Treatment of coronavirus patients with plasma taken from people who have recovered from COVID-19, the disease it causes, is picking up speed. Some doctors are reporting an improvement in some patients who have received this treatment. However, they cannot say for certain if the improvement was due to the plasma, other interventions the patients received in parallel, or whether it was a spontaneous improvement that is sometimes part of the course of this illness.
The first patient to receive plasma did so on April 9 at the Shamir Medical Center (formerly Assaf Harofeh Hospital). Since then, 12 other hospitals have started using this treatment. So far, 37 patients in moderate to serious condition have received plasma donated from people who recovered from the virus. The treatment includes two doses of plasma, given 24 hours apart, according to a protocol established by the Heath Ministry.
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The medical reasoning behind this treatment is the assumption that the immune system of recovering patients has developed effective antibodies against the virus, a concentrated dose of which can help the body fight it. Using antibodies is common practice with viral diseases such as German measles, rabies and others. However, with COVID-19, the science is still very shaky for now – it is based on a Chinese study that included just 10 patients and another one which included only three.
The prevailing opinion in the medical community is that in the absence of a vaccine or other proven treatments, there is justification for using donated plasma, even if its effects are not quite clear yet. Doctors are cautious about determining with certainty that this treatment is patently effective, but some of them believe it helps in improving the patient’s condition.
At Shamir Medical Center, four patients have received plasma so far. The first one was a man in his 60s who was on a ventilator in serious condition. His condition is still listed as serious, but he has improved. In the meantime, clear criteria for using this procedure have been put out by Health Ministry: It focuses on patients who are deteriorating from moderate to serious condition, not on those already in serious condition.
The other three patients who received plasma, whose ages are from their 50s to 80s, were in moderate condition. They improved after receiving plasma, and one was discharged.
“It’s hard to necessarily attribute the improvement to the plasma infusion. These patients get other interventions at the same time, including various anti-viral drugs,” says Dr. Naomi Rahimi-Levene, the head of the hospital’s blood bank. “Plasma probably has positive effects which improve the situation, but at this stage we cannot say to what extent this is so. This will be investigated and more will be known at a later stage. COVID-19 causes very serious pneumonia which demands patience, as well as using everything we have in our arsenal in order to defeat it.”
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Assouta Medical Center in Tel Aviv reported admitting an 88-year-old patient in moderate condition. She started receiving plasma and responded well. But not every patient in moderate condition gets plasma, which is given only according to specific medical criteria including the severity of symptoms, the oxygen saturation in a patient’s blood. The treatment is not given if more than 10 days have passed since the onset of the illness or when three or more bodily systems show signs of failure. There are other contraindications as well.
According to Prof. Dror Mevorach, the head of the coronavirus department and the director of the Rheumatology Research Center and the Institute for Rare Diseases at Hadassah University Hospital at Ein Kerem, “it’s hard to assess these treatments based on anecdotal cases. Many experimental procedures are being tried and at this point it’s unclear how effective they are. We see spontaneous improvement in some cases with this disease, even in serious cases of patients connected to an artificial cardio-pulmonary support system [ECMO]. There are still many unknown factors associated with this disease, including ones connected to the immune response. There is good reason to use plasma, but we’re far from determining if this is what saves patients’ lives.”
Prof. Eilat Shinar, the deputy director general of blood services at Magen David Adom, says 84 recovered patients have donated blood so far. Over 4,000 people have recovered from the coronavirus in Israel, but many of them cannot donate bodily fluids, certainly not immediately. The criteria for donating plasma include a 14-day wait after a patient recovers, which means two tests for the virus, taken 24 hours apart, giving negative results.
Even after this, many people still won’t be able to donate plasma. “Women who were pregnant or gave birth cannot donate,” says Shinar. “People with tattoos or who visited affected countries in the last six months are also excluded. Donors have to feel well physically. Some of them are recovering not just from the coronavirus, but from effects of other diseases they have. Between 10 and 15 percent of recovered people cannot donate plasma for objective medical reasons. Others are concerned about donating for various [other] reasons. Ultimately, only about 30 percent are potential donors. However, in contrast to blood donations, plasma can be donated every two weeks, and each donor leaves with a new appointment for another donation.”