to the study findings, Kumar stresses that the therapy is only useful in moderately ill patients. A therapy can be administered for a patient’s well-being and symptomatic relief, too, he adds. So, plasma therapy is part of a multi-pronged approach that includes steroids and medications such as the remdesivir drug. “If all other parameters are fine in a patient, we recommend plasma therapy even if oxygen saturation falls.”
Last month, the US Food and Drug Administration authorised the emergency use of convalescent plasma therapy, encouraging hospitals worldwide. In Delhi, despite the awareness campaign by the state government the number of donors has remained low. Kumar admits there is an acute shortage and wants more people to come forward. Lok Nayak hospital has held an awareness camp for Delhi Police personnel who were treated in the city’s hospitals, and plans to reach out to health workers soon.
Harjit Singh Bhatti, president of the Progressive Medicos and Scientists Forum, says there is no conclusive evidence of benefits from plasma therapy although it has been practised with new diseases repeatedly. It has also got politicised owing to differing views. For instance, the Centre had warned against its use, except for clinical trials, initially. However, with health being a state subject, several governments have batted for plasma therapy.
“In terms of scientific evidence, it remains a grey area as bigger studies are required to understand the effectiveness of plasma therapy,” says Bhatti. “But if not mortality benefit, it does seem to suggest that it shortens the duration of hospitalisation for Covid patients.”