Expediting the Coronavirus exit

The government has an ever-increasing need for a health solution: could Plasma Therapy be the way forward?

Artillery Row

Sooner rather than later, the government will need an exit strategy from the Coronavirus epidemic, otherwise the cure – an entire nation on lockdown – risks becoming worse than the disease.

In the 2008, an economic solution was required to stop the economy crashing. Today we urgently need a health solution to limit the economic damage.

This solution as everyone knows is mass testing, followed by vaccination. The former is clearly going to unavailable for weeks, perhaps months, and the latter, for some eighteen months.

Today we urgently need a health solution to limit the economic damage

Extraordinary times call for extraordinary measures so let me suggest one that went out of fashion in the 1930s because it became tainted with quackery, but if practised properly is a simple and safe way of providing immunity to the COVID-19 virus pending the arrival of a safe vaccine.

I refer to Convalescent Plasma Therapy – an old fashioned remedy for a new disease – but one that the Food and Drugs Administration in America this week approved for use on a critically ill COVID -19 patient in Houston, Texas.

Patients who have recovered from the virus will have developed an immune response to the virus and there will be antibodies in their serum.

Convalescent Plasma Therapy (CPT) involves collecting blood from recovered patients.  The red and white blood corpuscles are then separated leaving serum rich in the specific antibodies, which are then transfused, into sick patients.  In effect it is an injection of antibodies, which directly attack and destroy the virus.  This treatment was popular before the advent of antibiotics and vaccine science.  I believe it was used with good effect during the Spanish influenza pandemic.

According to a recently published Chinese medical bulletin, CPT has been tried on five critically ill COVID -19 patients at the Shenzhen Third People’s Hospital in China. All five (aged 36-65) required mechanical ventilation. 3 patients were weaned from ventilation within two weeks and subsequently discharged.  At the time of reporting (27 March) 2 patients remained in hospital but were in stable conditions 37 days after transfusion.

Is Plasma Therapy dangerous?

Plasma is the liquid content of the blood after the red and white corpuscles have been separated.  This means that plasma infusion carries no more risk than a normal blood transfusion.

Is CPT likely to be a game changer?

I believe so, especially if it is administered early in the disease before the lungs are too inflamed and multi –organ failure sets in.  Successful treatment will significantly reduce the pressure on our Intense Care Units and the need for ventilators.

CPT could also be administered to frontline personnel to protect them from COVID-19.  An infusion of antibody rich plasma will give passive immunity for a considerable period of time.  Another game changer?

How would it work?

Time is of the essence and the NHS would have to get organised quickly.  It is vital that survivors of COVID-19 are identified so that they can be asked to become plasma donors. We know that survivors far outnumber the deaths and therefore there is a big pool of potential donors. A high profile publicity campaign would be required.

A blood sample should be tested for the presence of antibody to COVID-19 before potential donors are enrolled into the program.  Donated blood should be screened to exclude contamination by HIV, Hepatitis and other such transmissible diseases. The plasma is separated from the cellular element of the blood by centrifuge and stored in a refrigerator in readiness for distribution to the hospitals.  The red and white cells may be returned to the donor’s circulation thereby reducing the risk of anaemia.

All this is routine work for the Regional Blood transfusion services that are best place to manage this part of the program.  Antibody rich plasma will then be available to treat sick patients when they present at the hospitals.  The plasma would be administered by standard intravenous infusion.

Research

Strictly speaking this is not experimental treatment but it would probably be wise to get ethical committee approval.  This would be best done centrally rather than by each NHS Trust.

It is vital that all aspects of this treatment are recorded and frequently reviewed so that the effectiveness or otherwise can be confirmed.  If there is a positive beneficial outcome, then the programme should be pursued more energetically.  Conversely the treatment should discontinued if it is ineffectual or harmful.  A central reporting system should be used if many hospitals are involved.

Too good to be true?

It is very strange that we haven’t heard any reference to CPT in the UK media.  Internet searches show that interest is stirring in the US.  I am sure that this line of treatment must have been discussed at the highest levels of the UK Government and I am surprised that the potential has not been realised.  Why is this?  Perhaps the chequered history of serum therapy could be to blame.  When convalescent serum therapy was first used to treat victims of Spanish flu’ in 1918 the doctors were on the right track.  Subsequently serum therapy was tried for many other diseases but in these cases the serum came from horses.  Not surprisingly this proved generally ineffective and also dangerous.  Many recipients of horse serum treatment developed serum sickness and some even fatal anaphylactic shock.

Charlatans and quacks through the ages have exploited the idea of serum therapy.  Even nowadays we see serum therapy being promoted for all kinds of conditions particularly by the cosmetics industry.  For these reasons our medical profession has developed an aversion to the idea of serum therapy.  To avoid this negative bias I think it is best to refer to this treatment as Plasma Therapy.

Finally, if I was seriously ill with COVID-19 I would like to receive Convalescent Plasma Therapy. I am sure many hundreds of patients now seriously ill in our hospitals would too.

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