Plasma donations from COVID-19 survivors could help the sick
A critically ill patient at Doctors Hospital will receive a plasma transfusion from Miami Mayor Francis Suarez, who has recovered from COVID-19, as part of a federally sanctioned experimental treatment that could help the sick.
Perhaps one of the most visible South Florida residents to be infected with COVID-19, Suarez’s case demonstrated why social distancing is important. He tested positive in midMarch and said he exhibited very mild to no symptoms for two weeks after, illustrating how asymptomatic carriers can worsen the pandemic if they don’t know they have the disease.
Suarez donated his blood as part of an experimental treatment called convalescent plasma therapy, which could help patients fight off the disease caused by the novel coronavirus that has killed more than 50,000 worldwide — more than 100 in Florida — infected about 1 million and forced governments to take containment measures that have crippled the economy. Plasma therapy is an experimental practice that uses blood taken from people who have recovered from a viral infection and injects it into those who are still sick. The treatment has been used in victims during recent infectious outbreaks like Ebola, SARS and H1N1 influenza.
Last week, the Food and Drug Administration authorized the emergency use of plasma for patients who are critically ill with COVID-19. The AABB (formerly American Association of Blood Banks), an international nonprofit agency focused on transfusion medicine, released guidelines Tuesday that plasma from patients who have recovered from COVID-19 could be used to treat others who have contracted the coronavirus.
“The idea is to encourage people who have reached the other side of this infection to continue to be proactive in defeating this,” Suarez told the Miami Herald.
The mayor has tested negative and emerged from quarantine March 31, and he is now promoting convalescent plasma therapy as a way for those who have recovered from COVID-19 to potentially help those who are seriously ill.
He initially received a call from the family of a patient on a ventilator at Doctors Hospital in Coral Gables, part of the Baptist Health network, asking if he would consider trying to help. It turned out that Suarez and the patient had matching blood types. Working through blood donation company OneBlood, the mayor has donated plasma to the patient.
While some studies suggest that using the plasma had been successful in past outbreaks of pneumonia and influenza with reducing symptoms and death, Kaiser Health News reports that it still has not proved to be particularly effective in clinical trials. However, anecdotal evidence from China — where the first widespread outbreak of COVID-19 occurred — shows that plasma therapy has helped sick patients stave off symptoms until they got stronger and could fight it themselves.
Dr. Carlos Espinal, an expert in infectious disease and director of the Global Health Consortium at Florida International University, said plasma from recovered patients could contain the protective antibodies that would help reduce the virus load in a sick patient.
There are protocols for those who have recovered from COVID-19 and wish to donate plasma. In Miami, Suarez had to show documentation proving he had tested positive for COVID-19, and that he had later tested negative. His blood type matched that of the Doctors Hospital patient. His lack of symptoms allowed him to make the donation.
“The person who could be a potential candidate would need to have complete resolution of their symptoms for at least 14 days before they would be able to be eligible to do this type of donation,” said Susan Forbes, senior vice president for communications and public relations for OneBlood.
Suarez donated his plasma Thursday at a OneBlood truck in Miami. The sample was driven to the company’s lab in St. Petersburg to be screened for use. The blood cleared the screening late Thursday, and as of Friday afternoon, the sample was being driven back to Miami for the transfusion.
PLASMA TREATMENT AND ANTIBODIES
The convalescent plasma treatment, which was first developed more than a century ago, is unproven and draws on multiple resources in short supply during the pandemic — time, energy and money. William Schaffner, a professor of preventive medicine and infectious disease at Vanderbilt University School of Medicine, recently told USA Today that despite the effort, the mixed success and how difficult it would be to scale up, he’s in favor of trying it.
With no vaccine and few methods to treat the disease in a fast-moving crisis, a consortium of 50 hospitals and universities formed the National COVID-19 Convalescent Plasma Project, an effort facilitated by Michigan State University.
Dr. Timothy Schacker, the vice dean for research at the University of Minnesota, said plasma therapy has been used for more than 100 years to treat everything from pneumonia to rabies. While the data for using it to treat COVID-19 patients is still anecdotal, Schacker said it’s “probably a good idea” given its history helping people recover from infections.
The main risk, he said, is accidentally giving a sick patient an unknown infectious disease or malady the donor may be carrying in their blood.
Forbes said the company does not test for COVID-19, but the company screens every donation for over a dozen different viruses and diseases. That includes HIV, syphilis and Zika, she said.
Plasma therapies could provide some advantages while a vaccine is developed, typically a lengthy process with multiple trial phases.
Dr. Michael Farzan, co-chair of Scripps College’s Immunology and Microbiology department in Claremont, California, said when it comes to coronaviruses, transmitting the wrong kind of antibody to a patient could enhance the infection, but that those errors generally happen in vaccines, not convalescent serums like plasma therapies.
“When you give a vaccine to 100 people, you’ll have different responses. With a serum, you can characterize it and know how good it is,” said Farzan, who has studied coronaviruses for more than 20 years.
Plasma therapy is also advantageous in that it is immediately available for use once a donor is matched with another.
However, one challenge with plasma therapy is that it is harder to offer on a broad basis because it must be obtained from a recently recovered person on a case-by-case basis.
“It’s a huge effort to obtain antibody serum from one individual for another individual,” he said. “It’s not a scalable operation, but it’s something that can be done immediately.”
The detection of antibodies is a key factor to understanding the scope and intensity of COVID-19 infections globally, as well as a tool to help development of a vaccine. In the U.S., the Food and Drug Administration approved the first antibody test Thursday. With the test, a finger prick of blood will help researchers learn whether someone has ever had the virus, as well as how long patients remain immune after recovering.
On Friday, the FDA announced the agency has partnered with the Mayo Clinic on a nationwide program to provide plasma to COVID-19 patients who don’t have easy access to sources for plasma therapy. The American Red Cross will help collect plasma and distribute it across the country. A news release stated the FDA intends to move thousands of plasma units to patients in the next few weeks.
The FDA is encouraging people who have fully recovered from COVID-19 for at least two weeks to donate plasma. Potential donors can visit the American Red Cross website at www.redcrossblood.org/plasma4covid or contact their local blood donor or plasma collection center.
THE FOOD AND DRUG ADMINISTRATION HAS AUTHORIZED THE EMERGENCY USE OF PLASMA FOR CRITICALLY ILL COVID-19 PATIENTS.