Questions on Plasma treatment...

[pat_k]

Do you think our hospitals are likely to adopt on more than some limited "experimental" basis?

If the length of hospital stays are essentially cut in half, as estimated, that would free up beds and make the burden far less. Seems to me this is as important to get off the ground as "social distancing" measures.

We've seen articles like the NBC article, but I haven't seen any discussion from officials. Has anyone else?

I wonder if it might even be a way to protect vulnerable people even before they become ill -- particularly in places like nursing homes or homeless shelters. Seems like it logically would, but only "treatment," not prevention is discussed in the article.

It would require coordination with public health labs, private labs, university labs, etc on identifying positives -- even mild cases -- who might volunteer to donate once recovered. Starting right now, when testing, they should be asking the person if they would be willing to donate plasma when they recover. Folks may of course change their minds later, but at least they would be identifying a pool of likely donors. That would save a hell of a lot of time if a program were to get off the ground.

Even if doctors want to use it, what are the chances they'll get the kind of support programs required from CDC and labs?

What to you think chances are that states are even considering preparing for "recovered plasma" needs?

I would like to think they have the foresight, but fear this is one more thing we'll "miss the boat" on.


NBC News
Doctors push for treatment of coronavirus with blood from recovered patient

A que

[hlthe2b]

1. The immune response is not yet fully understood. Hell we don't even have an antibody (serology) test

yet. Giving plasma from presumed recovered patients that tests PCR-negative (virus antigen-negative) is likely to be useful, but it is an incredibly scarce resource that can not be commercialized nor promulgated without a lot more basic information on the course of the disease and its resultant immune response.

Antibody rich plasma is used for certain purposes, especially very young infants/children exposed to deadly vaccine-preventable diseases. Extremely costly product to produce widely, but of course, we will want to try every option.

[pat_k]

2. Thanks

It sounds like barriers and questions are likely to keep it off the table. Nevertheless, I hope the feasibility of the approach is at at least being explored.

I poked around a little. The industry is able to cope with producing enough plasma-derived products to provide regular treatments to people with hemophilia. I wonder how much such programs could be "geared up" if a large pool of donors could be recruited?

Sounds like the sticking point is proof. Public heath planners would need pretty clear evidence that the treatment is effective and does significantly reduce time in the hospital to justify. Who knows? Reduced costs due to shorter hospitalizations (and a savings of a few days per person would certainly save both lives and money) -- could offset the high cost of plasma production.

[hlthe2b]

3. Because we have yet to be able to characterize the immune response, we don't know duration, nor

levels of protection, nor do we have the ability to identify persons who have sufficient antibodies over time. Plasma is not plasma is not plasma. That given hemophiliac is plasma rich in the clotting factors they require and which all normal people produce. Here, what we need is plasma rich in the protective antibodies needed to fight off a specific virus associated with COVID_19, assuming the virus isn't mutating enough that stable protective antibody can be passively transferred. That can only come from recovered patients currently and there aren't a lot of them. Might a major research hospital with recovered patients request and receive permission from FDA to collect and separate plasma for on an emergency trial basis? Possibly, but that that won't be more than an "experimental" use that won't translate to commercial production without much more information.

Further complicating, there are some cases reported of individuals being reinfected. While I still believe these cases may be explained by testing errors, including failure to fully document through repeated testing that an individual was truly CLEARED, there are other more disturbing possibilities. This includes concerns that immunity might not be long term, the virus might mutate sufficiently to escape a long term immune response, some people may have a defect preventing a long term immune response

All the above is why it is necessary to have a better understanding of the immune response before pinning ones hopes on that option. No commercial producer is going to try to produce a plasma product without having that basic information. To do so, might result in their producing a NON-protective product or worse, a contaminated (infected) product. Many people think of this as though it were like opening a plant to make coca cola. It is simply not like that at all.

This is why novel emerging viruses are so dangerous. It takes time, no matter what, to identify all the information we need to address, diagnose, treat, contain and prevent it.

[pat_k]

4. Looks like at least one Pharma co is working on -- but no timeline on research in press release.

Last edited Sun Mar 15, 2020, 05:42 PM - Edit history (1)

They https://www.takeda.com/newsroom/newsreleases/2020/takeda-initiates-development-of-a-plasma-derived-therapy-for-covid-19/

Apparently they reported to Congress March 4, so at least lawmakers are aware of possibility.

Unfortunately, report doesn't include any sort of possible timeline, or any sort of agreements with any national health entity for identifying potential donors.

Basically, if it happens at all, it would be a good distance in the future, given all the necessary research (as you point out).

[hlthe2b]

5. Yes.. it sounds very early as they don't even have access to recovered donors yet to study.