FIGHTING COVID-19 BY USING PLASMA
More survivors to donate, but effects remain unclear
Lisa Joyce relies on other people to catch her up on the past month.
She knows her husband dropped her off at Bon Secours Mary Immaculate Hospital in Newport News for a nagging cough on May 1. She was discharged with an oxygen tank on the 29th.
What happened in between is a blur.
Even after daily reminders in the news of a public health crisis and a stay-at-home order that had the entire state locked down, it never dawned on Joyce that she might be coming down with COVID-19, the disease caused by the coronavirus.
“I just thought (the virus) was something similar to the flu, and I didn’t have the flu,” she said. “I didn’t know anybody who had had it. It wasn’t a real thing in my mind.”
Joyce, 48, was close to death. Doctors at one point considered a tracheotomy when they had trouble weaning her off the ventilator she had used for 17 days. The coronavirus, which has led to a worldwide pandemic and killed more than 1,450 Virginians, has no proven drug treatments.
But around the country, thousands of people like Joyce are getting an experimental therapy that uses blood from coronavirus survivors to help them fight the infection. Some hospitals are offering convalescent plasma, the part of the blood that contains antibodies, through clinical trials, while others are administering it through a “compassionate-use” treatment on a case-by-case basis.
The protocol is somewhat controversial, with health experts cautioning that it’s still uncertain whether giving COVID-19 patients plasma decreases the severity of their illness or the risk of dying. And it’s not the only thing out there now: Hospitals are increasing their use of the experimental drug remdesivir, which has shown modest improvements in coronavirus patients.
Patients may receive the medication and the transfusion. Proponents of plasma say that with so few options, it’s worth a shot.
“It’s very important,” said Dr. Anhtai Nguyen, chief medical officer for Bon Secours Hampton Roads. “This is a novel virus that’s very efficient. There are no true therapeutics out there.”
To start, a nurse inserts a needle attached to an IV line into a vein in one of the patient’s arms. A plasma bag is attached to the tube and drips plasma through it over the course of a couple of hours.
Joyce is one of a mere handful of COVID-19 patients in Hampton Roads who has had a convalescent plasma transfusion.
For some physicians, getting the antibody-rich product hasn’t been easy. Bottlenecks in ordering and obtaining the product have kept sick people waiting for a week or more to receive it. Health care workers throughout Virginia say earlier snags in the process are smoothing out.
If a hospital has its own blood center and is in an area with a high prevalence of cases, such as Inova in Northern Virginia, convalescent plasma could be available on demand. At other hospitals where special blood products are delivered from other sources, the turnaround time still seems to be about one to three days.
“It’s a little different from ordering an antibiotic, which might be just down the hall in the pharmacy,” said Dr. John Brush, Sentara’s principal investigator on the protocol. “It’s not in our hospital, and it might even be outside our geographic area. It’s different from ordering another type of blood product that’s sitting in our blood bank in our same building.”
The number of patients who have received the treatment in Hampton Roads is quite low. Sentara Healthcare has given it to 19 patients throughout its system, and “less than 10” have gotten it at Bon Secours’ hospitals. Riverside Health hasn’t used the protocol in any patients. Hospital representatives attribute the limited use to the overall decline of the infection rate in the region.
There’s also a supply issue. Investigators heading up the programs throughout Virginia said people who have recovered from the coronavirus need to donate their plasma to expand the stockpile.
In late March, the U.S. Food and Drug Administration announced a new initiative to collect plasma from people who have recovered from COVID-19. Since then, blood banks have hustled to establish a process for screening donors and getting their plasma to the right places.
The American Red Cross supplies many medical facilities with plasma, though lots of other blood centers are involved.
“What we saw was that out of the thousands of people who applied, only about 10% were meeting the criteria,” said Jonathan McNamara, a spokesman for the Red Cross in Virginia. “They either didn’t have it or didn’t have a confirmed positive test, and we didn’t have an antibody testing program in the beginning because it hadn’t been approved yet. You had to have all of that to be eligible.”
The FDA required either a verified diagnosis and 28 days of being symptom-free or having a negative COVID-19 test result at least 14 days before donation.
McNamara said that only about 30 Virginians have donated through the Red Cross, but thousands have donated through the organization nationwide.
In late April, when the Red Cross began screening potential donors for COVID-19 antibodies with an automated test, the process worked more efficiently, he said.
Recently, the Mayo Clinic and other researchers released a preliminary report on convalescent plasma treatment that indicated it was likely safe. They studied the outcomes for 5,000 patients who received it and found that only two people had serious side effects thought to be caused by the plasma. The seven-day mortality rate was 14.9% — lower than would be expected in a severely ill set of COVID-19 patients.
Joyce does not remember receiving her transfusion. A Bon Secours representative said she got it May 10 while on a ventilator
It was 11 more days before she was breathing on her own.
From the perspective of her husband, Brad, it’s hard to say whether the antibodies made a difference. With visitor restrictions at the hospital, he never had a chance to see her. He waited for word from the doctors, while he fought his own milder case of the virus at their home in Hayes.
Every day seemed the same. He had hoped she’d bounce back after she got the plasma, but it was more than a week before she left the intensive care unit.
There were days he drove to the hospital’s parking lot, just to be nearer to her. He prayed in his car until he no longer felt terrified.
When he’d see “Bon Secours” light up on his phone, he’d take a moment to compose himself. “I would take a deep breath, bolster up my strength to hear what they were going to say,” he said.
The usual reports left him feeling hopeless. Once, he didn’t even bother to pick up. And then one day he was glad he did answer.
“I hear this weak voice,” he said. “The first good news came from her.”
He doesn’t even remember what she said. It didn’t matter. Hearing her was enough.
Since Joyce has returned home, she’s been doing her own version of rehabilitation. The couple own a small business called A Change of Place Movers, and neither has health insurance or a primary care doctor.
But after she rebuilds her strength, she plans to donate her plasma, something she hopes other people who have recovered from COVID-19 will do.
Dr. Scott Heysell, an infectious disease specialist at UVA Health and one of the lead investigators for the hospital’s own clinical trial, said it’s important for people to make donations at their local blood banks.
For people who have a family member battling the coronavirus, he recommends asking the patient’s health care team to discuss their treatment options.
“It’s possible to transfer them to other hospitals where the trials are available,” he said.
Convalescent plasma resources
To learn more about the convalescent plasma treatment, visit https://bit.ly/3eSnoKE and www.UScovidplasma.org.
For information about donating, visit RedCrossBlood.org/plasma4covid.